OBJECTIVETo study the feasibility and effect of Blunt esophageal denudation without thoracotomy in the treatment of cervical esophageal carcinoma with laryngeal function preservation.

METHODSThe data of 28 patients with cervical esophageal carcinoma, collected from Aug. 1997 to Nov. 2005, were investigated retrospectively.

RESULTSAll the 28 patients were diagnosed as cervical esophageal squamous cell carcinoma. Among them, 12 patients underwent surgery (surgery group), while the other 16 patients underwent surgery plus radiation therapy preoperatively or postoperatively (multimodality therapy group). No uncontrolled intraoperative and postoperative hemorrhage and tracheal tear occurred. The incidence of complications was 21.4% (6/28), including cervical anastomotic leakage in 2 patients and recurrent laryngeal nerve injury in 4 patients. The overall 5-year survival rate was 50.3%. The 5-year survival rate was 25.7% in surgery group and 66.1% in multimodality therapy group, and the difference between two groups was statistically significant (chi(2)=4.07; P=0.0438).

CONCLUSIONSBlunt esophageal denudation without thoracotomy in the treatment of cervical esophageal carcinoma with larynx function preservation is possible. Combined with radiotherapy preoperatively or postoperatively, the survival time in patients with cervical esophageal carcinoma is able to be prolonged.

Adult ; Aged ; Aged, 80 and over ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Esophagoplasty ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Neck ; Retrospective Studies

OBJECTIVETo evaluate the effect and safety of BCG vaccine on initially treated pulmonary tuberculosis and its controlling effect on multidrug-resistant tuberculosis.

METHODSAll 360 volunteers with initially treated pulmonary tuberculosis of positive smear and culture were divided into immunotherapy group (180 cases, also BCG group) and control group (180 cases) at random pair. The patients in BCG group were treated with chemotherapy of a regimen of 2HRZ/2HR and immunotherapy with BCG for 4 months,and the first BCG vaccine was given a month after chemotherapy. Meanwhile, the patients in the control group were treated with chemotherapy of 2HRZ/4HR only.

RESULTS(1) The negative conversion rate of sputum smear in BCG group was 98.3% (177/180), and it was 97.2% (175/180) in control group. There was no significant difference between the two groups both at the ends of 4 and 6 months after treatment (chi2 = 0.1278, P > 0.05). (2) The positive conversion rate of sputum smear in BCG group was 2.3% (4/177), and it was 6.9% (12/175) in control group followed up for 5 years. The successful rate was 96.1% (173/180) in BCG group, and it was significantly higher than that of 90.6% (163/180) in control group (chi2 = 4.4643, P < 0.05). (3) In the 5-year follow up, bacteriologic result was similar to that of X-ray. (4) The occurrence rate of multidrug-resistant tuberculosis was 2.3% (4/177) in BCG group,significantly lower than that of 7.3% (13/178) in the control group (chi2 = 4.9513, P < 0.05).

CONCLUSIONAs an adjunct chemotherapy,immunotherapy with BCG vaccine should be helpful for patients with initially treated pulmonary tuberculosis. It would further strengthen the effects of chemotherapy and reduce the occurrence rate of multidrug-resistant tuberculosis.

Adjuvants, Immunologic ; therapeutic use ; Adolescent ; Adult ; Aged ; Antitubercular Agents ; therapeutic use ; BCG Vaccine ; therapeutic use ; Child ; Female ; Follow-Up Studies ; Humans ; Immunotherapy, Active ; Male ; Middle Aged ; Tuberculosis, Multidrug-Resistant ; prevention & control ; Tuberculosis, Pulmonary ; therapy

OBJECTIVETo observe the effect of superparamagnetic iron oxide (SPIO) on the differentiation of rat bone marrow stem cells (BMSCs) into chondrocytes in vitro and explore the possible mechanism.

METHODSCCK8 assay was performed to examine the cytotoxicity of SPIO (1 and 5 µg/mL) on cultured SD rat BMSCs. Prussian blue staining and fluorescence excitation assay were used to assess the binding of the SPIO to BMSCs after the cells had been cultured in chondrocytes-induced medium in the presence of SPIO (1 and 5 µg/mL) for 9 days. The mRNA levels of COL2 α2, aggrecan and MMP13 in the cell culture were examined using Q-PCR, and the chondrogenic differentiation of the BMSCs was analyzed using alcian blue staining and immunofluorescence staining for COL2 α2. The protein levels of COL2 α2, aggrecan, MMP13, Ihh and PTHrP in the cells were examined using Western blotting.

RESULTSCCK8 assay showed no significant toxicity of SPIO on BMSCs. Compared with the control cells, the cells cultured in the presence of SPIO showed increased expressions of COL2 α2 and aggrecan and decreased expression of MMP13 at both mRNA and protein levels with also significantly increased expressions of Ihh and PTHrP proteins.

CONCLUSIONSPIO can promote the differentiation of rat BMSCs into chondrocytes and up-regulate the Ihh/PTHrP signal pathway, suggesting the potential of SPIO as a new therapeutic agent for chondrocyte-related diseases.

OBJECTIVETo summarize the experience of surgical treatment for cervical esophageal carcinoma.

METHODSClinical and follow-up data of 82 patients with cervical esophageal carcinoma undergone surgical treatment in Henan Provincial Cancer Hospital from Dec. 1993 to Dec. 2005 were analyzed retrospectively. The difference of the therapeutic regimen and 5-year survival rate of these patients were evaluated.

RESULTSBefore 1997, patients mainly underwent surgical therapy solely (27 cases). After 1997, 50 cases received surgical therapy following neoadjuvant radiotherapy (multimodality group), except 5 early-stage cases received surgical therapy solely. Seventy-three patients underwent esophagectomy without thoracotomy, including 21 cases of invert-stripping of the esophagus, and 52 cases of blunt denudation of esophagus. Nine patients underwent transthoracic esophagectomy. Concurrent monolateral or bilateral cervical lymph node dissection accounted for 14 cases and combined organ resection 12 cases. No serious hemorrhage and tracheal or bronchial tearing occurred. No hospital death occurred. Postoperative complications were found in 14 patients, and the incidence of complication was 19.5%. In sole surgery group, upper incised margins of 5 patients were confirmed to be positive. The laryngeal function of 26 patients in sole surgery group was preserved, while 47 patients in multimodality group preserved. Lymph node metastasis occurred in 14 cases, including 13 cases cervical lymph node metastasis (monolateral 9, bilateral 4) and 1 case of upper mediastinal lymph node metastasis. During follow-up, 3 patients were lost. The total 5-year survival rate was 43%. The patients in multimodality group had higher 5-year survival rate as compared to those in sole surgery group. (50.2% vs 33.9%,chi(2 )=7.17,P=0.007). The 5-year survival rates of patients with transthoracic esophagectomy, esophagectomy plus concurrent monolateral or bilateral cervical lymph nodes dissection or combined organ resection were 36.5%, 45.8% and 33.3% respectively. All the 5-year survival rates of these subgroups were lower as compared to multimodality group.

CONCLUSIONSFor patients with early stage cervical esophageal carcinoma and with proximal end of residual normal esophagus longer than 2 cm, the optimal therapy should be surgery. For most of the patients, surgery combined with neoadjuvant radiotherapy is the ideal therapeutic strategy, which can lower the risk of positive revised margin, improve the possibility of preserving the laryngeal function and result in the improvement of 5-year survival rate. Esophagectomy without thoracotomy should be preferred. Combined organ resection or bilateral lymph node dissection should be chosen carefully because these operating procedures may lead to severe injury and function lose.

Adult ; Aged ; Aged, 80 and over ; Esophageal Neoplasms ; pathology ; surgery ; Esophagectomy ; Female ; Humans ; Male ; Middle Aged ; Neck ; Retrospective Studies

AIMTo investigate the changes of the spermatozoa ultrastructures before and after renal transplantation in uremic patients.

METHODSThe sperm of five uremic patients before and after transplantation and four healthy volunteers were collected and examined by scanning electron microscopy.

RESULTSAbnormal spermatozoa were found in patients pre-transplantation; abnormalities included deletion of the acrosome, absence of the postacrosomal and postnuclear ring, dumbbell-like changes of the head, tail curling, and absence of the mitochondrial sheath in the mid-segment. After renal transplantation, most of the spermatozoa became normal.

CONCLUSIONThere are many abnormalities with regard to the appearance and structure of the head, acrosome, mitochondria and tail of the spermatozoa in uremic patients. The majority of the spermatozoa returned to normal after renal transplantation, but a few still presented some abnormalities possibly relating to the administration of immunosuppressants.

Acrosome ; pathology ; Adult ; Case-Control Studies ; Humans ; Kidney Failure, Chronic ; complications ; Kidney Transplantation ; Male ; Microscopy, Electron ; Renal Dialysis ; Sperm Head ; pathology ; Sperm Tail ; pathology ; Spermatozoa ; pathology ; ultrastructure

BACKGROUND: Previous studies have found that polygonatum sibiricum polysaccharide (PSP) exhibits anti-osteoporosis effect, but its therapeutic effect in ovariectomized osteoporotic rats and the molecular mechanisms are poorly understood. OBJECTIVE: To investigate the effect of administration of PSP on the bone microstructure, bone mineral density as well as osteoblast- and osteoclast-related gene expression in rats. METHODS: Twenty-five infertile female Sprague-Dawley rats aged 3 months were randomly allotted into five groups (n=5 per group): sham operation (same volume normal saline), model, zoledronate (0.2 mg/kg?d), high-dose PSP (800 mg/kg?d) and medium-dose PSP (400 mg/kg?d) groups. All rats were subjected to ovariectomy except sham operation group. The administration was intragastrically given every 2 days beginning at 7 days after modeling and lasted 12 weeks. Then, the rats were sacrificed, and the uterus was weighed. The bilateral tibias were removed, one side for histomorphometric analysis by micro-CT, and the other one for RNA detection by qualified PCR. RESULTS AND CONCLUSION: Compared with the sham operation group, the rat body mass in the model group was significantly increased and the weight of uterus was significantly decreased (P < 0.05). Compared with the model group, zoledronate and high-dose PSP could significantly alleviate the excessive increase in body mass (P < 0.05). The bone mineral density in the model group was decreased by 63% compared with the sham operation group (P < 0.01), Compared with the model group, after 12-week high-dose PSP and zoledronate administration, the bone mineral density was increased by 44% and 38%, respectively (P < 0.01); the trabecular bone volume fraction and trabecular number rose significantly(P<0.05),while the trabecular separation decreased significantly(P<0.05).In vivo,PSP could significantly promote the expression levels of osteoblast-related genes (alkaline phosphatase, RUNX2, Col1a1 and osteocalcin), and significantly inhibit the expression levels of osteoblast-related genes (ACP5 and CTSK) (P < 0.05). These results imply that high-dose PSP can reduce bone loss and decrease of bone mineral density, improve the destruction of bone microstructure, as well as promote osteoblast-related genes but inhibit osteoclast-related gene mRNA expression in the ovariectomized rats.

Objective: To evaluate the efficiency and safety of low intensity conditional regimen for children with Fanconi anemia (FA) receiving allogenic hematopoietic stem cells transplantation (allo-HSCT). Methods: Four patients diagnosed as Fanconi anemia were enrolled in this study. One patient received HLA-identical sibling donor hematopoietic stem cell transplantation, two patients underwent unrelated donor matched (UD) HSCT, and one patient received unrelated cord blood transplantation. The conditional regimen consisted of Busulfan with low dose of cyclophosphamide. Results: All 4 cases succeeded in allo-HSCT. The median time for neutrophils engraftment was 11(9-15) day, median time to platelets (PLT) engraftment was 12 (8-28) day. One case occurred with grade I of aGVHD, 1 case with hemorrhagic cystitis. No patient happened with hepatic veno-occlusive disease (VOD). Conclusion: Low intensity of conditional regimen is efficient and safe which should be recommended for FA patients with HSCT.
Busulfan ; Fanconi Anemia ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation ; Humans ; Transplantation Conditioning

Under the situation of the rapid expansion of hospital, the dilemma of acupuncture-moxibustion department, as well as the relevant solutions are explored. The main reasons for the shrinking situation of the service in acupuncture-moxibustion department include: the disease-based department division trends to divert many diseases suitably treated in acupuncture-moxibustion department; the environment pursuing economic benefits restricts the development of acupuncture-moxibustion therapy characterized by "simple and low-cost operation". There are three important approaches for breaking through the dilemma of acupuncture and moxibustion therapy. First, modifying the traditional service mode as waiting for patients in acupuncture-moxibustion department and promoting acupuncture and moxibustion technology to be adopted in other departments rather than limited only in acupuncture-moxibustion department. Second, increasing the charges of acupuncture and moxibustion technology rationally. Third, positioning accurately the role of acupuncture and moxibustion technology in health services based on its own characteristics and advantages and promoting it in community medical institutions. All of these solutions require the guidance of supporting policies.
Acupuncture ; Acupuncture Therapy ; Hospitals ; Humans ; Moxibustion

Objective:To study the clinical medication regulation for the prevention and treatment of new coronavirus pneumonia with traditional Chinese medicine（TCM），especially prescriptions，on the basis of "treatment in accordance with seasonal conditions". Method:The guidelines and suggestions on novel coronavirus pneumonia formulated and published by national，provincial and municipal governments and experts before February 17，2020, were retrieved and summarized. Data was recorded in stages according to "prevention period，clinical observation period，pre-clinical period，middle clinical period，late clinical period and recovery period". The frequency analysis of TCM and its efficacy，prescription and proprietary Chinese medicine was carried out，and then the factor analysis and cluster analysis of TCM were carried out to obtain rational drug combinations. Result:Totally 172 suggestions on combined structure of drugs，50 suggestions on prescriptions and 31 suggestions on proprietary Chinese medicine were involved in the study，and provided by 24 official agencies and 24 medical experts， 147 kinds of herbs，44 prescriptions and 16 proprietary Chinese medicines were collected. No matter for the drug category or for the specific drug selection，the law of drug use in different stages was not the same. Huoxiang Zhengqi capsule，Shufeng Jiedu capsule，Lianhua Qingwen capsule and Jinhua Qinggan capsule can be used in the observation period. Xuanbai Chengqitang can be used in the middle of the disease. Angong Niuhuangwan，Suhexiangwan or Zixuedan, and Angong Niuhuangwan can be selected in the middle of the disease. And Qingfei Paidu decoction can be used in all stages of the disease. Conclusion:Doctors need to adjust their prescriptions along with the progress of the disease，because the law of medication in each stage of the new coronavirus pneumonia is different.