Updates and advances in the concept of gallbladder cancer treatment / 中华外科杂志

The gallbladder is the most common site of tumor occurrence among biliary tract cancer. Gallbladder cancer accounts for approximately 0.6% of new cancers and 0.9% of cancer-related deaths. The risk factors identified for the development of gallbladder cancer include being female,>65 years of age, asymptomatic gallstone disease,and obesity. Surgical resection is the only curative treatment for early-stage gallbladder cancer, and some intermediate or advanced gallbladder cancers can be radically cured by extended resection. However, the extent of liver resection or lymph node dissection and whether to combine it with bile duct removal, revascularisation,and multiple organ resection remain somewhat controversial. After neoadjuvant treatment, up to a third of patients with locally advanced gallbladder cancer benefit from secondary surgical treatment. Only a small proportion of patients with gallbladder cancer at high risk for recurrence will benefit from postoperative adjuvant therapy. With the advent of different target-targeted drugs and the use of genetic tests in biliary tract cancer, targeted therapy and PD-1/PD-L1 inhibitors may become the new standard of care for gallbladder cancer and need to be further explored.

Clinical characteristics of 's acupuncture and moxibustion / 中国针灸

The clinical characteristics of -s acupuncture and moxibustion in the aspects of syndrome differentiation based on meridian and collateral and the techniques of acupuncture and moxibustion were explored by analyzing and summarizing -s clinical experience in acupuncture and moxibustion practice. - pointed out a compound symptoms with the three and three of hand and foot meridians, which enriches the connotation of the diagnosis and treatment on base of the meridian-collateral theory. In clinical practice, the therapeutic method with acupuncture and moxibustion is combined with herbal medicine. He believed that acupuncture is mostly used for reducing rather than reinforcing purpose. Hence, the bloodletting technique of acupuncture is commonly used. The moxibustion therapy is applicable for all of the conditions of deficiency, excess, cold and heat. In clinical practice, moxibustion is used for heat syndrome and acute syndrome by reducing heat, removing toxin and regaining consciousness. The timing of moxibustion should be considered specifically in the treatment for tonifying , generating , reducing heat and removing toxin. The unique characteristics of -s experience provide the reference for the clinical practice of acupuncture and moxibustion in the later generations.

Discrepancy between radiological and pathological sizes of renal masses / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the differences between tumor sizes measured by preoperative computed tomography (CT) imaging and pathologic examination of surgical specimens in Chinese patients who received extirpative surgery for renal tumors.</p><p><b>METHODS</b>From September 2008 to September 2010, 204 patients with renal tumors treated in the Renji Hospital were enrolled in this study, and their clinicopathological data were collected and analyzed. The paired Student's t-test was used to compare the mean radiological tumor maximum diameter and the mean pathological tumor maximum diameter. All cases in which post-operative down-staging or up-staging occurred due to the discrepancy between radiological and pathological tumor maximum diameters were identified. In addition, the relationship between radiological and pathological tumor maximum diameters and histological subtypes was analyzed.</p><p><b>RESULTS</b>Overall, the radiological mean maximum diameter of tumors on CT was 48.3 mm and the pathological mean maximum diameter was 47.0 mm. On average, CT overestimated pathological size by 1.3 mm (P = 0.018). CT overestimated pathological tumor size in 111 (54.4%) patients, underestimated in 71 (34.8%) patients and equal pathological size in 22 (10.8%) patients. Among the 190 patients with pT1 or pT2 tumors, there was a discrepancy between clinical and pathological staging in 35 (18.4%) patients. Of these, 29 (15.3%) patients were down-staged post-operatively and 6 (3.2%) were up-staged. When subjects were categorized according to radiographic tumor size associated with clinical stage, statistically significant difference (average of 1.76 mm) was observed between radiographic and pathologic maximum diameters ranging 41-70 mm (P = 0.035). For clear cell carcinoma, mean radiographic tumor maximum diameter was significantly larger than the pathologic maximum diameter by 1.69 mm (P = 0.003).</p><p><b>CONCLUSIONS</b>There is a statistically significant but small difference (1.3 mm) between mean radiological and mean pathological tumor maximum diameters. For some patients, this difference leads to a discrepancy between clinical and pathological staging, which may have implications on pre-operative clinical decision and prognosis prediction.</p>

Analysis of clinicopathological features and prognosis in 68 patients with chromophobe renal cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features and prognosis of chromophobe renal cell carcinoma (ChRCC).</p><p><b>METHODS</b>The clinical data of 68 ChRCC cases treated in our department between January 2003 and September 2010 were collected and retrospectively analyzed. The prognostic factors were evaluated by Log-rank test. Kaplan-Meier survival curve was used to estimate the survival rate.</p><p><b>RESULTS</b>Fifty cases were treated with radical nephrectomy and 18 with partial nephrectomy. The mean tumor size was 5.7 cm (1.5 - 16.0 cm). The TNM stages were as follows: pT1aN0M0 in 25, pT1bN0M0 in 22, pT2aN0M0 in 9, pT2bN0M0 in 5, and pT3aN0M0 in 7. According to the Fuhrman grading system, 8 patients were classified as grade I, 42 cases were grade II, 14 cases were grade III, and 4 cases were grade IV. The 3-year and 5-year survival rates were 93.0% and 90.0%, respectively. The log-rank test showed that tumor size (> 7 cm vs. ≤ 7 cm) (P = 0.004), TNM stage (T1-2 vs. T3-4) (P = 0.008) and urinary collecting system invasion (P = 0.024) were associated with survival time. The multivariable Cox regression model revealed that tumor size (> 7 cm vs. ≤ 7 cm) was an independent predictor of aggressive ChRCC (P = 0.038).</p><p><b>CONCLUSIONS</b>ChRCC is a distinct type of renal cell carcinoma exhibiting a low degree of malignancy. Most tumors are larger, but predominantly with a favorable prognosis. Fuhrman nuclear grading is not suitable for ChRCC. Tumor size (> 7 cm vs. ≤ 7 cm) is an independent predictor of prognosis of ChRCC.</p>

mRNA expression of chemokine receptors on peripheral blood mononuclear cells and correlation with clinical features in systemic lupus erythematosus patients / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the expressions of chemokine receptors and interleukin (IL) receptors on the peripheral blood mononuclear cells (PBMCs) from systemic lupus erythematosus (SLE) patients and their correlations with clinical features as well as SLE disease activity index (SLEDAI).</p><p><b>METHODS</b>The mRNA expressions of chemokine receptors and IL receptors on PBMCs of 93 SLE patients and 30 healthy controls were detected by reverse transcription-polymerase chain reaction, including CCR2, CCR3, CCR4, CCR5, CCR6, CCR8, CXCR3, CXCRS, CX3CR1, XCR1, IL-4R, and IL-10R. The clinical features of SLE patients were recorded. The correlations of chemokine receptors and IL receptors mRNA expressions with clinical features as well as SLEDAI were assayed using linear regression analysis.</p><p><b>RESULTS</b>The level of CCR5 mRNA in SLE patients (including active and inactive SLE) was significantly higher than that in healthy controls (P < 0.05), and there was no significant difference between active and inactive patients in this respect (P > 0.05). CX3CR1 mRNA expression significantly increased from healthy control to inactive SLE to active SLE in sequence. The others (except for CCR8, CXCR3, and IL-10R) in active SLE patients were significantly higher than those in both inactive SLE patients and healthy controls (all P < 0.05). There were positive correlations between SLEDAI and CCR2 (r = 0.424, t = 4.313, P < 0.001), CCR3 (r = 0.518, t = 5.410, P < 0.001), CCR4 (r = 0.376, t = 3.851, P < 0.001), CCR6 (r = 0.457, t = 4.513, P < 0.001), CXCR5 (r = 0.455, t = 4.629, P < 0.001), CX3CR1 (r = 0.445, t = 4.523, P < 0.001), as well as XCR1 (r = 0.540, t = 5.445, P < 0.001). And CCR5 mRNA expression level was positively correlated with IL-4R mRNA (r = 0.313, t = 2.353, P < 0.05). The patients with myositis and cutaneous vasculitis simultaneously showed lower levels of CCR5 and CX3CR1, and CCR5 expression was negatively correlated with the scores of SLEDAI in SLE cases accompanied by photosensitivity (r = 0.426, t = -2.155, P < 0.05).</p><p><b>CONCLUSION</b>Increased expressions of CCR5 and CX3CR1 on PBMCs may be indicators in clinical survey for SLE.</p>

Combination of tamsulosin and tolterodine alleviates refractory lower urinary tract symptoms in male patients / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate and compare the clinical efficacy and safety of the highly selective alpha receptor antagonist tamsulosin and its combination with the M receptor antagonist tolterodine in the treatment of refractory lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH).</p><p><b>METHODS</b>We included in this study 184 BPH patients with refractory LUTS with the disease course of 4 weeks to 2 years, whose LUTS were not alleviated after a week's treatment with tamsulosin. The patients were randomly divided into Groups A and B, the former (n=89) treated with tamsulosin at 0.2 mg qd and the latter (n=95) given tolterodine at 2 mg bid in addition to tamsulosin medication, both for 4 weeks. Scores on IPSS, QOL and Qmax were obtained before and after the treatment, and the improvement of LUTS evaluated after the medication.</p><p><b>RESULTS</b>The tamsulosin group showed no significant differences before and after the treatment in the scores on IPSS (13.23 +/- 4.39 vs. 12.21 +/- 4.07), QOL (4.23 +/- 1.27 vs 3.53 +/- 0.95) and Qmax ([12.3 +/- 8.39] ml/s vs. [14.1 +/- 8.62] mls) (P > 0.05), while the combination group exhibited significantly higher scores on IPSS and QOL and lower score on Qmax after the medication than before it (IPSS: 14.45 +/- 5.31 vs. 6.56 +/- 2.03, P < 0.05; QOL: 4.45 +/- 0.79 vs. 2.34 +/- 0.73, P < 0.05; Qmax: [11.4 +/- 9.21] ml/s vs. [15.5 +/- 8.35] ml/s, P < 0.01). No severe complications were found in any of the cases.</p><p><b>CONCLUSION</b>Combination of tamsulosin and tolterodine can significantly alleviate refractory LUTS and improve QOL without causing serious adverse events in BPH patients.</p>

Study on original meaning and application of "Gen, Liu, Zhu, Ru" / 中国针灸

To probe into the original meaning and clinical application of "Gen, Liu, Zhu, Ru" in Miraculous Pivot * Genjie, based on Huangdi's Internal Classic and other opinions of annotation experts of successive dynasties, deeply analyze and study. The results indicate that two characteristics of "Gen, Liu, Zhu, Ru": similar to Maikou (the position to feel pulse in ancient Chinese medical classics); closely related to blood collaterals. It is suggested that "Gen, Liu, Zhu, Ru" can be used to diagnose disorder of meridians, and to treat the excess syndrome of meridians and collaterals with reducing method, including bleeding method.

Juvenile psoriatic arthritis / 中国当代儿科杂志

A case of juvenile psoriatic arthritis in a 12 year-old boy was reported. The patient had a history of one and half a year of bilateral heel pain, followed by pain in the right knee and ankle and right hip joint. He developed psoriatic lesions affecting his nails and skin. He had increased erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) contents. Human leukocyte antigen (HLA) B27 was detected but serum rheumatoid factor was not in the patient. A skin biopsy revealed psoriasis and ultrasonography demonstrated synovitis in right knee and ankle. Juvenile psoriatic arthritis was diagnosed based on his physical, laboratory and skin biopsy findings. A treatment with nonsteroidal anti-inflammatory drugs and sulfasalazine produced no effect. Leflunomide in conjunction with anti-TNF biologic agents (Etanercept) was administered, followed by symptomatic improvement 2 weeks later.

Germ line mutations in Chinese kindreds with von Hippel-Lindau syndrome / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To investigate the germ line mutations in Chinese kindreds with von Hippel-Lindau syndrome (VHL) and to explore its role in clinical management.</p><p><b>METHODS</b>The clinical and familial data were reviewed from 6 Chinese kindreds with VHL, of which the VHL germ line mutation in 21 members was analysed by polymerase chain reaction and sequencing analysis.</p><p><b>RESULTS</b>Among 6 kindreds, there were 5 type I and 1 type IIA. The germ line mutations consisted of 4 missense mutations, 1 nonsense mutation and 1 deletion, of which 4 mutations existed in exon 1, 1 in exon 2 and 1 in exon 3. Of the 21 members who volunteered for genetic analysis, 14 members presented the VHL germ line mutations, including 10 affected patients, 1 suspected patients and 3 carriers.</p><p><b>CONCLUSION</b>The germ line mutations in Chinese kindreds with VHL could be dominant in exon 1. It plays an important role in early detection of asymptomatic patients and the carriers, in the diagnosis of VHL and the clinical screening for members in the VHL families.</p>

Clinical analysis of radical retropubic prostatectomy: a report of 132 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of radical retropubic prostatectomy (RRP) and the multi-factors which influence on the prognosis and long life quality.</p><p><b>METHODS</b>From January 1993 to March 2005, 132 cases radical retropubic prostatectomy were performed. The patients were divided into 2 groups: the early group and recent group. Eleven items in peri-operative time and follow up results were analysed. The erection function of 78 cases were investigated with international index of erectile function 5 score. In these patients, nocturnal electrobioimpedance volumetric assessment (NEVA) were observe in 19 cases.</p><p><b>RESULTS</b>Comparing of the 2 groups, the index connected with operative skill changed to optimization. No one died of prostate cancer in 63 follow up patients. Nine cases showed biochemical failure with criterion as prostate specific antigen > 0.4 microg/L. Fifty patients passed urine normal post-operation in 6 months. Eight patients had stress incontinence and 5 had entire incontinence at 6 month. Four patients had vesical neck stricture. Another follow up result shows 33 (58.9%) erection function recovered in 55 bilateral nerve-sparing operation and 7 recovered in 22 of unilateral nerve-sparing operation. NEVA shows 14 cases with artery supply insufficient in whom 4 regained erection function and 5 cases vein leakage in whom no one recovered.</p><p><b>CONCLUSIONS</b>The radical retropubic prostatectomy remains the procedure of choice for the cure of localized prostatic cancer. The keys for the operation are anatomic dissection, preservation of the neurovascular bundle and good skill. These are also important for a good life quality for the patients.</p>