Purpose: Whether craniospinal irradiation (CSI) could be replaced by limited-field radiation in non-metastatic bifocal germinoma remains controversial. We addressed the issue based on the data from our series and the literature. Methods: Data from 49 patients diagnosed with non-metastatic bifocal germinoma at our hospital during the last 10 years were collected. The Pediatric Quality of Life Inventory 4.0 was used to evaluate health-related quality of life (HRQOL). Additionally, 81 patients identified from the literature were also analyzed independently. Results: In our cohort, 34 patients had tumors in the sellar/suprasellar (S/SS) plus pineal gland (PG) regions and 15 in the S/SS plus basal ganglia/thalamus (BG/T) regions. The median follow-up period was 52 months (range, 10 to 134 months). Our survival analysis showed that patients treated with CSI (n=12) or whole-brain radiotherapy (WBRT; n=34) had comparable disease-free survival (DFS; p=0.540), but better DFS than those treated with focal radiotherapy (FR; n=3, p=0.016). All 81 patients from the literature had tumors in the S/SS+PG regions. Relapses were documented in 4/45 patients treated with FR, 2/17 treated with whole-ventricle irradiation, 0/4 treated with WBRT, and 1/15 treated with CSI. Survival analysis did not reveal DFS differences between the types of radiation field (p=0.785). HRQOL analysis (n=44) in our cohort found that, compared with S/SS+PG germinoma, patients with BG/T involvement had significantly lower scores in social and school domains. However, HRQOL difference between patients treated with CSI and those not treated with CSI was not significant. Conclusion In patients with non-metastatic bifocal germinoma, it is rational that CSI could be replaced by limited-field radiation. HRQOL in patients with BG/T involvement was poorer.

The immune system is a complex system involving multiple organs,and it is vulnerable to age,gender,environment and other factors.For a variation normal physiological range,it is a great challenge to evaluate drug-induced immunotoxicity in preclinical safety study.Histomorphologic assessment of the immune system is a recognized cornerstone in the identification of immunotoxicity at present.In this paper,the principles of pathological evaluation for immune system,and pathological evaluation for important immune organs including thymus,spleen,lymph nodes are discussed briefly,so that it is intended to assist toxicity pathologists in the accurate and consistent characterization of intended and unintended drug-induced alterations of the immune system.

Toxicological pathology is a morphological elucidatet ion of tissue damage caused by drug toxicity,including damage type,location,severity grade and prognosis.It provides objective and accurate data to support preclinical drug safety evaluation.Therefore,toxicological pathology plays an important role in drug safety evaluation,and the pathologic data or conclusion often determines the termination or continuation in many drug development projects.In this paper,the characteristic of toxicological pathology,standardized management,the development of new techniques including in situ hybridization,laser scanning cytometry and laser capture microdissection,and related problems in pathology are discussed briefly.

Objective The aim of this study was to describe the clinical outcomes and improvement of clivo-axial angle (CAA) during the posterior approach surgery of upper cervical anomaly instability patients.Methods All of 32 patients with symptomatic upper cervical anomaly instability were followed up from 2004 Apr.to 2014 Aug.in which 1 patient was excluded because of reoperation.There were 10 patients with OS odontiodeum,5 with odontoid deformity,4 with Klipple-Feil syndrome,4 with atlantoaxial dislocation,4 with atlantoaxial instability,1 with rheumatoid arthritis,1 with old odontoid fracture,1 with OS odontoideum and foramen magnum stenosis,1 with basilarinvagination and Klipple-Feil syndrome.They were all performed posterior reduction internal fixation and fusion,and then released spinal cord compression with the promotion of CAA.The patients were divided into two groups on the basis of decompression or not:non-decompression group 17 cases (male 8 cases,female 9 cases;age 13-65 years old,average 50.1 years old) and decompression group 14 cases (male 7 cases,female 7 cases;age 19-68 years old,average 49.6 years old).The CAA numbers were measured and compared.The clinic date was compared between preoperatively and postoperatively,which included Neck Disability Index and Nurick Classification System for Myelopathy.Results All patients were followed up,the follow-up time of non-decompression group was 0.7-10.7 years,average 2.9 years;the follow-up time of compression group was 0.3-5.5 years,average 2.9 years.Analysis of CAA,NDI and Nurick score were performed with t-test.The postoperative CAA,NDI and Nurick score improved significantly compared to preoperative ones.There was no difference between non-decompression group and decompression group.One patient felt nausea and vomited,one got soleal vein thrombosis,one had a swelling face and blurring vision and one had decompression syndrome after operation,all of these were improved using respectively therapy.No such serious complications as injury to vertebral artery,infection or internal fixation loosening occurred.Conclusion Neck ability and spinal cord function was significantly improved through increasing CAA for the upper cervical anomaly instability patients underwent posterior reduction internal fixation and fusion.

Objective To investigate the incidence of heterotopic ossification in cervical artificial disc replacement in Chinese mainland population by meta-analysis.Methods The related literatures published between 1997 and June 2012 were collected from both English databases,including Pubmed,Ovid,Cochrane library and Embase,and Chinese databases including Chinese Biomedical Literature Database,China National Knowledge Infrastructure,VIP database and Wanfang database.Literatures were selected in strict accordance with the inclusion and exclusion criteria.Studies providing data of prevalence of heterotopic ossification after cervical artificial disc replacement in Chinese mainland population were included.The information of literatures was extracted by excerpts questionnaire,and recorded by two independent researchers.I2 was calculated to test heterogeneity among studies.A random effects model was used if I2 ≥25％.Subgroup analysis was done according to the number of levels of disc replacement,brands of implants and duration of follow-up.Sensitivity analysis was done according to the sample size.The Meta-Analyst software was used for statistical analysis.Results A total of forty studies (1822 cases) were included in this study.The pooled incidence of heterotopic ossification was 7.3％ (95％CI:4.7％ to 11.0％).For single and mixed level disc replacement,the incidence was 11.6％ and 5.8％,respectively.For single and mixed level disc replacement using Bryan disc,the incidence was 13.8％ and 5.4％,respectively,and the total incidence was 7.2％.No matter the single or mixed level disc replacement,the incidence of heterotopic ossification increased with follow-up.Conclusion The incidence of heterotopic ossification in cervical artificial disc replacement is high in Chinese mainland population,while it is lower than in foreigners.However,it is necessary to monitor its long-term incidence due to its increase with follow-up.

Objective To analyze the influencing factors on hospitalization costs of osteoporosis hip fracture in elderly patients.Methods The hospitalization expenses of patients with osteoporotic hip fracture and influencing factors were analyzed by single factor analysis of variance and multiple regression analysis method in Beijing Ji Shuitan Hospital from 2009 July to 2010 December.Results Among 565 patients who underwent operation treatment,hospitalization costs of femoral neck fracture was (42 127±20 821) yuan,wherein the treatment fee was (27 283± 14 959) yuan,other expenses (expenses for medicine,examination and chemical examination) were (14 844 ± 8717) yuan.The above values of intertrochanteric fracture were (52 965± 15 901) yuan,(36 872±11 763) yuan and (16 093±7793) yuan,respectively.Treatment fee occupied 65％ of hospitalization expenses.Multivariate regression analysis of influencing factors of costs intertrochanteric revealed that femoral neck fractures hip arthroplasty,femoral intertrochanteric fracture,venous thrombosis of the lower extremity,and albumin infusion in perioperative period were correlated firmly with the increased hospitalization expenses and treatment expenses (P＜0.001).Comorbidities such as diabetes and anemia,perioperative complication such as delirium,cardiac disease,pulmonary embolism,pulmonary infection were related to the other higher expenses (P＜0.05).The longer of hospital stay resulted in higher cost of hospitalization (P ＜ 0.001).Conclusions Comorbidities and preoperative complications can increase other expenses.Osteoporotie hip fracture,with a high hospitalization cost,is a heavy economy burden.It is important to emphasize the disease prevention of both osteoporosis and aging chronic illness.

Objective To investigate the prevalence of cervical spondylosis among adults in Beijing.Methods The prevalence of cervical spondyiosis among people older than 18 years who had lived in Beijing for more than six months was investigated in December 2010.The multi-stage sampling was used in this cross-sectional study.The related information was obtained by a self-designed questionnaire.Single and muhivariable Logistic regression models were applied to analyze high risk districts and populations.Results A total of 3859 people were enrolled in this study.Among them there were 531 people with cervical spondylosis,and the prevalence was 13.76％.The prevalence of cervical spondylosis in suburb (15.97％) was the highest compared with city center and countrysides (x2=8.257,P=0.016).The prevalence in females (10.49％) was higher than that (16.51％) in males (x2=29.432,P＜0.001).The distribution of prevalence among different age populations was inverted U shape,and the prevalence was higher in 45 years group (20.43％) and 60 years group (18.91％) compared with other two groups.The prevalence in employed group was 1.303 times higher than that in unemployed group (95％CI:1.008,1.684).According to the muhivariable logistic regression result,suburb (OR=1.306,P=0.026),females (OR=1.81 1,P＜0.001),people who were 45years or 60 years (OR=2.171,P＜0.001; OR=2.430,P＜0.001,respectively) and employed and retired people (OR=1.664,P=0.001; OR=1.303,P=0.043,respectively) were high risk population of cervical spondylosis.Conclusion The prevalence of cervical spondylosis among adults in Beijing was much higher and vastly distributed.It's necessary to reinforce the prevention,diagnosis and treatment study.Young females,people aged 45 years or 60 years,and employed people were high risk populations.

ObjectiveTo evaluate the value of adenosine-stress myocardial perfusion imaging (MPI)in post-operation follow-up after the percutaneous coronary intervention(PCI) in the elderly.MethodsThere were patients (53 cases) underwent adenosine-stress MPI prior to and 6 months after PCI. Major adverse cardiovascular events (MACE) were followed. Left ventricular ejection fraction (LVEF) was analyzed in 40 cases. The image of the left ventricular myocardium was divided into 16 segments to calculate total defect score using a 4-grade assessment.Myocardial scintigrams were evaluated by calculating the summed adenosine-stress score and coronary angiography assessed by calculating the summed score of coronary artery stenosis.Results There was a significant correlation between the scores of coronary artery stenosis and adenosine-stress MPI scores (r=0.675,P＜0.01). Adenosine-stress MPI scores were obviously lower after PCI than before(2.2± 2.3 vs. 4.5±1.9,t= 7.348, P＜0.01); LVEF was significantly greater after PCI than pre-operation[(58.3±10.5 ) ％ vs. (53.8 ± 10.3) ％, t = 3.497, P＜0.01] and the effective rate for myocardial perfusion were 86.84 ％. Conclusions Adenosine stress MPI is a good noninvasive diagnostic method with high accuracy and plays an important role for evaluating recovery of myocardial perfusion and left ventricle function in the elderly patients after PCI.