Background and purpose:Radical cystectomy is viewed as the standard treatment for bladder carcinoma,but organ preservation has been attempted for patients with muscle-invasive bladder carcinoma over the past decades as an alternative to radical cystectomy.The majority of studies included transurethral resection of bladder tumor(TURB),radiotherapy,and chemotherapy,as a feasible and safe organ-sparing approach with the similar outcome to radical cystectomy.The current study evaluated the outcomes and complications of the radiation therapy for the patients with bladder cancer,and prognosis factors had been analyzed.Methods:We retrospectively analyzed 21 patients with bladder cancer.The clinical stages of the patients were 15 with T_2;5 with T_3 and 2 with T_4.2 of them were lymph node-positive,16 of patients were pathologically proved as transitional cell carcinoma,4 as adenocarcinoma and 1 as transitional cell carcinoma plus squamous cell carcinoma.Conventional fractionation radiotherapy was given at a median dose of 54.5Gy(ranged 49.2-69.9 Gy) after surgery.Kaplan-Meier method and Logrank method were used for the statistical analysis.Results:Median follow-up was 32 months.The overall survivals at 1 year,3 years and 5 years were 90.5%,47.1%,and 36.7% respectively.The local disease free rates were 95.0%,62.4%,and 47.5% respectively.15 of 16 patients' deaths were related to the tumor.In univariate analysis,only small field irradiation was found as a prognosis factor in survival(?~(2)=5.36,P=0.02).Conclusions:Combined treatment appears to provide high response rates and can be offered as an alternative option to radical cystectomy for selected patients who refuse or are unsuitable for surgery.A large number of patients,multicenter,prospective randomized trial would be desirable to evaluate the role of radiotherapy in the multi-modality treatment of bladder cancer.

Therapies for malignant glioma include surgery,radiotherapy and chemotherapy.In recent years,the overall effective rate of temozolomide is better than other chemotherapy drugs,but partly patients have resistance to temozolomide.Angiogenesis inhibitors show promising activity,but it is expensive.Celecoxib has antiangiogenic activity,which has become a new option.

Objective To analyze the cost-effectiveness of selective intraoperative laparoscopic cholangiography (LIOC) in the county level hospitals.Methods The medical costs and cost-effectiveness of 60 patients undergoing LIOC (group A) during laparoscopic cholecystectomy (LC) in 2014 and 52 patients undergoing LC (group B) only in 2013 at 3 county level hospitals were analyzed.Results The direct medical care costs of group A were less than that of group B significantly [(9 072 ± 1 282) Yuan vs.(10 941 ± 4 064) Yuan,t =-3.38,P =0.001],there were no significant different in indirect medical care costs between group A and group B[(2 039 ± 1 020) vs.(2 100 ± 1 172) Yuan,t =0.24,P =0.810].The cure rate was 100％ in two groups;however,the cost per patient in group A was less than that in group B [(11 111 ± 2 348)vs.(13 041 ± 5 118)Yuan].The direct medical care cost of the patients who needed additional treatment in group A was significantly less than that in group B [(10 828 ± 1 101)vs.(16 533 ±1 733)Yuan,t =-11.45,P =0.000].There were no significant different in direct operational costs between group A (LIOC + LC) groups and group B (LC) [(8 378 ± 326) vs.(8 225-± 363) Yuan,t =1.96,P =0.054].Conclusions Selective LIOC is a cost-effective procedure and should be recommended in county level hospitals in which magnetic resonance cholangiopancreatography is not available.

Objective To investigate the clinical application value of the laparoscopic intraoperative cholan-giography in laparoscopic cholecystectomy,and summarize the experience.Methods The clinical data of 169 cases of laparoscopic cholecystectomy intraoperative cholangiography were analyzed retrospectively.Results 169 patients were successfully completed,131 cases recovered well and no complications occurred after operation.29 patients showed hyperamylasemia,of which 3 patients had intractable hyperamylasemia,8 patients complicated with secondary acute pancreatitis,with fasting,gastrointestinal decompression,enzyme inhibition(plus somatostatin)and acid,analgesic, anti infection,rehydration treatment after remission.Conclusion Laparoscopic cholecystectomy intraoperative cholan-giography is a safe and reliable diagnostic technique,on the occurrence of biliary residual stones in prevention of post-operative prevention and timely detection of bile duct injury during operation and improves the success rate of repair of bile duct injury has important clinical value;control adaptation of intraoperative cholangiography has important clinical significance of reasonable application license.

Objective To investigate changes in the expression of apurinic/apyrimidinic endonuclease (APE) and the oxidative DNA damage marker 8 OHdG in distant hippocampus regions of the rat brain after focal cerebral ischemia of the middle cerebral artery.Methods SD rats were divided into the sham surgery group and the pMCAO group (induced by middle cerebral artery occlusion).Pathological changes in brain tissues were examined at 2 h,6 h,12 h,24 h,48 h and 72 h.The expression of APE and 8-OHdG was measured by immunohistochemical staining methods.TUNEL staining was performed to detect apoptosis.Results Reduction of APE expression in the CA1 region of the hippocampus on the ischemia side appeared at 2 h in the pMCAO group and continued as ischemia persisted (F=11.91,P＜0.05).The expression of 8OHdG and TUNEL immunoreactivity in the CA1 region of the hippocampus on the ischemia side were first observed at 6h in the pMCAO group and intensified during the remainder of induced ischemia (F=9.23 and 10.46 respectively,P＜0.05 for both).Compared with the sham group,8-OHdG expression and TUNEL immunoreactivity in the pMCAO group were at nearly the same levels from 24 h to 72h.Conclusions Oxidative DNA damage occurs in hippocampus regions of the rat brain after experimentally induced focal cerebral ischemia of the middle cerebral artery.APE expression declines in regions distant from focal cerebral ischemia.Development and accumulation of oxidative DNA damage can induce apoptosis in certain brain regions.

Objective To evaluate the outcome , side effects and prognosis of prostate carcinoma treated with external radiotherapy. Methods From 1990 to 1999, a total of 45 prostate carcinoma patients were treated. Four cases were lost during follow up. Forty one patients underwent orchiectomy before radiation therapy , 29 received orchiectomy combined with hormone treatment. All patients received conventional radiation therapy with a median dose of 68.3 ?Gy (50.4 75.9?Gy), 1.8 2.0?Gy per fraction, five fractions weekly. Results The median follow up duration was 28 months (1 111 months). The overall 5 year survival was 76.4% and the 5 year disease specific survival was 76.5%. In terms of acute GI side effects, the frequencies of Grade Ⅰ, Ⅱ or Ⅲ reactions were 53.5%, 7.0% and 9.3% while Grade Ⅰ or Ⅱ , acute GU side effects were 41.9% and 4.7%, respectively. For the long term deleterious effects,Grade Ⅰ or Ⅱ in GI late complications were 16.7% and 7.1% and the GU late morbidities of Grade Ⅰ,Ⅱ or Ⅲ were 23.8%, 4.8% and 2.4%, respectively. Regional lymph node metastasis was closely correlated with both overall survival (P= 0.002 ) and disease specific survival (P= 0.002 ). Multivariate analysis revealed, only regional lymph node metastasis was of prognostic value to predict the overall survival and disease specific survival. Conclusion The outcome of radiation therapy for patients with T 2 T 4 prostate carcinoma is satisfactory with the side effects tolerable to most patients.

Objective On basis of physical dose optimization, LQ model was used to investigate the difference between the curves of biological effective dose and physical isodose. The influence of applying the biological dose concept on three dimensional conformal radiotherapy of prostate carcinoma was discussed. Methods Four treatment plannings were designed for physical dose optimization: three fields, four-box fields, five fields and six fields. Target dose uniformity and protection of the critical tissue -rectum were used as the principal standard for designing the treatment planning. Biological effective dose (BED) was calculated by LQ model. The difference between the BED curve drawn in the central layer and the physical isodose curve was studied. The difference between the adjusted physical dose (APD) and the physical dose was also studied. Results Five field planning was the best in target dose uniformity and protection of the critical tissue -rectum. The physical dose was uniform in the target, but the biological effective doses revealed great discrepancy in the biological model. Adjusted physical dose distribution also displayed larger discrepancy than the physical dose unadjusted. Conclusions Intensified Modulated Radiotherapy (IMRT) technique with inversion planning using biological dose concept may be much more advantageous to reach a high tumor control probability and low normal tissue complication probability.

Objective To observe the therapeutic effect of Shenmai injection on rats with acute edematous pancreatitis (AEP) and its mechanism.Methods The model of AEP in rats was induced by intraperitoneal injection of caerulein every one hour for 7 times.One hour after last injection,intravenous Shenmai injection (5 ml · kg-1 · d-1) was given to rats in Shenmai injection treatment (SI) group,while same amount of normal saline was given to rats in control (AEP) group.One hour and 1,3,5,7 d after AEP induction,the blood was taken,and the method of double antibody sandwich enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of amylase,platelet activating factor (PAF),vascular endothelial growth factor (VEGF).The rats were sacrificed at 7 and 14 d,and pancreatic tissue samples were harvested.RT-PCR and Western Blot were used to determine the expression of NF-κB mRNA and protein,and normal pancreatic tissue samples were used as control.The positive expression of CD31 in pancreatic tissue was determined by immunohistochemical method to calculate microvascular density (MVD).Results The serum levels of amylase and PAF in both groups were increased and gradually decreased 3 days later,while the decrement in SI group was greater than that of AEP group.At the 5th day after AEP induction,the serum levels of amylase in SI group and AEP group were (4569 ± 158),(5056 ± 198) U/L,and the serum levels of PAF were (25.30 ± 4.76),(36.06 ± 5.57)μg/L,and the difference between the two groups was statistically significant (P ＜ 0.05).The serum levels of VEGF were increased 1 d after AEP induction,and the increase in SI group was greater than that of AEP group 3 d later,and the serum levels of VEGF were (139.78 ±24.30),(118.51 ±21.70)pg/ml at 5th day,and the difference between the two groups was statistically significant (P ＜ 0.05).The expression levels of NF-κB mRNA and protein of pancreatic tissue in SI group were O.834 ±0.031 and 0.49±0.24,and MVD was 6.41 ± 1.14,while the corresponding values in AEP group were 1.000 ± 0.059,0.93 ± 0.45,3.62 ± 0.89,and the difference between the two groups was statistically significant (P ＜ 0.05 or P ＜ 0.01).Conclusions In the course of acute pancreatitis,Shenmai injection has the therapeutic effects of promoting new angiogenesis,improving the microcirculation,reducing the inflammatory cascade.

OBJECTIVE: To explore the significance of the lacrimal bone at the lateral nasal wall in endoscopic dacryocystorhinostomy. METHOD: The position, dimension and thickness of the exposed lacrimal bone at the lateral nasal wall in 10 cadaveric heads(male 5, female 5) were examined and the anatomy of uncinate process, the maxillary line and M point were studied, too. RESULT: The lacrimal bone at the lateral nasal wall is always situated immediately anterior to the uncinate process. The average length and width of the lacrimal bone was 9.23 mm and 3.63 mm, respectively. The lacrimal bone was very thin with an average thickness of 0.06 mm. CONCLUSION The study indicates that the lacrimal bone is so thin that a bony rongeur is usually sufficient to nibble it away. The medial wall of the sac is then removed without the use of drill or chisel with less operative trauma. The uncinate process, the maxillary line and M point are reliable landmarks in endoscopic dacryocystorhinostomy.
Adult ; Dacryocystorhinostomy ; Female ; Humans ; Male ; Nasal Bone ; anatomy & histology ; surgery ; Orbit ; anatomy & histology ; surgery

OBJECTIVE: To discuss the method and efficacy of Wormald technique application in opening frontal recess surgery. METHOD: Twenty cases with chronic frontal sinusitis underwent surgery with Wormald technique were subjected to this study. Preoperative CT scan and especially sagittal reconstructing were used to indicate the extent of lesion, source and key adjacent structure. RESULT: All patients were followed up for more than half a year with an average of nine months. The effective rate was 90% and no recurrence appeared except for two cases. CONCLUSION Application of Wormald technique for frontal recess open surgery under endoscope is safe and feasible, with no intracranial, orbital, and other serious complications. All treatments including preoperative sagittal CT, that help to a clear locating the cell lead to the frontal recess obstructive lesions, awarding of the potential difficulties while frontal recess could not be identified, protecting mucous membrane in operation, and strengthening medication, washing, and oxygen spray after operation, can improve operational efficiency.
Axilla ; surgery ; Chronic Disease ; Endoscopy ; Female ; Frontal Sinus ; surgery ; Frontal Sinusitis ; surgery ; Humans ; Male ; Middle Aged ; Treatment Outcome