Objective To evaluate clinical characteristics and prognostic factors of synchronous multiple primary esophageal carcinomas (SMPEC).Methods Clinical data including sex,age,smoking history,regions,lymph node status,length of tumor,therapeutic methods and survival data of 52 patients with SMPEC were analyzed.The rates of OS depending on the different factors were calculated using the method of Kaplan-Meier analysis.Log-rank test was used for univariate survival analysis and Cox's proportional hazards regression model was used for multivariate survival analysis.Results The 1-,3-,5-year OS rates and the median survival time (MST) were 65.4 ％,17.3 ％,7.7 ％ and 15.0 months for the whole cohort,75.0 ％,33.3 ％,16.7 ％ and 19.5 months for the surgery subgroup,62.5 ％,10.0 ％,5.0 ％ and 14.5 months for the 40 non-operative patients.Multivariate analysis of prognostic factors identified that tumor length and M stage were independent prognostic factors for the whole cohort,while tumor length,M stage and chemotherapy were independent prognostic factors for the radiotherapy subgroup patients.Conclusion The tumor length and M stage are independent prognostic factors for the SMPEC patients.Combined radiotherapy with chemotherapy seems to bring survival benefit and maybe a better management choice for unresectable and non-operative SMPEC.

MiR-494 involves in cell cycle regulation,differentiation and apoptosis processes of normal ceils.Recent study shows that abnormal expression of miR-494 is associated with oncogenesis closely,and it participates in the invasion and metastasis of tumor cells and so on.MiR-494 is not only a tumor suppressor gene,but also can be considered as a cancer-promoting gene.MiR-494 can regulate the oncogenesis and development of the tumor through a variety of target genes and signaling pathways.

Objective To evaluate the efficiency of Ginkgo biloba extract 50 (GBE50) on learning memory ability and inflammatory response in hippocampus of natural aging mice, and explore the underlying anti-aging mechanisms.Methods 16-month-old ICR mice were randomly divided into three groups:model group, GBE50 low and high dose groups. 1 month mice were as normal group. The mice in GBE50 low and high dose groups received GBE50. The mice in the normal and model groups received solvent (1%CMC-Na+) by intragastric administration. The Morris water maze test and step-down test were used to assess behaviors of the mice. Immunofluorescent staining was used to detect the number of Iba-1 positive cells. The enzyme linked immunosorbent assay was used to determine the expression of TNF-α and IL-1β.Results Compared with normal group, escape latency and swimming distance in the Morris water maze test in the model group increased (P<0.05);latency shorted and error times decreased in the step-down test (P<0.05);the number of Iba-1 positive cell in the hippocampus CA1 in the model group increased considerably (P<0.01);TNF-α expression was in a general upward trend while IL-1β increased apparently (P<0.01). Compared with model group, escape latency and swimming distance decreased in the Morris water maze test in GBE50 high dose group;latency and the error times increased in the step-down test (P<0.05);the number of Iba-1 positive cells decreased (P<0.05). TNF-α expression showed a downward trend and IL-1β expression decreased in GBE50 low dose group (P<0.05). Conclusion GBE50 can delay aging and increase learning memory of natural aging mice.

Objective To compare and evaluate dose at optic structures (eyeballs, optic nerves and chiasma) between conventional and CT simulated treatment planning for nasopharyngeal carcinoma. Methods Thirty three patients with T1 to T4 nasopharyngeal carcinoma underwent simulated spiral CT with picker PQ 5000 and AcQ plan 4.1.1 software system. At first irradiation portals were delinated by the simulation films taken on the conventional X ray simulator using the digital reconstruction (DRR) of the treatment planning system (TPS) supplemented by the patient's CT (or MRI) and clinical findings. Then, the gross tumor volume (GTV),clinical target volume (CTV) and planned target volume (PTV) were delineated on every section of the CT scans. At the same time, the silhouette of the nearby important organs was drawn out ,paying special attention to the backward passage of the retrobulbar optic nerves up to the optic chiasma. The final portals were designed by the 3 dimensional relation between the tumor and its surrounding organs. Then dose distribution was separately calculated by two independent TPSs,with 100% at the target center. Finally,the maximum dose (D max ),average dose (D ave ) and median dose (D med ) of the tumor target area, eye ball,optic nerve and also the length of optic nerve included within the portal of these two technics were compared.Results The dose distribution in nasopharyngeal GTV and CTV were satisfactory both in CT simulated and conventional planning. However, the D max ,D ave and D med all showed significant differences. Those by CT simulated planning were obviously lower than those by conventional planning. CT simulated planning was able to spare more optic nerve by leaving it out of the irradiation portal,thereby,avoiding unwanted radiation.Conclusion CT simulated treatment planning is able to reduce the superfluous radiation to the optic nerve in external irradiation of nasophargngeal carcinoma.

Objective To evaluate vagina reconstruction with the use of sigmoid colon. Methods 21 cases underwent vagina reconstruction with the use of sigmoid colon were reviewed of which 13 were male pseudohermaphrodism and 8 congenital devoid of vagina. Results The appearence of the reconstructed vagina has been good in all the 21 patients.15 of the 21 have been followed up for 3～24 months with no overproduction of mucus and no need of routine dilatation. Conclusions Vagina reconstruction with the use of an isolated sigmoid loop is an ideal procedure for juveniles and adults.

Objective To observe the clinical effects of modified Shengxian decoction in the treatment of thyroid cancer postoperative hypothyroidism patients.Methods 60 patients of thyroid cancer postoperative hypothyroidism due to deficiency of spleen and kidney were randomly divided into a control group and a treatment group.The control group (28 cases) was by levothyroxine sodium tablets conventional treatment,while the treatment group (32 cases) was treated with Shengxian decoction based on thecontrol group.The changes of the symptom integral and HAMD-17 were observed between two groups before and after treatment.Results After treatment,the total effective rate was 87.5％ in the treatment group and 64.3％ in the control group,the clinical effect of treatment group was significantly better than the control group (x2=4.499,P＜ 0.05).After treatment,the total score of HAMD-17 was 6.8±2.3 in the treatment group and 15.8±2.1 in the control group,both significantly improved than that before the treatment (which were 19.4±1.45 and 18.9± 1.32 respectively).Compared with the control group,the treatment group improved significantly (P＜ 0.01).Conclusion Shengxian decoction plus western medicine has remarkable curative effect in the treatment of thyroid cancer postoperative hypothyroidism,it can improve the depressive state of patients and improve the quality of life.

ObjectiveTo assess the feasibility and efficacy of a docetaxel plus cisplatin regimen for patients of locally advanced nasopharyngeal carcinoma(NPC)treated concurrently with definitive IMRT in a short-term observation.MethodsRadiation consisted of 7000 cGy given to the planning target volume (PTV) of primary tumor, 6600 cGy given to the PTV of metastatic lymph nodes and 6000 cGy to the PTV of subclinical disease in 220-228 cGy/fraction were delivered over 31-32 treatment days. Thirty-two patients with newly diagnosed NPC received definitive intensity-modulated radiation therapy(IMRT)concurrent with docetaxel 75 mg/m2 on day 1 and DDP 75 mg/m2 on day 1(or DDP 25 mg/m2 on day 1-day 3), repeating every 21 to 28 days for 2 cycles.ResultsAll patients received the full dose of radiotherapy and completed 2 cycles of chemotherapy with a median follow-up of 13 months (2-28 months).No treatment-related death was observed. Major toxicities included hematologic toxicity and mucositis. The incidence rates of grade 3-4 leucopenia,grade 3-4 neutropenia and grade 3 acute mucositis were 46.9 ％ (15/32),59.4 ％ (19/32) and 40.6 ％ (13/32) respectively.The complete remission (CR) rate was 96.9 ％ (31/32).During treatment,90.6 ％ (29/32)patients acquired granulocyte colony stimulating factor (G-CSF)for leucopenia. The 1-year overall survival, local recurrence-free survival, regional recurrence-free survival and distant metastasis-free survival were 100 ％ (31/32),96.9 ％ (31/32),96.9 ％ (31/32),96.9 ％ (31/32),respectively,for the whole cohort.Conclusions2 cycles of the docetaxel plus cisplatin regimen with concurrent IMRT are demonstrated being feasible and effective in treating locally advanced NPC with promising results.The major toxicities are leucopenia and neutropenia, but they are tolerable with the use of G-CSF. Further investigation of long-term efficacy of the regimen is required.

Objective To evaluate the left ventricle geometry shape and left heart regional function in mitral insufficiency (MI) by quantitative tissue velocity imaging (QTVI) and the left ventricle systolic and diastolic geometry spbericity index. Methods Thirty normal subjects and 62 MI patients underwent QTVI and color Doppler imaging (CDFI) were enrolled in this study in order to measure the left ven-tricular geometry shape and left ventrieular regional function along LV apical long-axis view. Off-line LV regional velocity images along LV apical long-axis view were synchronously obtained. Peak tissue velocities of LV regional muscular tissue during systole(Vs),systolic acceler-ation(a), early diastole(Ve), LA contraction(Va)were synchronously measured as the index of left ventricular regional systolic and dias-tolic function. The left ventricle geometry shape index were reflected from the systolic and diastolic geometry sphericity index (SIs and Sid) and the left ventrieular ejection fraction (LVEF) and the peak D and peak a (PVd/PVa) of pulmonary veins flowing spectrum reflected the global left ventricular function index. The Vs, Ve, Va, a, PVd/PVd ratio, LVEF, SIs, SId were recorded and their correlation between normal subjects and patients with MI were compared. Result Vs, Ve,Va,a,PVd/ PVa ratio,SIs,SId in patients with MI were significantly re-duced. There was positive relation between Sis and a(r=0.602)and Ve/Va and SId(r=0.635). Conclusion There was negative rela-tion between regional cardiac function and LV spberieity, the higher cardiac function was accompanied with the lower SI.

Objective: To investigate the effects of Ginkgo biloba extract 50 (GBE50) preconditioning on contents of inflammation-related cytokines in rats with myocardial ischemia-reperfusion. Methods: Fifty-eight SD rats were divided into sham-operated group, untreated group, Salviae miltiorrhizae (SM) injection group and low-, medium- and high-dose GBE50 groups. After intragastric administration for 7 d, the left anterior descending (LAD) coronary artery was occluded for 30 min followed by 60-min reperfusion to induce ischemia-reperfuion injury. Myocardium histopathologic change was observed by HE staining under a light microscope; myeloperoxidase (MPO) activity in myocardium was measured by colorimetric detection; tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and IL-8 were detected by radioimmunoassay; IL-4 and IL-10 were tested by enzyme-linked immunosorbent assay (ELISA). Results: Compared with untreated group, rats in medium-dose GBE50 group had lower inflammatory reaction and MPO activity (P<0.01). GBE50 also decreased the content of IL-6 (P<0.05, P<0.01) and increased the content of IL-4 in myocardium (P<0.05, P<0.01) as compared with the untreated group. The content of TNF-alpha in myocardium in the medium-dose GBE50 group was lower and IL-10 was higher than those in the untreated group, but without significant differences. Conclusion: GBE50 can decrease the content of IL-6 and increase the content of IL-4 in myocardium after ischemia-reperfusion injury. It suggests that GBE50 can regulate the inflammatory reaction after ischemia-reperfusion injury via inhibiting inflammatory cytokines and promoting anti-inflammatory cytokines.

Objective To discuss perioperative features, operative approach and surgical effects of spinal tuberculosis in older patients. Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients with spinal tuberculosis ranging in age from 61 to 78 years (average, 67 years). The lesion was located in thoracic vertebrae in 9 patients, thoracolumbar vertebrae in 14, lumbar in 16, and lumbosacral in 6. Preoperative Frankel grades were B in 7 cases, C in 21, D in 11 and E in 6. Among them, 21 had cardio-cerebrovascular disease, 10 had diabetes mellitus. With preoperative medicine and chemotherapy for 2-3 weeks, all patients were treated surgically. The surgical procedures included: 1) Posterior focus debridement, bone grafting and one-stage posterior transpedicular screw system fixation in thoracic vertebrae (T2-T7). 2) Anterior debridement, bone grafting and one-stage posterior transpedicular instrumental fixation in lumbosacral vertebrae (L5-S1). 3) Anterior focus elimination, bone grafting and one-stage anterior plate fixation in the other vertebrae. Results Forty-five patients were followed up for 24 to 40 months, with the average of 28.5 months. No severe complication occurred during and after operation. Forty-four cases had recovered and 1 recurred. Spinal fusion occurred 12-18 months after operation. Frankel neurological grades improved significantly. Conclusion With the effective management of comorbidities in perioperative period,the elderly could tolerate surgical treatment. The appropriate approaches, thorough debridement and reasonable bone grafting with internal fixation are key to therapeutic success.