BACKGROUND & AIMS: :Fludarabine and alemtuzumab are routinely used for treatment of B-cell chronic lymphocytic leukemia (B-CLL). The present study aimed to compare the expression of signaling molecules and cytokine production by T cells of B-CLL patients in long-term unmaintained remission/plateau phase following fludarabine or alemtuzumab treatment with that of indolent/untreated B-CLL patients and healthy donors. The frequency and intensity of TCR-CD3zeta chain, p56lck, p59fyn, ZAP-70, PI3-kinase and interferon (IFN)-gamma/interleukin (IL)-4 production in CD4 and CD8 T cells was examined by flow cytometry. T-cell function was assessed by stimulation with purified protein derivative (PPD) and phytohemagglutinin (PHA). Despite a reduction in number, the expression of IFN-gamma/IL-4 in T-cells in patients was significantly higher than in healthy donors. The intensity of most signaling molecules in treated patients was relatively unaffected vs. healthy donors but lower than untreated-indolent patients. However, the total number of T cells which expressed each of the signaling molecules was decreased in patients, with no difference between fludarabine- and alemtuzumab-treated patients. The T-cell response to PHA but not PPD was reduced in treated patients. The results suggest that, despite some alterations in signaling molecules and a reduction in T-cell number, overall T-cell functions may be relatively well preserved long-term after treatment with fludarabine and alemtuzumab.

背景与目标： : 氟达拉滨和阿仑单抗通常用于治疗b细胞慢性淋巴细胞白血病 (b-cll)。本研究旨在比较在氟达拉滨或阿仑单抗治疗后长期未维持缓解/平台期的b-cll患者的T细胞与惰性/未治疗的b-cll患者和健康的T细胞的信号分子表达和细胞因子产生供体。通过流式细胞术检查CD4和CD8 T细胞中TCR-CD3zeta链，p56lck，p59fyn，ZAP-70，PI3-kinase和干扰素 (IFN)-γ/白细胞介素 (IL)-4产生的频率和强度。通过纯化蛋白衍生物 (PPD) 和植物血凝素 (PHA) 刺激来评估T细胞功能。尽管数量减少，但患者T细胞中IFN-γ/IL-4的表达显着高于健康供体。与健康供体相比，接受治疗的患者中大多数信号分子的强度相对不受影响，但低于未经治疗的惰性患者。然而，在患者中表达每种信号分子的T细胞总数减少，而氟达拉滨和阿仑单抗治疗的患者之间没有差异。在治疗的患者中，T细胞对PHA的反应降低，但对PPD的反应降低。结果表明，尽管信号分子发生了一些变化，T细胞数量减少，但在用氟达拉滨和阿仑单抗治疗后，总体T细胞功能可能长期保持良好。

BACKGROUND & AIMS: :The failure of lesioned axons to regenerate over long distances in the mammalian central nervous system (CNS) is not due to an inability of central neurons to regenerate, but rather to the non-permissive nature of the CNS tissue environment. Regenerating CNS axons, which grow well within a peripheral nerve, for example, fail to penetrate mature CNS tissue by more than about 1 mm. Recent evidence indicates that this may be due to inhibitory membrane proteins associated with CNS oligodendrocytes and myelin. We report here that human telencephalic neuroblasts implanted into the excitotoxically lesioned striatum of adult rats can escape or neutralize this inhibitory influence of the adult CNS environment and extend axons along major myelinated fibre tracts for distances of up to approximately 20 mm. The axons were seen to elongate along the paths of the striato-nigral and cortico-spinal tracts to reach the substantia nigra, the pontine nuclei and the cervical spinal cord, which are the normal targets for the striatal and cortical projection neurons likely to be present in these implants.

背景与目标： : 受损的轴突在哺乳动物中枢神经系统 (CNS) 中无法长距离再生不是由于中枢神经元无法再生，而是由于CNS组织环境的非宽松性质。例如，在周围神经内良好生长的再生CNS轴突不能穿透成熟的CNS组织超过约1毫米。最近的证据表明，这可能是由于与CNS少突胶质细胞和髓磷脂相关的抑制性膜蛋白所致。我们在此报告，植入成年大鼠兴奋性毒性病变纹状体的人类端脑神经母细胞可以逃避或中和成年CNS环境的这种抑制作用，并沿主要有髓纤维束延伸轴突，距离可达约20毫米。可以看到轴突沿着纹状体-黑质和皮质-脊髓束的路径伸长，到达黑质，桥脑核和颈脊髓，这是纹状体和皮质投射神经元的正常目标。这些植入物。

BACKGROUND & AIMS: PURPOSE:Making good consumer decisions requires having good information. This study compared long-term-care recommendations among various types of health professionals. DESIGN AND METHODS:We gave randomly varied scenarios to a convenience national sample of 211 professionals from varying disciplines and work locations. For each scenario, we asked the professional to recommend the appropriate forms of long-term care. RESULTS:Although the professional respondents used the full spectrum of options offered to them, some professionals tended to favor the sector they worked in. Advanced practice nurses recommended day care and homemaking more and adult foster care less. Gerontologists used skilled nursing-facility placement more actively and rehabilitation, homemaking, and home health care less actively. Geriatricians and primary care physicians both favored rehabilitation and skilled nursing-facility care and were both less enthusiastic about assisted living, homemaking, and informal care, but the geriatricians favored day care more than did the primary care physicians. Registered nurses were highly supportive of assisted living, adult foster care, homemaking, and home health care, and they opposed skilled nursing-facility care. Social workers were less likely than other participants to endorse rehabilitation and adult foster care. IMPLICATIONS:Because consumer preference should be a major factor in making long-term-care decisions, many consumers need information about what options may best fit their situation. In the absence of empirical data on which types of long-term care work best for whom, consumers have to rely on expert judgment-but that judgment varies. Clients should be aware that an expert's background (as defined by discipline and work situation) may affect his or her recommendations. Each discipline appears to have its own set of experiences and beliefs that may influence recommendations.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:The combination of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABA) is recommended by treatment guidelines for the treatment of persistent asthma. Two such combination products, salmeterol/fluticasone propionate (SFC, Seretide GSK, UK) and formoterol/budesonide (FBC, Symbicort, AstraZeneca, UK) are commercially available. OBJECTIVES:The purpose of these studies was to evaluate and compare the duration of bronchodilation of both combination products up to 24 hours after a single dose. METHODS:Two randomised, double blind, placebo-controlled, crossover studies were performed. Study A was conducted in 33 asthmatic adults receiving 400-1200 mcg of budesonide or equivalent. Serial forced expiratory volume in one second (FEV1) was measured over 24 hours to determine the duration of effect of both SFC (50/100 mcg) and FBC (4.5/160 mcg). Study B was conducted in 75 asthmatic adults receiving 800-1200 mcg of budesonide or equivalent and comprised a 4 week run-in of 400 mcg bd Becotide followed by 4 weeks treatment with either SFC 50/100 mcg bd or FBC 4.5/160 mcg bd taken in a cross-over manner. Serial 24-hour FEV1 was measured after the first dose and the last dose after each 4-weeks treatment period to determine the offset of action of each treatment. RESULTS:In study A, a single inhalation of SFC and FBC produced a sustained bronchodilation at 16 hours with an adjusted mean increase in FEV1 from pre-dose of 0.22 L (95% CI 0.19, 0.35 L) for SFC and 0.25 L (95% CI 0.21, 0.37 L) for FBC, which was significantly greater than placebo for both treatments (-0.05 L; p < 0.001). In study B, the slope of decline in FEV1 from 2-24 hours post dose was -16.0 ml/hr for SFC and -14.2 ml/hr for FBC. The weighted mean AUC over 24 hours was 0.21 Lxmin and 0.22 Lxmin and mean change from pre-dose FEV1 at 12 hours was 0.21 L for SFC and 0.20 L for FBC respectively CONCLUSION:Both SFC and FBC produced a similar sustained bronchodilator effect which was prolonged beyond 12 hours post dose and was clearly measurable at 24 h.

背景与目标：

BACKGROUND & AIMS: :Like other thalamic nuclei, the primate pulvinar is considered not to have long-range intrinsic connections, either excitatory or inhibitory. Injections of biotinylated dextran amine (BDA) in the medial pulvinar, however, reveal retrogradely filled neurons up to 2.0 mm from the injection edge. Serial section reconstruction (n = 18) confirmed that retrogradely filled neurons projected to the injection site and showed that they had additional long-range collaterals within the posterior pulvinar. Arrays of small, beaded terminations occurred in multiple foci along the collaterals. Terminal arrays were up to 1.0 mm in length; foci were separated by about 0.7 mm. Somata were large (average area = 220 microm2), and dendritic arbors were radiate and also large (about 1.0 mm in diameter), but without either the appendages of classical interneurons or the hairlike spines characteristic of radiate pulvinocortical projection neurons. Double labeling for BDA and parvalbumin (PV) or BDA and gamma-aminobutyric acid (GABA) indicated that these large neurons were positive for both PV and GABA. Double labeling for PV and GABA, or PV and glutamic acid decarboxylase 67 (GAD67) revealed a small number of similarly large neurons in the posterior pulvinar that were positive for both substances. Thus, we propose that these neurons are a novel class of inhibitory interneuron, longer range than the classic thalamic local circuit interneurons. Future questions include how these neurons relate to other inhibitory systems and specific postsynaptic populations and whether they are located preferentially within the posterior pulvinar, possibly related to the multimodal character of this thalamic region.

背景与目标： : 与其他丘脑核一样，灵长类脉冲被认为不具有兴奋性或抑制性的远距离内在联系。然而，在内侧髓中注射生物素化的葡聚糖胺 (BDA) 显示出从注射边缘到2.0毫米的逆行填充的神经元。连续切片重建 (n = 18) 证实，逆行填充的神经元投射到注射部位，并显示它们在后牙髓内有其他远距离侧支。沿侧支的多个病灶中出现了一系列小的串珠末端。末端阵列的长度可达1.0毫米; 病灶间隔约0.7毫米。躯体很大 (平均面积 = 220 microm2)，树突状乔木辐射且也很大 (直径约1.0毫米)，但没有经典中间神经元的附属物或辐射的皮质投射神经元的毛状刺特征。BDA和小白蛋白 (PV) 或BDA和 γ-氨基丁酸 (GABA) 的双重标记表明，这些大神经元对PV和GABA均为阳性。对PV和GABA或PV和谷氨酸脱羧酶67 (GAD67) 的双重标记显示，后牙髓中少量类似的大神经元对两种物质均呈阳性。因此，我们建议这些神经元是一类新型的抑制性中间神经元，其范围比经典的丘脑局部电路中间神经元更长。未来的问题包括这些神经元与其他抑制系统和特定的突触后种群之间的关系，以及它们是否优先位于后牙髓内，这可能与该丘脑区域的多模式特征有关。

BACKGROUND & AIMS: :A number of groups have developed libraries of siRNAs to identify genes through functional genomics. While these studies have validated the approach of making functional RNAi libraries to understand fundamental cellular mechanisms, they require information and knowledge of existing sequences since the RNAi sequences are generated synthetically. An alternative strategy would be to create an RNAi library from cDNA. Unfortunately, the complexity of such a library of siRNAs would make screening difficult. To reduce the complexity, longer dsRNAs could be used; however, concerns of induction of the interferon response and off-target effects of long dsRNAs have prevented their use. As a first step in creating such libraries, long dsRNA was expressed in mammalian cells. The 250 nt dsRNAs were capable of efficiently silencing a luciferase reporter gene that was stably transfected in MDA-MB-231 cells without inducing the interferon response or off-target effects any more than reported for siRNAs. In addition, a long dsRNA expressed in the same cell line was capable of silencing endogenous c-met expression and inhibited cell migration, whereas the dsRNA against luciferase had no effect on c-met or cell migration. The studies suggest that large dsRNA libraries are feasible and that functional selection of genes will be possible.

背景与目标： : 许多小组已经开发了sirna文库，以通过功能基因组学鉴定基因。尽管这些研究已经验证了制作功能性RNAi文库以了解基本细胞机制的方法，但由于RNAi序列是合成生成的，因此它们需要现有序列的信息和知识。另一种策略是从cDNA创建RNAi文库。不幸的是，复杂性的文库sirna将筛选困难.为了降低复杂性，可以使用更长的dsrna; 然而，对干扰素反应的诱导和长dsrna的脱靶效应的担忧阻止了它们的使用。作为创建此类文库的第一步，长dsRNA在哺乳动物细胞中表达。250 nt dsrna能够有效地沉默在MDA-MB-231细胞中稳定转染的荧光素酶报告基因，而不会比sirna所报道的更多诱导干扰素应答或脱靶效应。此外，在同一细胞系中表达的长dsRNA能够沉默内源性c-met表达并抑制细胞迁移，而针对荧光素酶的dsRNA对c-met或细胞迁移没有影响。研究表明，大型dsRNA文库是可行的，并且基因的功能选择将是可能的。

BACKGROUND & AIMS: -2

背景与目标： -2

BACKGROUND & AIMS: The clinical outcome of treatment using conical crown-retained dentures was evaluated. Of the initial 25 patients provided with 26 conical crown-retained dentures, 18 patients with 18 restorations could be examined after a time ranging between 73 and 92 months. Of the eight restorations lost, four had been changed as a result of factors that might have been related to the prosthodontic care. Most of the patients were very satisfied with the restorations both functionally and esthetically and found their chewing comfort to be better after treatment with conical crown-retained dentures. However, 50% of the patients reported speech problems related to treatment. Technical failures were not insignificant but were treatable. The survival rate after 73 to 92 months was 78.3%.

背景与目标： 评估了使用锥形冠保留义齿治疗的临床结果。在最初提供26个圆锥形冠保留义齿的25例患者中，可以在73至92个月的时间内检查18例具有18个修复体的患者。在丢失的八个修复物中，有四个由于可能与口腔修复有关的因素而被更改。大多数患者在功能和美学上都对修复体感到非常满意，并发现在使用圆锥形冠保留义齿治疗后，其咀嚼舒适度更好。然而，50% 患者报告了与治疗相关的言语问题。技术故障并非微不足道，但可以治愈。73 ~ 92个月后的生存率为78.3%。

BACKGROUND & AIMS: Etoposide produces reversible inhibition of topoisomerase II, leading to cleavage of DNA, and thereby has an antitumor effect. This mechanism suggests that the longer treatment is continued, the greater the antitumor effect will be. In the present study, both therapeutic and adverse effects of long-term treatment with low-dose oral etoposide were studied in 29 patients aged > or = 65 years with non-Hodgkin's lymphoma (NHL) for whom standard chemotherapy was not effective or refractory. These patients received etoposide at a dose of 50 mg/d for as long as possible. Treatment was continued until white blood cell count decreased to < or = 2,000/microL or the platelet count decreased to < or = 5 x 10(4)/microL. According to the World Health Organization (WHO) criteria of therapeutic effects, 6 (20.7%) of the 29 patients achieved complete remission and 13 patients (44.8%) had partial remission, for a response rate of 65.5%. Adverse effects of > or = grade 3 included leukopenia in 24 patients (82.8%) and anemia in 7 (24.1%). Granulocyte colony-stimulating factor (G-CSF) was given in combination with etoposide to eight patients because of leukopenia (granulocyte count < or = 1,000/microL). In view of the excellent subjective tolerance, low incidence of serious adverse effects, and good activity, single agent oral etoposide given continuously over prolonged periods represents a useful treatment for elderly patients with NHL.

背景与目标： 依托泊苷产生拓扑异构酶II的可逆抑制，导致DNA裂解，从而具有抗肿瘤作用。这种机制表明，持续治疗的时间越长，抗肿瘤作用就越大。在本研究中，对29例年龄> 或 = 65岁的非霍奇金淋巴瘤 (NHL) 患者进行了低剂量口服依托泊苷长期治疗的治疗和不良反应的研究，这些患者的标准化疗无效或难治性。这些患者尽可能长时间地接受依托泊苷50 mg/d的剂量。继续治疗直到白细胞计数降低至 <或 = 2,000/microL或血小板计数降低至 <或 = 5 × 10(4)/microL。根据治疗效果的世卫组织标准，29例患者中有6例 (20.7% 例) 完全缓解，13例 (44.8% 例) 部分缓解，缓解率为65.5%。> or = 3级的不良反应包括白细胞减少24例 (82.8%) 和贫血7例 (24.1%)。由于白细胞减少 (粒细胞计数 <或 = 1,000/microL)，将八名患者与依托泊苷联合给予粒细胞集落刺激因子 (g-csf)。鉴于其良好的主观耐受性，低的严重不良反应发生率和良好的活性，长期连续给予单药口服依托泊苷代表了对老年NHL患者的有用治疗。

BACKGROUND & AIMS: OBJECTIVE:The authors' goal was to test the hypothesis that the antidepressant effect of total sleep deprivation can be maintained by initially avoiding sleep during a supposedly "critical" time period in the early morning.

METHOD:They studied 33 inpatients with major depression, melancholic type, all of whom responded positively to total sleep deprivation. Twelve of the patients were men and 21 were women; their mean age was 46.7 years (SD = 13.7). After total sleep deprivation, the patients started a sleep schedule from 5:00 p.m. to 12:00 midnight, which then was shifted back by 1 hour each day until a sleep time of 11:00 p.m. to 6:00 a.m. was reached.

RESULTS:Twenty (61%) of the 33 patients who responded to total sleep deprivation with an improved state of mood maintained this improvement during sleep phase advance therapy. Drug-free and medicated patients did not differ from each other.

CONCLUSIONS:The rapid amelioration of mood observed with total sleep deprivation can be preserved with a succeeding phase shift of the sleep period.

背景与目标： 目的 : 作者的目标是检验以下假设: 完全睡眠剥夺的抗抑郁作用可以通过最初在清晨的一个所谓的 “关键” 时期避免睡眠来维持。
方法 : 他们研究了33名患有抑郁症，忧郁型的住院患者，他们都对完全睡眠不足有积极的反应。12名患者为男性，21名患者为女性; 他们的平均年龄为46.7岁 (SD = 13.7)。完全睡眠剥夺后，患者开始从下午5:00到午夜12:00的睡眠计划，然后每天向后转移1小时，直到达到下午11:00上午6:00的睡眠时间。
结果 : 33名对完全睡眠剥夺有改善的情绪状态有反应的患者中有20名 (61% 名) 在睡眠阶段提前治疗期间保持了这种改善。无药物和药物治疗的患者彼此之间没有差异。
结论 : 完全睡眠剥夺所观察到的情绪迅速改善可以通过睡眠期的后续相移来保持。

BACKGROUND & AIMS: CONTEXT:Chronic pain in patients with advanced cancer poses a serious clinical challenge. The Δ9-tetrahydrocannabinol (THC)/cannabidiol (CBD) oromucosal spray (U.S. Adopted Name, nabiximols; Sativex(®)) is a novel cannabinoid formulation currently undergoing investigation as an adjuvant therapy for this treatment group. OBJECTIVES:This follow-up study investigated the long-term safety and tolerability of THC/CBD spray and THC spray in relieving pain in patients with advanced cancer. METHODS:In total, 43 patients with cancer-related pain experiencing inadequate analgesia despite chronic opioid dosing, who had participated in a previous three-arm (THC/CBD spray, THC spray, or placebo), two-week parent randomized controlled trial, entered this open-label, multicenter, follow-up study. Patients self-titrated THC/CBD spray (n=39) or THC spray (n=4) to symptom relief or maximum dose and were regularly reviewed for safety, tolerability, and evidence of clinical benefit. RESULTS:The efficacy end point of change from baseline in mean Brief Pain Inventory-Short Form scores for "pain severity" and "worst pain" domains showed a decrease (i.e., improvement) at each visit in the THC/CBD spray patients. Similarly, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 scores showed a decrease (i.e., improvement) from baseline in the domains of insomnia, pain, and fatigue. No new safety concerns associated with the extended use of THC/CBD spray arose from this study. CONCLUSION:This study showed that the long-term use of THC/CBD spray was generally well tolerated, with no evidence of a loss of effect for the relief of cancer-related pain with long-term use. Furthermore, patients who kept using the study medication did not seek to increase their dose of this or other pain-relieving medication over time, suggesting that the adjuvant use of cannabinoids in cancer-related pain could provide useful benefit.

背景与目标：

BACKGROUND & AIMS: :The transection of the inferior alveolar nerve (IANx) produces allodynia in the whisker pad (V2 division) of rats. Ectopic discharges from injured trigeminal ganglion (TG) neurons and thalamocortical reorganization are possible contributors to the sensitization of uninjured V2 primary and CNS neurons. To test which factor is more important, TG and ventroposterior medial nucleus (VPM) neurons were longitudinally followed before, during, and after IANx for up to 80 d. Spontaneous discharges and mechanical stimulation-evoked responses were recorded in conscious and in anesthetized states. Results show (1) a sequential increase in spontaneous activities, first in the injured TG neurons of the IAN (2-30 d), followed by uninjured V2 ganglion neurons (6-30 d), and then VPM V2 neurons (7-30 d) after IANx; (2) ectopic discharges included burst and regular firing patterns in the IAN and V2 branches of the TG neurons; and (3) the receptive field expanded, the modality shifted, and long-lasting after-discharges occurred only in VPM V2 neurons. All of these changes appeared in the late or maintenance phase (7-30 d) and disappeared during the recovery phase (40-60 d). These observations suggest that ectopic barrages in the injured IAN contribute more to the development of sensitization, whereas the modality shift and evoked after-discharges in the VPM thalamic neurons contribute more to the maintenance phase of allodynia by redirecting tactile information to the cortex as nociceptive.

背景与目标： : 下牙槽神经 (IANx) 的横切在大鼠的晶须垫 (V2分区) 中产生异常性疼痛。受损的三叉神经节 (TG) 神经元的异位放电和丘脑皮层重组可能是未受损的V2初级和CNS神经元致敏的原因。为了测试哪个因素更重要，在IANx之前，期间和之后纵向跟踪TG和腹后内侧核 (VPM) 神经元长达80 d。在有意识和麻醉状态下记录自发放电和机械刺激诱发反应。结果表明 (1) 自发活动依次增加，首先是IAN损伤的TG神经元 (2-30 d)，其次是未损伤的V2神经节神经元 (6-30 d)，然后是VPM V2神经元 (7-30 d)。IANx后的d); (2) 异位放电包括TG神经元的IAN和V2分支中的爆发和规则放电模式; (3) 感受野扩大，模态改变，并且仅在VPM V2神经元中发生持久的放电。所有这些变化都出现在后期或维护阶段 (7-30 d)，并在恢复阶段 (40-60 d) 消失。这些观察结果表明，受伤的IAN的异位弹幕对敏化的发展做出了更大的贡献，而VPM丘脑神经元的模态变化和诱发的放电后放电通过将触觉信息重定向到皮层作为伤害性，对异常性疼痛的维持阶段做出了更大的贡献。

BACKGROUND & AIMS: PURPOSE:To identify risk factors for corneal graft rejection and rejection irreversibility. DESIGN:Retrospective cohort study. METHODS:setting: Institutional. patients: A total of 1438 consecutive eyes of 1438 patients who underwent corneal transplantation for optical indication at the Centre Hospitalier National d'Ophtalmologie des XV-XX, Paris, France, between December 1992 and December 2010 were studied. Surgical technique was penetrating keratoplasty (PK) in 1209 cases, anterior lamellar keratoplasty (ALK) in 165 cases, and Descemet stripping with endothelial keratoplasty in 64 cases. main outcome measures: Cumulative incidence of rejection episodes and rejection irreversibility rate. RESULTS:A total of 299 cases of rejection episodes were identified, of which 145 (48.5%) were irreversible after treatment. In multivariate analysis, the cumulative incidence of rejection episodes was influenced by recipient age (P = .00002), recipient rejection risk (P = .0003), lens status (P = .00003), and surgical group (P = .035). A higher incidence of rejection episodes was observed in young patients (<20 years) and patients aged from 41 to 50, high-risk recipients, aphakic eyes and eyes with anterior chamber intraocular lens, and eyes with PK (compared with eyes with ALK). Rejection episodes were more likely to be irreversible for high-risk recipients (P = .02), for eyes with preoperative hypertony (P = .009), and for eyes with poor visual acuity at presentation (P = .002). CONCLUSIONS:Recipient rejection risk and surgical group are the main risk factors for rejection as they both influence the incidence of rejection and the reversibility rate. Recipient age and lens status are predictive factors for the occurrence of rejection. Preoperative hypertony is a predictive factor for rejection irreversibility.

背景与目标：

BACKGROUND & AIMS: :Leiomyosarcoma of the innominate vein is a rare but usually lethal disease. We report the case of a 50-year-old woman, undergoing a curative resection of the tumor. She is alive and free of disease at 88-month follow-up. Surgical excision remains the current optimal treatment able to provide a chance of cure. KEY WORDS: Late survival, Venous leiomyosarcoma.

背景与目标： : 无名静脉平滑肌肉瘤是一种罕见但通常致命的疾病。我们报告了一名50岁的女性，正在接受肿瘤的根治性切除。在88个月的随访中，她还活着并且没有疾病。手术切除仍然是目前能够提供治愈机会的最佳治疗方法。关键词: 晚期生存，静脉平滑肌肉瘤。

BACKGROUND & AIMS: AIM:There is still no consensus about the optimal surgical approach for esophageal replacement in the case of long-gap esophageal atresia (LGEA) or extensive corrosive strictures. The aim of this article was to perform a meta-analysis comparing the most widely used techniques for esophageal replacement in children: jejunal interposition (JI), colon interposition (CI), and gastric pull-up (GPU). METHODS:Review of the English-language literature published in the past 5 years about esophageal replacement in children was done. The focus was on postoperative survival rate, morbidity (gastrointestinal complications such as anastomotic stenosis/leakage and respiratory complications such as pneumothorax, pneumonia, and atelectasis), and long-term follow-up when available. Among long-term gastrointestinal outcomes were dysphagia, reflux, and dumping; among long-term respiratory outcomes were recurrent pneumonia and recurrent aspiration leading to chronic lung disease. Data were computed by Comprehensive Meta-Analysis software (Version 2.2.064). MAIN RESULTS:A total of 15 studies (4 comparative retrospective, 8 retrospective, and 3 prospective) including 470 patients (264 LGEA) were identified; 344 (73%) patients underwent CI, 99 (21%) GPU, and 27 (6%) JI. Among these 15 studies, 9 provided data about long-term follow-up. CONCLUSION:Proper prospective comparative studies are lacking. GPU and CI appear comparable regarding postoperative mortality, anastomotic complications, and graft loss. On the long-term, GPU seems to be associated with a higher respiratory morbidity but fewer gastrointestinal complications than CI. Based on this article only two series provide data about JI, and they show highly divergent results. JI appears to be a valid replacement technique when performed by experienced centers; however larger numbers are needed to assess the outcomes of this procedure.

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