2008年 · 第121卷第22期

Abstract：Background Endovascular stent-graft treatment has emerged as an altemative for patients with type B aortic dissection (AD),either at acute or chronic phase,in selected patients.This study aimed to investigate the results of endovascular stent-graft repair for acute and chronic type BAD.Methods From May 2002 to July 2007,67 patients with type BAD were treated by endovascular stent-graft placement.There were 32 patients in the acute phase (PAD group) and 35 patients in the chronic phase (CAD group).The patients were followed up from 1 to 65 months (average,17±16 months).The immediate and follow-up clinical outcomes were documented and compared between the 2 groups.Results Placement of endovascular stent-grafts across the primary entry tears was technically successful in all 67 patients.Compared with patients in the CAD group,those in the AAD group had higher percentages of pleural effusion (15.6% vs 0,P=0.02) and visceral/leg ischemia (21.9% vs 2.9%,P=0.02).Procedure related complications,including endoleak and post-implantation syndrome occurred more frequently in PAD group than in CAD group (21.9% vs 2.9% and 31.3% vs 8.6%,respectively;P=0.02 and P=0.02).Kaplan-Meier analysis showed no significant difference in survival rate at 4 years between the 2 groups (86.4% vs 92.3%,P=0.42 by Log-rank test).But the 4-year event-free survival rate was higher in patients with chronic dissection than in patients with acute dissection (96.2% vs 73.9%;P=0.02 by Log-rank test).Conclusions Endovascular repair with stent-graft was safe and effective for the treatment of both acute and chronic type BAD.However,both immediate and long term major complications occurred more frequently in patients with acute dissection than in those with chronic dissection。

Abstract：Background It is still controversial as to the implementation of higher positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome (ARDS).This study was conducted to compare the lower and higher PEEP in patients with ARDS ventilated with low tidal volume,to investigate the relationship between the recruited lung volume by higher PEEP and relevant independent variables and to provide a bedside estimate of the percentage of potentially recruitable lung by higher PEEP.Methods Twenty-four patients with ARDS were studied.A lung recruiting maneuver was performed,then each patient was ventilated with PEEP of 8 cmH2O for 4 hours and subsequently with PEEP of 16 cmH2O for 4 hours.At the end of each PEEP level period,gas exchange,hemodynamic data,lung mechanics,stress index "b" of the dynamic pressure-time curve,intrinsic PEEP and recruited volume by PEEP were measured.Results Fourteen patients were recruiters whose alveolar recruited volumes induced by PEEP 16 cmH2O were (425±65) ml and 10 patients were non-recruiters.Compared with the PEEP 8 cmH2O period,after the application of the PEEP 16 cmH2O,the PaO2/FiO2 ratio and static lung compliance both remained unchanged in non-recruiters,whereas they increased significantly in recruiters.Changes in PaO2/FiO2 and static lung compliance after PEEP increase were independently associated with the alveolar recruitment.Analyzing the relationship between recruiting maneuver (RM)-induced change in end-expiratory lung volume and the alveolar recruitment induced by PEEP,we found a notable correlation.Conclusions The results of this study indicated that the potential for alveolar recruitment might vary among the ARDS population and the higher PEEP levels should be limited to recruiters.Improving in PaO2/FiO2,static lung compliance after PEEP increase and the shape of the pressure-time curve could be helpful for PEEP application。

Abstract：Background Proprioception plays an important role in knee movements.Since there are controversies surrounding the overall recovery time of proprioception following surgery,it is necessary to define the factors affecting proprioceptive recovery after anterior cruciate ligament (ACL) reconstruction and to investigate the relationship between proprioception and muscle strength.Methods A total of 36 patients who had their ACL reconstructed with a semitendinosus/gracilis graft (reconstructed group:6 months post-surgery) and 13 healthy adults without any knee injury (control group) were included in the study.Knee proprioception was evaluated with a passive reproduction test.Isokinetic strength was measured using the Biodex System.Statistical analysis was used to compare proprioception of the reconstructed group versus the control group,and to define causal factors,including sex,hamstring/quadriceps ratio,and the course of injury before reconstruction.We also investigated the correlation between the passive reproduction error and quadriceps index.Results There was a significant difference in proprioception between the reconstructed and control groups (P ＜0.05).When the course of injury before reconstruction was less than 4 months,there was a linear correlation with proprioception 6 months after the operation (r=0.713,P ＜0.05).There was a positive correlation between post-surgery proprioception and the quadriceps index at 6 months post-surgery.Conclusions Impaired knee proprioception is observed 6 months after ACL reconstruction.Within 4 months of injury,early undertaking of reconstruction is associated with better proprioception outcome.Patients with enhanced proprioception have a better quadriceps index。

Abstract：Background The change of anaerobic exercise abilities during and after a high-altitude expedition or hypoxic exposure is not well studied.To evaluate the effects of an extreme-altitude expedition on anaerobic performance,the 10-second supramaximal test and endocrine hormones were evaluated before and after an expedition to Peak Lenin.Methods Four subjects (3 male and 1 female,age (30.5+16.5) years) were recruited into the study.Three sets of tests were performed,including a basic test at sea level and 20 days before first arrival at the base camp (3600 m),a middle test done at day after returning from the summit to the base camp and the post test at the 10th day after return to the sea level.Both the supramaximal test,performed by a cycle ergometer,and body composition,performed by bioelectrical impedance analysis,were completed before the basic test and post test.The endocrine hormones including cortisol,growth hormone,testosterone,noradrenaline,adrenaline,dopamine,glucagon and β-endorphin were measured at all tests.Results Comparing the conditions before and after the expedition,the body measurement parameters were decreased after the expedition,i.e.,body weight (-4.22%,P ＜0.05),fat-free mass (-2.09%,P ＜0.01 ) and body fat (-8.95%,P=0.172).The peak power relative/body weight ratio (PP/BW) was similar ((9.70+1.97) vs (9.11+1.80) W/kg,P=0.093),while mean power/body weight ratio (MP/BW) was reduced significantly after the expedition ((9.14+1.77) vs (8.33+1.74) W/kg,P ＜0.05).Peak power/fat-free mass (PP/FFM),mean power/fat-free mass (MP/FFM) and fatigue index (FI) were significantly lower after the expedition (PP/FFM:(11.95+1.71) vs (10.99+1.59) W/kg,P ＜0.05;MP/FFM:(11.26+1.50) vs (10.04+1.55) W/kg,P＜0.O05;FI (85.55±4.17)% vs (77.25±4.40)%,P＜0.05).Hormone assays showed a significant increase of noradrenaline (basic vs middle,P＜0.05) as well as decrease of adrenaline (P＜0.05).Meanwhile,a trend towards an increase in dopamine (basic vs middle) and a decrease of β-endorphin (basic vs post) were also noted.Conclusions These results suggested that an expedition to an extreme altitude may have negative effects on anaerobic performance.It showed that a significant increase of noradrenaline (basic vs middle) as well as decrease of adrenaline after the expedition to Peak Lenin had occurred.The real physiological significance needs to be further investigated。

Abstract：Background Although antiangiogenesis therapy plays an important role in anti-neoplastic treatment with its recognized efficacy and slight adverse effect,there is no prospective clinical trial to define ideal markers for predicting efficacy of antiangiogenic therapy.This study was undertaken to investigate the changes of activated circulating endothelial cells (aCECs) and survMn after anti-angiogenesis therapy and their significance in predicting the efficacy of the therapy.Methods Patients of non-small cell lung cancer (NSCLC) treated with chemotherapy with or without Endostar were observed.The amount of activated CECs was detected by flow cytometry,and the expression of survivin mRNA was determined by real-time polymerase chain reaction (PCR).Results After treatment,the amount of activated CECs decreased significantly in clinical benefit cases (P=-0.021 in chemotherapy alone,P=0.001 in chemotherapy plus Endostar),increased in disease progressive cases (P=-0.015 in chemotherapy alone,but P=0.293 in chemotherapy with Endotatar).After therapy,the expression of survivin mRNA decreased in clinical benefit cases (P=0.001) and increased in disease progressive cases (P=0.018).A positive correlation was found between activated CECs and survivin in the chemotherapy group pre- and post-therapy (P=0.001 and 0.021,respectively),but only in the chemotherapy with Endostar group pre-therapy (P=0.030) rather than post-therapy.A positive correlation was found between the decreased activated CECs after therapy and time to progression (TTP) (r=0.322,P=0.012);a negative correlation was found between the amount of survivin mRNA in serum post-therapy and TTP(r= -0.291,P=0.048).Conclusions Activated CECs and survMn may be ideal markers forecasting efficacy and prognosis of NSCLC.The former can reflect more sensitively antiangiogenic efficacy and the latter is more sensitive to shrinkage or swelling of tumors.Their combination can evaluate more accurately the efficacy of antiangiogenic therapy of NSCLC。

Abstract：Background Radiofrequency catheter ablation (RFCA) has been established as an effective and curative therapy for ventricular tachycardia (VT) and severely symptomatic premature ventricular contraction (PVC) from the outflow tract in structurally normal hearts.This study aimed to investigate electrophysiologic characteristics and effects of RFCA for patients with idiopathic VT and symptomatic PVC originating from the valve annulus.Methods Characteristics of body surface electrocardiogram (ECG) and endocardiogram in a successful RFCA target were analyzed in 16 patients with idiopathic VT and symptomatic PVC originating from the valve annulus.Additionally,the ECG characteristics of vr or PVC were compared with those of manifest Wolff-Parkinson-White (WPW) syndrome originating from the same site of origin in 15 patients.Results Thirteen patients were successful,2 recurrent and 1 failed.The recurrent cases underwent successful ablation the second time guided by the Ensite 3000 mapping system.In all patients with the WPW syndrome,the characteristics of QRS morphology were well matched with those of the VT and PVC that originated from corresponding sites of origin.Conclusions RFCA is an effective curative therapy for VT and symptomatic PVC originating from the valve annulus.There are specific characteristics in ECG and the ablation site could be located by means of the WPW syndrome accessory pathway's algorithm。

Abstract：Background Decayed teeth are harmful to children's growth and development and can severely jeopardize their health.This study was set out to investigate and analyze the prevalence of dental caries in preschool children in Shanghe County in Shandong Province,China,and provide new insights into potential prevention and treatment strategies.Methods Based on the random sampling method,we performed dental examinations of children aged 2 to 6 years in kindergartens of Shanghe County.The prevalence of caries,the average number of decayed teeth per capita as well as the constituent rates of decayed,missing and filled teeth were determined retrospectively.SPSS software was used for data analysis.Results Dental caries were found in 1088 out of 2052 children from 56 kindergartens.The total number of decayed teeth was 4487 with a prevalence of 53.02%.The average number of decayed teeth per capita was 2.187,and the filling rate was 0.29%.There was no statistical difference in the prevalence of caries between boys and girls though there were significant differences between different age groups.The prevalence of decayed teeth as well as the mean number of decayed teeth infected per capita increased with age.In addition,urban children had a higher prevalence than those from rural areas (P ＜0.01).Conclusions The prevalence of decayed caries among kindergarten children in Shanghe County was high,suggesting that more emphasis should be put on improving oral health education with priority given to prevention.Further efforts should be made to increase the decayed caries filling rate。

Abstract：Background It is well known that conventional splenectomy,which requires careful handling and ligation of tissue of the splenic hilum,can easily cause complications such as splenic fever and pancreatic fistula.Here,we use the technique of dissection of the secondary branches of the splenic pedicle to handle the hilum in the portal hypertension patients who are subjected to splenectomy.Methods We retrospectively compared and analyzed the complications,postoperative hospital stay,operative time,and occurrence of hemorrhage in 121 patients with portal hypertension undergoing splenectomy and devascularization of the gastric cardia from January 1999 to December 2007.The selected cases consisted of 51 patients undergoing conventional splenectomy and 70 patients undergoing dissection of secondary branches of the splenic pedicle.In addition,we analyzed the relationship between size of the spleen and occurrence of complications.Results The incidence of pancreatic fistula and splenic fever (0/70 and 9/70) was lower in patients undergoing dissection of secondary branches of the splenic pedicle as compared with that of the conventional group (5/51 and 18/51 respectively).In addition,there was no significant difference in operative time and volume of blood loss between two groups.The spleen thickness of those patients who had pancreatic fistula and splenic fever was significantly greater than those without complications.Conclusions These results indicate that dissection of secondary branches of the splenic pedicle in portal hypertension patients undergoing splenectomy can decrease the incidence of splenic fever and pancreatic fistula,and shorten the postoperative hospital stay,especially in the patients with a large spleen.So dissection of secondary branches of the splenic pedicle is a valuable technique for splenectomy。

Abstract：Background Human metapneumovirus (hMPV) has recently been recognized as a notable respiratory pathogen in children.However,no isolation processes and only a limited understanding of hMPV epidemiology present in Chinese children are documented by far.Methods Nasopharyngeal aspirates from 86 hospitalized children with acute respiratory tract infections from December 2004 to July 2005 were inoculated onto Vero-E6 cells for hMPV isolation.Total RNA was extracted from infected cells with a cytopathic effect and then subjected to a RT-PCR amplification of the N and F genes of the hMPV.Nucleotide sequences of amplified F gene products were examined using a variation analysis with the MegAlign program and the phylogenetic tree construction using the neighbor-joining algorithm with a Phylip package.Results Six strains of hMPV were isolated from the samples during winter,spring and summer.The most common symptoms were coughing and cyanosis,and the diagnoses were bronchiolitis,bronchopneumonia,infantile asthma,or upper respiratory tract infection.All isolates were in the A2 genetic sublineage and shared a high percentage of homology with the F gene in the nucieotide (99.8%-100%) and amino acid (99.3%-100%) sequences.Conclusions This report indicates that hMPV is an important viral agent for acute respiratory tract infections present in Chongqing,China.Knowledge of phylogeny and genes will benefit the studies on the treatment and prophylaxis of hMPV infection。

Abstract：Background Transcription factors hypoxia inducible factor 1α (HIF 1α) and endothelial PAS domain protein 1 (EPAS1)promote the transcription of vascular endothelial growth factor (VEGF).VEGF enhances angiogenesis and vascular permeability of tumours,which promotes tumour growth and facilitates entry of cancer cells into blood circulation and metastasizing.This study examined whether HIF 1α and EPAS1 stimulated angiogenesis through activation of VEGF in human pancreatic carcinoma.Methods Specimens from pancreatic carcinoma and healthy parts of same pancreas were taken from 60 patients.Real time quantitative reverse transcription polymerase chain reaction estimated expression of HIF 1α,EPAS1,and VEGF mRNAs.Western blotting and immunohistochemical,streptavidin peroxidase method assessed expression of HIF 1α,EPAS1,and VEGF proteins.Microvessel density (MVD) was assessed.Results Highly significant increases in expression of EPAS1,VEGF,and MVD were found in pancreatic carcinoma tissue but not in normal pancreatic tissue:VEGF at mRNA and protein levels (t=17.32,P=0.0001;t=98.41,P=0.0001);EPAS1 protein level (t=22.51,P=0.0001).Expression of HIF 1α was similar in pancreatic carcinoma and normal pancreatic tissues at both mRNA and protein levels.Significant correlations were observed between EPAS1 and VEGF (r=0.736,P=0.0041),between VEGF and MVD (r=0.858,P=0.0001),and between EPAS1 and MVD (r=0.641,P=0.0003).No significant correlations were observed between HIF 1α and VEGF,or between HIF 1α and MVD.MVD and expression of EPAS1 and VEGF were significantly related with TNM staging,so was EPAS1 and VEGF with size of tumour.Conclusions EPAS1 and VEGF,but not HIF1α,are overexpressed in pancreatic carcinoma.The expression of EPAS1 is correlated with that of VEGF and MVD.EPAS1 may be involved in the angiogenesis of pancreatic carcinoma by upregulating the expression of VEGF.Targeting EPAS1 may be a new method of antiangiogenic tumour therapy for pancreatic carcinoma。

Abstract：Background Many studies have suggested that angiotensin II (Ang II) and its receptors may be involved in the development of asthma.However,the expression of angiotensin II receptors (AGTR) is not clear in the lung tissue of chronic asthmatics.This study was designed to determine the relationship between airway remodeling,dysfunction and the expression of AGTRs in a rat model of asthma.Methods Rats were sensitized with ovalbumin (OVA) for 2 weeks.Sixty minutes before an inhalation challenge,the rats challenge for 30 alternative days.Acetylcholine (Ach)-induced bronchoconstriction was measured after the final antigen challenge.White cell counts in bronchoalveolar lavage fluid (BALF) and morphological changes in the airways were then assessed.The levels of transforming growth factor-beta 1 (TGF-β1) and platelet-derived growth factor (PDGF) in BALF were detected by ELISA.The levels of AGTR1 and AGTR2 mRNA and protein in lung tissues were measured by RT-PCR and Western blotting.Results AGTR1 mRNA and protein levels in repeatedly OVA-challenged rats were significantly increased as compared with negative controls.The AGTR1 mRNA expression versus white cell counts of BALF and airway wall thickness (mainly in small airways) in lungs of chronic antigen-exposed rats were positively correlated.Valsartan decreased the level of AGTR1 in repeatedly OVA-challenged rats.However,AGTR2 mRNA and protein levels in the OVA-challenged rats and accumulation and attenuated Ach-evoked bronchoconstriction in repeatedly antigen-challenged rats.Valsartan also decreased allergen-induced structural changes in rat airway (including total airway wall thickness and smooth muscle area) and the levels of TGF-β1 and PDGF in BALF.Conclusions AGTR1 expression is potentially associated with airway remodeling and dysfunction in asthma.Ang II and AGTR1 may participate in airway inflammation and airway remodeling of chronic antigen-exposed rats.Valsartan,a AGTR1 antagonist,could inhibit AGTR1 expression and partially inhibits structural airway changes as well as airway inflammation in chronic OVA-exposed rats。

Abstract：Background Tumstatin is a recently developed endogenous vascular endothelial growth inhibitor that can be applied as an anti-angiogenesis and antineoplastic agent.The study aimed to design and synthesize the small molecular angiogenesis inhibition-related peptide (peptide 21),to replicate the structural and functional features of the active zone of angiogenesis inhibition using tumstatin and to prove that synthesized peptide 21 has a similar activity:specifically inhibiting tumor angiogenesis like tumstatin.Methods Peptide 21 was designed and synthesized using biological engineering technology.To determine its biological action,the human umbilical vein endothelial cell line ECV304,the human ovarian cancer cell line SKOV-3 and the mouse embryo-derived NIH3T3 fibroblasts were used in in vitro experiments to determine the effect of peptide 21 on proliferation of the three cell lines using the MTT test and growth curves.Transmission electron microscopy (TEM) and flow cytometry (FCM) were applied to analyze the peptide 21-induced apoptosis of the three cell lines qualitatively and quantitatively.In animal experiments,tumor models in nude mice subcutaneously grafted with SKOV-3 were used to observe the effects of peptide 21 on tumor weight,size and microvessel density (MVD).To initially investigate the role of peptide 21,the effect of peptide 21 on the expression of vascular endothelial growth factors (VEGFs) by tumor tissue was semi-quantitatively analyzed.Results The in vitro MTT test and growth curves all indicated that cloned peptide 21 could specifically inhibit ECV304 proliferation in a dose-dependent manner (P ＜0.01);TEM and FCM showed that peptide 21 could specifically induce ECV304 apoptosis (P ＜0.01).Results of in vivo experiments showed that tumors in the peptide 21 group grew more slowly.The weight and size of the tumors after 21 days of treatment were smaller than those in the control group (P ＜0.05),with a mean tumor inhibition rate of 67.86%;MVD of the tumor tissue in the peptide 21 group was significantly lower than in the control group (P＜0.05);the number of cells positive for VEGF in the peptide 21 group was significantly fewer than in the control group (P ＜0.01).Conclusions Similar to the activity of tumstatin in specifically inhibiting tumor angiogenesis,peptide 21 may specifically inhibit tumor endothelial cell proliferation and induce their apoptosis,thereby suppressing tumor angiogenesis and indirectly inhibit the growth,infiltration and metastasis of tumors.Peptide 21 may exert its effect through down-regulating the VEGF expression of tumor cells and vascular endothelial cells。

Abstract：Background It is unclear whether a laser epithelial keratomileusis (LASEK) has any significant advantage over a photorefractive keratectomy (PRK) for correcting myopia.We undertook this meta-analysis of randomized controlled trials to examine possible differences in efficacy,accuracy,safety and side-effects between two methods,LASEK and PRK,for correcting myopia.Methods A systematic literature retrieval was conducted in the PubMed,EMBASE,Chinese Bio-medicine Database,and Cochrane Controlled Trials Register to identify potentially relevant randomized controlled trials.The statistical analysis was performed using a RevMan 4.2 software.The results included efficacy outcomes (proportion of eyes with uncorrected visual acuity (UCVA)≥ 20/20 at 1 month and 12 months post-treatment),accuracy outcomes (proportion of eyes within ±0.50 diopters (D) of target refraction at 1 month and 12 months post-treatment),safety outcomes (loss of ≥2 lines of best spectacle-corrected visual acuity (BSCVA) at ≥ 6 months post-treatment),mean pain scores on day 1 post-treatment,and mean corneal haze scores at 6 and 12 months post-treatment.Results Seven articles describing a total of 604 eyes with myopia from 0 to -9.0 D were identified in this meta-analysis.The combined results showed that the efficacy and accuracy outcomes between the two groups at 1 month and 12 months post-treatment were comparable.No patient lost ≥ 2 lines of BSCVA at ≥ 6 months post-treatment in four relevant trials.Compared with PRK,LASEK did not relieve discomfort on day 1 post-treatment or reduce corneal haze intensity at 6 and 12 months post-treatment.Conclusions According to the available data,LASEK does not appear to have any advantage over PRK for correcting myopia from 0 to -9.0 D.This meta-analysis focuses mainly on the comparison of the early,mid-term and mid-long term results of the two methods.Additional studies to compare the long-term (＞one year) results should be considered。

Coronary artery disease is the most common cardiovascular disease and constitutes the major cause of death in China.The interventional treatment of coronary artery disease has developed rapidly during the last decade,with the number of percutaneous coronary intervention (PCI) procedures being around 147 300 in the year of 2007.The number is expected to be elevated greatly in the coming years because of great improvement in national health care system and interventional expertise.This article reviews the current status of coronary intervention in China。

Men who have sex with men (MSM) are at high risk for infection with human immunodeficiency virus type 1 (HIV- 1) because of risk behaviors such as multiple partners and unprotected anal intercourse (UAI).Approximately 5% to 10% of all new HIV-1 infections are transmitted by male homosexual behaviors globally.1 The HIV epidemic in China is currently spreading from high risk groups to the general population.The high risk behaviors in MSM and the relatively large size of this population suggest that they have the potential to significantly contribute to an increasing HIV-1 epidemic in China.2 The latest HIV-1 estimates from China indicate that 11% of the approximately 700000 infected individuals were infected through homosexual transmission,which has increased from 7.3% in 2005。

Arsenic trioxide (AT) has a long history of use in both traditional Chinese medicine and in modern medicine in asthma therapy.Recently,Yin et al1 found that AT even at small doses reduced the airway inflammation of sensitized guinea pigs.However the mechanism underlying this is still largely unknown.Interleukin 13 (IL-13),as one of the important TH2 cytokines,plays an important role in asthma pathogenesis through promoting eosinophilic inflammation,mucus secretion and airway hyperresponsiveness.2 To further explore the molecular anti-inflammatory basis of AT,we employed Hut-78 cells,a human T cell line,with activation via CD3/CD28 receptors to mimick in vivo co-stimulation to investigate the effect of AT on IL-13 transcription。

Sub-hypothermia therapy is one of the treatments for patients with severe head injury.The objective of the therapy is to treat traumatic brain injury (TBI) by alleviating brain edema,protecting blood brain barrier (BBB),and preventing subsequent damage to neurons.It can protect brain function by depressing metabolism,reducing the release of excitatory amino acids and free radicals,reducing the level of lactic acid,and lowering the damage of cytoskeletal structure.1 However,sub-hypothemia may-affect patients' coagulatory function including amendment to hypercoagulation state or hyperfibrinolysis and platelet (PLT) functional disturbance.2,3 This study aimed to observe how sub-hypothermia therapy exerts effects on coagulopathy of patients after head injury。

Hepatic cancer is associated with very high mortality and morbidity,and the world's highest morbidity and mortality rates for this malignant tumor are found in China.Each year,the number of people who die of hepatic cancer in China amounts for 53% of the world total.1 Although resection is the first-choice treatment for hepatic cancer,only 20%-30% of patients have the opportunity to undergo resection.2 Transcatheter arterial chemoembolization (TACE) is a typical intervention therapy.Its advantages include minimal trauma,precise efficacy,and ease of administration.Consequently,it has become a widely used first-line treatment for patients who cannot undergo resection.Effective treatment planning and follow-up require an imaging method for evaluation of tumor response and detection of tumor recurrence.The objective of this study was to evaluate the efficacy of diffusion-weighted imaging (DWI)quantitative technique in identifying the composition of tissue after TACE,detecting remnant tumor after TACE,and detecting the sensitivity and specificity for recurrence by means of magnetic resonance imaging (MRI)。

Paget's disease of bone is a deforming bone disease (osteitis deformans) characterized by increased bone remodeling,bone hypertrophy,and abnormal bone structure,leading to bone expansion,deformities,easy fractures,and occasionally,neoplastic transformation.It is the second most common bone disorder after osteoporosis.1 The disease is relatively rare in Asia but is common in Europe and North America,affecting approximately 2% of the population over 50 years,although lately,a decline in the prevalence has been reported.2 Paget's disease commonly affects people in or past their middle age and is slightly more common in men than in women.1 The exact cause of Paget's disease is not known.Environmental agents,particularly paramyxoviral infections (measles and canine distemper viruses) have been postulated as potential etiological factors.3 Recently,a strong genetic component has been described,with candidate loci suggested at 18q,5q35-QTER,and particularly,the squestosome 1/p62.2,3 The pathological process in Paget's disease consists of one or more areas of aggressive and relentless osteoclastic activity,coupled with deposition of structurally abnormal excessive bone and matrix tissues.1,4 Most of the cases involve only one (monostotic) or few bones,particularly skull,vertebrae,pelvis,femur,and tibia。

The rationale for using albumin in the critically ill intensive care unit (ICU) patient showing hypoalbuminemia is to increase colloid oncotic pressure (COP) to prevent extravasation of fluid from the intra- to the extravascular space.Correction of low albumin plasma levels is also justified by the role of albumin for binding and transportation of drugs and for its possibly beneficial role as an oxygen radical scavenger.1 Hypoalbuminemic patients have been shown to have a higher morbidity and mortality compared with patients with normal serum albumin levels.2 A serum albumin level of ＜2.0 g/dl has been documented to be associated with a mortality of nearly 100%.3 We report a patient showing an albumin plasma level of ＜0.5 g/dl on admission in whom no human albumin (HA) has been given。

Pancreatic somatostatinoma represents a rare group of neuroendocrine tumors,which was first reported by Ganda and Larsson in 1977.Less than 50 cases have been reported to the present.We treated a case of pancreatic somatostatinoma at our hospital。

Aspergillus fumigatus infection is a clinically rare condition.Here we report a case of facial cutaneous Aspergillus fumigatus infection where the skin lesions gradually extended to the eyes forming corneal and conjunctival ulcers that developed to panophthalmia.Fungus cultures were repeatedly performed on specimen from the eyes and from skin lesions.Aspergillus fumigatus was the pathogen identified morphologically and molecular biologically。