Objective To determine the value of dynamic contrast enhanced (DCE?MRI) in predicting treatment response before preoperative chemoradiotherapy in locally advanced rectal cancer. Methods A cohort of consecutive patients with histologically confirmed rectal adenocarcinoma treated with preoperative chemoradiotherapy followed by total mesorectal excision (TME) surgery was enrolled in a prospective, pilot trial. All enrolled patients were examined using DCE?MRI at two time points: 2 to 5 days before neoadjuvant chemoradiation, 1 to 4 days before surgery. The following perfusion parameters (Ktrans, Kep, Ve) were measured for tumor. The patients were classified into pathological complete response (pCR) and non?pCR group according to the pathological results after operation. Those perfusion parameters were compared between the pCR and the non?pCR group and between before and after CRT in pCR and the non?pCR group with the t test. Receiver?operating curves (ROC) were constructed to further investigate the predictive value of Ktrans, Kep, Ve before neoadjuvant chemoradiation and were used to determine a threshold value at which patents with pCR could be distinguished from patients without complete response. Results The final study population consisted of 38 patients. There were 12 patients with a pCR and 26 patients with non?pCR. Before neoadjuvant chemoradiation, the mean tumor Ktrans, Kep and Ve for pCR group were (1.25 ± 0.56)/min, (2.10 ± 1.61)/min and 0.73 ± 0.34, respectively, for non?pCR group they were (0.46 ± 0.39)/min, (1.15 ± 0.77)/min and 0.32±0.12, respectively. All perfusion parameters showed significant difference between those two groups(t values were 3.45,5.67 and 6.23 respectively, all P<0.05). After neoadjuvant chemoradiation, the mean tumor Ktrans, Kep and Ve for pCR group were (0.28 ± 0.13)/min, (0.62 ± 0.27)/min and 0.21 ± 0.13 respectively, for non?pCR group, they were (0.32±0.12)/min, (0.83±0.42)/min and 0.17±0.10, respectively. All perfusion parameters showed no difference between those two groups(P>0.05), as well as the changes before and after neoadjuvant chemoradiation in those groups(P>0.05). ROC analysis for Ktrans pre?treatment revealed that Ktrans had an AUC of 0.837 in predicting pCR. A Ktrans of 0.66/min was emerged as the optimal cut?off for distinguishing pCR from non?pCR and for Ktrans>0.66/min, the sensitivity and specificity for predicting pCR were 75.0% (9/12) and 96.2% (25/26). Kep and Ve showed an AUC of 0.655 and 0.654 in predicting pCR. Conclusions In locally advanced rectal cancer, DCE?MRI can aid in predicting treatment response before preoperative chemoradiotherapy. Ktrans may become a better predictor to classify which patients will benefit from neoadjuvant chemoradiation.

Objective To explore the efficacy of high-resolution MRI in the prediction of tumor complete response after neoadjuvant chemoradiation therapy for T3 rectal cancer.Methods The clinical data of 108 patients with T3 rectal cancer who were admitted to Shanghai Cancer Center of Fudan University from 2010 to 2012 were retrospectively analyzed.The TNM stage of tumor,extramural depth of tumor invasion (mrT3 stage),involvement of mesorectum and rectal fascia,tumor diameter and distance from anal edge to lower edge of tumor were the main items of evaluation using the high-resolution MRI.A total of 108 patients underwent surgical resection of tumor after neoadjuvant chemoradiation therapy.The tumor complete response after neoadjuvant chemoradiation therapy was evaluated by tumor node metastasis (TNM) stage and tumor regression grade (TRG).The categorical data and multivariate analysis were done by the single factor analysis of variance (ANOVA) and Logistic regression analysis.Results The positive response rate of the T3a,T3b and T3c in the patients were 61.5％ (16/26),36.9％ (24/65) and 11.8％ (2/17) after neoadjuvant chemoradiation therapy,respectively.The mrT3,mrN and tumor diameter were the potential factors affecting response of neoadjuvant chemoradiation therapy by the univariate analysis of pathological restaging (x2 =50.474,30.985,8.318,P ＜ 0.05).The mrT3 was an independent risk factor affecting response of neoadjuvant chemoradiation therapy by the multivariate analysis of pathological restaging (OR =4.473,95 ％ confidence interval:2.003-9.991,P ＜ 0.05).There was no significant difference between the mrT3 stage,N stage,involvement of mesorectum and rectal fascia,tumor diameter and distance from anal edge to lower edge of tumor before therapy and the response after neoadjuvant chemoradiation therapy based on the tumor regression grade(TRG) (x2 =6.264,6.159,2.949,2.189,6.335,P ＞ 0.05).Conclusion The mrT3 in patients undergoing high-resolution MRI before neoadjuvant chemoradiation therapy could predict the tumor complete response after neoadjuvant chemoradiation therapy for T3 rectal cancer.

ObjectiveTo observe the effects of lung resection surgery on left heart hemodynamics in elderly patients, and explore its correlation with postoperative arrhythmia.Methods The 16 elderly patients (age≥75 years) receiving lung resection surgery were selected. At the same time, 21 patients (age＜60 years) were selected as controls. The hemodynamic parameters of each patient were recorded at the time of preoperative (T1), surgery completion (T2) and first day after surgery (T3). For patients with arrhythmia during three days after operation, the parameters would be recorded before and after arrhythmia. Results There were no significant changes in heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), cardiac stroke volume ( SV),acceleration index (ACI), systemic vascular resistance (SVR) at T2 and T3 compared with T1 for both the two groups (P＞0. 05). Only the central venous pressure (CVP) increased at T2 compared with that at T1 [elderly group: (7.58±0.45) cm H2O vs. (5.92±0. 51) cm H2O, t=2.641, P＜0.01; control group: (7.49±0.34) cm H2O vs. (6.23±0.47) cm H2O, t=1.982, P＜0.05], while the CVP recovered to the preoperative level at T3. The incidence of arrhythmia was significantly higher in elderly group than in control group (31.3% vs. 14.3%, x2 = 4.26, P＜0.05), but there were no significant changes in the parameters before and after arrhythmia compared with those before surgery (P ＞ 0. 05 ).Conclusions The effects of pulmonary resection surgery on left heart hemodynamics in elderly patients can be avoided through full assessment preoperatively, heart-lung protection intraoperatively, as well as the correctly and timely clinical treatment and intensive care postoperatively. Pulmonary resection surgery has no effect on left heart hemodynamics even for patients with postoperative arrhythmia.

0.05). Conclusions Low dose continuous infusion of CAZ to treat low respiratory infections is efficacious ,safe and economical.

Objective To explore the dead reasons and related factors of acute leakemia(AL)in children.Methods The clinical data of 42 dead cases of children with AL,who were admitted to Guangzhou Children's Hospital between Jan.1999 and Mar.2007 were reviewed.Nineteen cases were boys,23 cases were girls;the aging from 4 months to 12 years old and 5 months.Of 42 children,21 cases were acute lymphoblastic leukemia(ALL),18 cases were acute myeloid leukemia(AML),3 cases were unclassified AL.Results Ten out of 12 early-dead cases died of bleeding.Among 30 cases who received chemotherapy,4 cases died of bleeding,others of myelosuppression combined with infection,14 of whom died from sepsis,3 cases with fungal infection,1 case with virus infection,4 cases with unknown pathogens.Sixteen children relapsed among those who got remission,half of them relapsed within 1 year since diagnosed.Treatment-related mortality(TRM)was 90%(27 out of 30 cases).The main causes of TRM were infection and hemorrhage.Hyperleukocytosis and bleeding were 2 risk factors related to early death in new-diagnosed children.Conclusions More emphasizes should be put on bleeding tendency during early treatment in children with AL and treatment of infection complications during induction chemotherapy to reduce TRM.

Objective:To evaluate the clinical experience and working method of the department of stomatology,otorhinolarynogology and ophthalmology during the peacekeeping period in Liberia.Methods:Five hundred twenty five patients with stomatological,otorhinolaryngological or ophthalmological diseases during the peacekeeping period were reviewed.Results:The patients with stomatogical disease(455),NEN disease(38) and eye disease(32) were treated by a stomatological without mistake during 7 months. Conclusion:Stomatological doctors should be versatile to accomplish their peacekeeping mission.

Objective To investigate the neuropathic pain (NP) accompanying spinal cord injury (SCI),and to analyze the related factors to provide references for its prevention and treatment.Methods Seventy SCI patients with NP were selected using the DN4 scale.Their age,gender,occupation,education level,monthly income,injury position,marital status and other data were surveyed using a general questionnaire.Their NP situation was surveyed using a simplified McGill pain questionnaire (SF-MPQ).Results The patients' average visual analogous scale (VAS) score was 4.37.Their average pain rating index (PRI) according to the SF-MPQ was 8.23,with the PRI-sensory and PRI-emotional components 5.23 and 3.00 respectively.The average degree of present pain intensity was 1.86,between mild pain and discomfort,and discomfort was the description most commonly used.The most common pain descriptor was prickling pain,followed by burning pain and bulge pain.85.7％ of the patients felt that their pain had an adverse effect on their affective state,and exhaustion occurred more often than any other descriptive words.Univariant analysis showed that the degree of injury,education level,marital status,monthly income,family support and medication history were all factors correlated with NP perceptions.Multi-variate logistic regression analysis showed that being unmarried and severity of injury were independent protective factors against NP.No family support,no medication and low income were independent risk factors for NP.Conclusion The type of neuropathic pain varies in patients with spinal cord injury.The intensity of the pain is mostly at a medium level.The emotional state of most patients was affected.Neuropathic pain involves many factors.Being unmarried and severely injured are independent protective factors,while lack of family support,no medication,and having low income were independent risk factors.

Objective:To investigate the optimal administration approach of using aspirin by observing the effects of the rats in-testinal mucosal barrier and somatostatin receptors level with different administration approaches of using non-steroid anti-inflammatory drugs-aspirin.Methods:32 SD rats were randomly divided into 4 groups:oral intake group,enema group,intraperitoneal injection group and control group.Every group had 8 rats.The ileum mucosal injury was scored.The level and distribution of SSTRs in every group was detected by ELISA and immunohistochemistry, respectively, The IOD score in each group was measured by image analysis.Results:(1) The scores of ileum mucosal injury in aspirin experimental groups were significantly higher than that in control group (P<0.05), but there were no difference among aspirin experimental groups.( 2 ) All subtypes of SSTR were expressed in rat intestinal mucosa.However,SSRT1 and SSTR2 were expressed mainly ( P<0.05 ).( 3 ) The expressions of SSTR1-5 on intestinal mucosa in aspirin experimental groups were significantly less than that in control group (P<0.05).(4) There was incompletely no same effects of SSTR1-5 in intestinal mucosa by different approaches ( P<0.05 ).( 5 ) There were no significant difference of SST concentration and IOD score among all groups ( P>0.05).Conclusion:Aspirin can damage the rat intestinal mucosa.Aspirin could lead to the decrease of SSTR1-5 expression in the intestinal mucosa.All subtypes of SSTR in rat small intestine mucosa were expressed, suggesting that aspirin could affect the barrier function of the intestine.There were different influences on SSTR1-5 expression by different administration approaches,suggesting aspirin by parenteral approach may reduce the intestinal damage.

Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Osteogenesis Imperfecta ; diagnosis ; therapy