Objective:To evaluate the effects of perioperatively administrated enteral immunonutrition in gastrointestinal cancer patients on immune and inflammatory responses,nutrition states and postoperative morbidity.Methods:Sixty patients with gastrointestinal cancer were divided randomly into two groups.Two groups perioperatively(from preoperative day 5 to postoperative day 7) received an supplemented diet with arginine,RNA,and ?-3fatty acids(immunonutrition group;n=30) or an isoenergetic and isonitrogenous standard diet (standard-nutrition group;n=30).All variables of immune and inflammatory responses,nutrition states and postoperative morbidity were measured on preoperative day 5 and postoperative day 1,4 and 8.Results:On postoperative day 4 and 8,most immune variables and prealbumin in the immuno-group were significantly higher than those in the standard-group(P0.05),and inflammatory variables as CRP in the immunonutrition group were significantly lower than those in the standard group.In the immunonutrition group,there were significantly fewer patients who experienced postoperative complications and shorter days of hospital stay compared with standard group(P0.05).Conclusion:The perioperative administration of enteral immunonutrition in gastrointestinal cancer patients can significantly modulate the postoperative immunosuppressive and inflammatory responses at the early postoperative day,can significantly decrease the occurrence of infectious and overall postoperative complications as well as the length of hospital stay.

Objective:To explore the expressions of the nuclear factor-?B(NF-?B),C- myc and ICAM-1 in human colon and rectal cancer and the relationship between NF-?B and the occurrence,the metastasis of human colon and rectal cancer.The clinical significance was analyzed.Methods:Fifty human colon and rectal cancer cases ,16 colon and rectal adenomas,9 carcinomatous change of colon and rectal adenoma and 8 normal colon were studied,the expressions of NF-? Bp65,C- myc and ICAM-1 in them were examined by immunohistochemical method.Results:NF-?Bp65,C- myc were strongly expressed in the colon and rectal cancer and carcinomatous change of colon and rectal adenomas than those in colon and retal adenoma;C- myc could not express in normal colon;NF-? Bp65 and C- myc were significantly positive correlation with colon and rectal cancer;NF-?Bp65,ICAM-1 were strongly expressed in the colon and rectal cancer which had metastasis than those had no metastasis,and they had striking positive correlation with colon and rectal cancer which had metastasis.ConclusionTo control the transcription of C- myc and ICAM-1,NF-?B plays an important action in the occurrence and metastasis of colon and rectal cancer.It will become a new target of treatment of colon and rectal cancer.

Objective To investigate the clinical outcomes of the surgical management for spinal tuberculosis with paraplegia retrospectively.Methods From March 2008 to April 2012,we retrospectively analyzed 78 patients with spinal tuberculosis combined with paraplegia.Among them,45 patients were male and 33 were female.The average age was 39.5(13 to 71) years.69 patients had focus-active paraplegia.41 patients had received chemotherapy before admissed to our hospital.They also received further standard chemotherapy for an average period of 2.3 (0 to 4) weeks after the admission.22 patients with complex complications (6 patients with active pulmonary tuberculosis,5 with tuberculous meningitis,7 with drug hepatitis,3 with kidney failure and 1 with unstable angina) received preoperative treatment for an average period of 4.5(3 to 8) weeks after the admission.6patients were managed with chemotherapy only.All 9 patients who had focus-healed paraplegia received surgical treatment after the admission immediately.Results All the patients were followed up clinically and radiologically for an average period of 31.4 (12 to 48) months.There was no recurrence of patients.At the final follow-up,all the patients had achieved rigid bony fusion.Both the VAS score and the Cobb angle had satisfactory improvement postoperatively and at the final follow-up.The neurological status began to improve 1-21 days after the operation.From 3 months postoperatively to the final follow-up,65 patients achieved complete recovery,7 partial recovery and 6 no recovery.The clinical outcomes for focus-active paraplegia were similar,while focushealed paraplegia had slower recovery and worse outcomes.Conclusion Patients with focus-active paraplegia combined with mild destruction and relative favourable neurological status could be treated conservatively.For patients with severe bony destruction and neurologic deficits (Frankel A-C,or combined with kyphosis),surgical treatment as early as possible is crucial to improve the neurologic status.If patients had contraindications,operation could be performed after the complications had been cured.However,the neurologic status improvement in focus-healed paraplegia is worse than focus-active paraplegia,suggesting that the reconstruction of spinal stability is important for initial treatment of spinal tuberculosis and children.

Objective To detect the effects of 17 β-estradiol(E2)on the expression of Calbindin-D9k (CaBP-9k) in pituitary GH3 cells,and to investigate the antagonistic effect of a selective estrogen receptor antagonist,ⅡCI 182780 on CaBP-9k expression.Methods A rat pituitary prolactinoma cell line,GH3 cell was used as the in vitro model.The localization of CaBP-9k in GH3 cells was observed by immunofluorescence.GH3 cells were cultured with exogenous E2-added medium for 24 hours,and the concentrations of E2 were 10-8,10-9,10-10M,respectively.mRNA and protein expression levels of CaBP-9k in different groups were analyzed by RT-PCR and Western blot analysis.The estrogen receptor antagonist,and ⅡCI 182780 was added to GH3 cells before E2 administration (10-8M)with the concentration of 10-6M,in order to investigate the regulation of ER-mediated pathway on the expression of CaBP-9k.Immunoprecipitation was used to detect the interaction between CaBP-9k and ERα.Results E2 had significant stimulatory effect on the CaBP-9k expression of GH3 cells in a dose dependent manner,and the expression level of CaBP-9k was higher when treated with a higher concentration of E2.ⅡCI 182780 could suppress the stimulatory effect of E2 on the CaBP-9k expression of GH3 cells.The expression level of CaBP-9k was significantly reduced by coadministration of E2 with ⅡCI 182780 in GH3 cells,which meant the CaBP-9k expression was mediated through ERα pathway.The immunoprecipitation results further illustrated the fact that CaBP-9k could directly interact with ERα,and E2 could increase the interaction between CaBP-9k and ERα.Conclusion Estrogen might induce CaBP-9k expression via ERα mediated pathway and CaBP-9k could directly combine with ERα,suggesting that CaBP-9k might be involved in the biological effects mediated by ER pathway in GH3 cells.

Objective To study the diagnosis and treatment of blunt pancreatic injury (BPI). Methods A retrospective analysis was made on the clinical data of 58 cases of BPI admitted and treated in our hospital during 23 years. Results The positive diagnosis rate was 51.1%(23/45) for single BUS examination ,but 70.0%(21/30) for two and more BUS examimations. The positive diagnosis rate was 65.0%(26/40) for single CT scanning, but 91.3%(21/23) for two and more CT scannings. Twenty-five cases(25/37,67.6%) with BPI were determined preoperatively, and 12 cases(12/37,32.4%)during (operation).Thirty-seven cases underwent operatiom, included grade I in 10cases、grade II 13cases、grade III 9cases、 grade IV 4cases and gradeV 1case. Twenty-one cases received nonoperative treatment, included 11 grade in I,7 grade II and 3 grade III. In the entire group, 6 cases died(10.4%).The mortality in the operation group was 16.2%(6/37).There were no deaths in the nonoperative group. The main cause of death was multiorgan failure(5/6,83.3%). There were 11(19.0%)cases of pancreatic pseudocyst after treatment in the entire group, included 3(3/37,8.1%) in operation group and 8(8/21,38.1%) in nonoperation group. Conclusions The diagnosis of BPI should combine the clinical findings with repeated BUS and CT scanning. Nonoperative treatment is a good choice for BPI without main pancreatic duct injury. Operative treatment is suitable for serious BPI and those with other intra-abdominal organ jnjury.

ObjectiveTo discuss the feasibility and safety of anterior pedicle screw (APS) fixation in treatment of lower cervical spine injuries.MethodsA total of 10 patients with lower cervical spine injuries were treated with APS fixation.All the patients received preoperative cervical CT scans,and then three-dimensional model was reconstructed by using Mimics software to measure the screw placement parameters (insertion point,screw placement angle,screw length and diameter).All APS fixations were performed through anterior cervical approach,and then centrums antetheca and bilateral outer edges were exposed to distinguish the vertebral end plates.Screw insertion was strictly operated under the fluoroscopic assistance and preoperative screw placement parameters.The postoperative efficacy of APS fixation was evaluated by radiologist and other orthopedist via anteroposterior and lateral radiation,CT scan,three-dimensional model reconstruction and MRI.A follow-up was carried out at 1,3,6 and 12 months after operation.ResultsExcept for one screw for C4 and one for C7,another 24 crews for C3-C7 were successfully inserted.Postoperative CT scan demonstrated four screws breaking the outer vertebral wall.Except for one patient suddenly died from acute myocardial infarction one week after operation,the other nine patients received follow-up.Of three trauma patients,one patient at Grade A did not get improvement but with no aggravation and two achieved improvement for 2-3 grades according to Frankel grade.Among six non-trauma patients,spinal function score by JOA was averagely elevated to 13.4 points,with improvement rate of 60.7％ according to Hirabayashi method.There were no serious complications except for two patients of dysphagia among the patients who were followed up. Conclusions APS fixation is feasible for lower cervical spine injuries.The keys to successful screw insertion are preoperative measurement of individualized screw insertion parameters and appropriate application of intraoperative fluoroscope technique.

Objective The present study aimed to establish a bone mineral density (BMD) reference database in China and to investigate the prevalence of osteoporosis in Chinese adults aged 50 years and older using dual energy X-ray absorptiometry (DXA). Method A total of 75321 examineers over 25 years old who underwent health checkups in 7 health check centers between 2008 and 2018 were included. All centers used a GE Lunar-DXA system to measure BMD of the lumbar spine (L1-L4), femoral neck, and total femur. The same European Spine Phantom (ESP) was used for scanning 10 times at every center, a regression equation was generated, and BMD data were cross-calibrated in each center. Peak BMD and standard deviation (SD) were identified according to 5-year age groups, and T scores were calculated based on the peak BMD and SD. Osteoporosis was defined according to the World Health Organization criteria. The prevalence of osteoporosis was standardized based on 2010 national census data for the Chinese population. Result The mean BMD values decreased with age, were highest in North China, followed by Northeast China, East China, and Southwest China, respectively, and increased with body mass index. Males aged 20-30 years and females aged 35-40 years had peak BMD values. Peak BMD values of the lumbar spine, femoral neck, and total femur were 1.09 g/cm2, 0.97 g/cm2, and 0.97 g/cm2 in males, and 1.11 g/cm2, 0.84 g/cm2, and 0.88 g/cm2 in females, respectively. Among all scanned sites, the prevalence of osteoporosis was highest in the femoral neck in males (4.58％) and in the lumbar spine in females (23.38％). The age-standardized prevalence of osteoporosis at any site was 6.46％ in males and 29.13％ in females aged 50 years and older. Based on the 2010 national census data, 10879115 males and 49286542 females currently have osteoporosis. Conclusion Mean BMD values varied according to geographic region, body mass index, age group, and sex in Chinese adults. The age-standardized prevalence of osteoporosis was 6.46％ in males and 29.13％ in females aged 50 years and older.

BACKGROUND: To compare the efficacy and safety of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Waldeyer's ring diffuse large B-cell lymphoma (WR-DLBCL) at a single institution. METHODS: This retrospective study included 115 newly diagnosed patients with WR-DLBCL, of whom 68 patients received R-CHOP, and 47 patients received DA-EPOCH-R as their first-line treatment. The baseline features of the two groups were well balanced using a 1:1 propensity score matching method, and a total of 84 cases were obtained, including respective 42 cases in the R-CHOP and DA-EPOCH-R groups, for further survival and prognosis analysis. The primary objectives included progression-free survival (PFS) and overall survival (OS). RESULTS: During a median follow-up of 45 months, there were nine (21.4%) deaths in the R-CHOP group and two (4.8%) in the DA-EPOCH-R group. Kaplan-Meier analysis showed statistically significant improvements in PFS and OS in patients with DA-EPOCH-R compared with those treated with R-CHOP (log-rank test, P  = 0.025 and P  = 0.035, respectively). The 2-year PFS and OS rates in the DA-EPOCH-R group were 90.1% (95% confidence interval [CI]: 81.4-99.8%) and 95.2% (95% CI: 89.0-100.0%), respectively, and 80.5% (95% CI: 69.3-93.6%) and 90.5% (95% CI: 52.8-99.8%) in the R-CHOP group. Patients without B symptoms and elevated lactate dehydrogenase levels had a higher PFS in the DA-EPOCH-R group, with P values of 0.038 (hazard ratio [HR]: 0.11; 95% CI: 0.01-0.88) and 0.042 (HR: 0.19; 95% CI: 0.04-0.94), respectively. There were no statistically significant differences in clinical responses and treatment-related toxicities between the two groups. CONCLUSION Compared with patients received R-CHOP, those treated by DA-EPOCH-R had superior PFS, OS, and controlled toxicity in patients with WR-DLBCL.
Humans ; Rituximab/therapeutic use* ; Vincristine/therapeutic use* ; Retrospective Studies ; Prednisone/therapeutic use* ; Etoposide/therapeutic use* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Lymphoma, Large B-Cell, Diffuse/drug therapy* ; Cyclophosphamide/therapeutic use* ; Doxorubicin/therapeutic use*