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Sarcomatoid renal cell carcinoma is a highly malignant tumor with sarcomatoid dedifferentiation, which has rapid progression, high mortality rate and poor prognosis. Studies have shown that cytoreductive surgery, chemotherapy or targeted therapy are not effective to patients with advanced sarcomatoid renal cell carcinoma. With the further study of pathogenesis and molecular biological characteristics of sarcomatoid renal cell carcinoma, it is found that the expression levels of PD-1 and PD-L1 in it are higher than those of other subtypes, so the combination of immune checkpoint inhibitors and immunotherapy combined with targeted therapy have become the first-line therapy. This article mainly reviews the latest treatments for advanced sarcomatoid renal cell carcinoma, including surgery, chemotherapy, targeted drugs, immunotherapy and so on.
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Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare subtype of pulmonary malignant tumors, accounting for
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Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders characterized by social communication disorders,narrow interest and repetitive behavior,which has an early childhood onset,resulting in high disability.The etiology of autism spectrum disorder is unknown and the prognosis is poor.There is no specific medication at present.Early diagnosis and intervention can improve the symptoms and prognosis of children with autism spectrum disorder.However,due to the lack of awareness of autism spectrum disorder among some medical staff and parents,the diagnosis and treatment of children are often delayed.This article reviews the early behavioral characteristics,screening tools,laboratory tests,diagnostic criteria,and the impact of early intervention on children with autism spectrum disorder,providing reference for early identification and intervention of children with autism spectrum disorder.
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Objective To compare the setup errors of the negative pressure vacuum air cushion (vacuum bag) and the Orfit body foam fixator (Orfit frame) in radiotherapy for cervical cancer.Methods A total of 40 patients receiving three-dimensional radiotherapy for cervical cancer were enrolled in this study and equally and randomly divided into vacuum bag group and Orfit frame group.And the two groups were divided into Orfit-1 group, Orfit-2 group, vacuum-1 group, and vacuum-2 group according to the treatment course.The Orfit-1 group and vacuum-1 group were the data in the first 12 treatments, while the Orfit-2 group and vacuum-2 group were the data in the following 13 treatments.A cone-beam computed tomography scan was performed before each treatment to analyze setup error and then the body position was corrected to start the treatment.Comparison of continuous data between groups was made by paired t-test, while comparison of categorical data was made by chi-square test.Results There was a significant difference in the setup error in y-axis direction between the Orfit-1 group and the Orfit-2 group (P=0.003) and the setup error in r-axis direction between the vacuum-1 group and the vacuum-2 group (P=0.013).There were no significant differences in the setup errors in four directions (x-axis, y-axis, z-axis, and r-axis) between the Orfit-1 group and the vacuum-1 group (P>0.05).There were significant differences in the setup errors in y-axis and z-axis directions between the Orfit-2 group and the vacuum-2 group (P=0.007;P=0.001).Conclusions The Orfit frame and the vacuum bag have their own advantages and disadvantages in the fixation of body position in radiotherapy for cervical cancer.The setup error can be improved by long vacuum bags, ultrasound bladder capacity scanner, image-guided radiotherapy, or sectional radiotherapy plan.
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Objective To find out the risk factors of postoperative low cardiac output syndrome(LCOS) of patients undergoing cardiac valvular surgery in ICU in order to provide basic for prevention and control measures.Methods Ninety-six valve replacement patients with valvular heart disease were enrolled as our subjects and they were hospitalized in ICU of the First People's hospital of Yichang from Jan.2008 to May.2013.The patients postoperative LCOS (Dopamine ＞ 10 μg/(kg · min)) were served as observation group (n =41),and the other were control groups(n =55).All data of the patients were recorded.Non-conditions Logistic regressions analysis were adopted to analyze the independent risk factors which resulted in LCOS undergoing cardiac valvular surgery.Results Of 96 patients undergoing cardiac vavular surgery,41cases (42.7％) had postoperative LCOS.Single factor analysis showed that hepatomegaly (P =0.007),course of diseases ≥ 15 years (P =0.042),cardiopulmonary bypass ≥ 120 min (x2 =3.937,P =0.047),pre-operative cardiac function ≥ Ⅲ degree (P =0.003) were the independent risk factors of postoperative LCOS undergoing cardiac valvular surgery.The Logistic multi factor regression analysis showed that the independent risk factors of postoperative LCOS undergoing cardiac valvular surgery included course of diseases ≥ 15 years (OR =2.825,95％ CI =(1.015-7.861)),Pre-operative cardiac function ≥ Ⅲ degree (OR =7.306,95％ CI =(2.050-26.035),P=0.002).Conclusion Course of diseases ≥15 years and Pre-operative cardiac function≥ Ⅲ-Ⅳ degree are the independent risk factors of LCOS undergoing cardiac valvular surgery.
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Objective To investigate the expression and the effects of tissue inhibitor of metalloproteinases-1 (TIMP-1) on lungs of rats with sepsis.Methods Forty Sprague-Dawley (SD) rats were randomly divided into two groups,namely sham group (n =8) and sepsis model group (n =32).The rats of model group were modeled by cecal ligation and puncture (CLP),and were further divided into four subgroups as per the time after modeling,namely 6 h (n =8),12 h (n =8),24 h (n =8),48 h (n =8)subgroups.Blood and lung samples were taken 6 h,12 h,24 h and 48 h after modeling.The histological changes in lungs of the rats were observed under light microscope.Expressions of TIMP-1 mRNA,Bax mRNA and Bcl-2 mRNA in lungs were measured by RT-PCR.The immunohistochemistry was used to label the CD18 in lungs during different phases of sepsis.The data were processed by t test.Results Compared with sham group,the lung tissues of rats in model group were injured to a certain extent after CLP.The expression of TIMP-1 mRNA and the number of CD18 positive cells increased at the same time (P ＜ 0.01),and peaked 24 hours later (P ＜ 0.01).While the expression of Bax mRNA in model group decreased markedly 12-48 hours after modeling (P ＜ 0.01-0.05),and reached minimum 48 hours later (P ＜ 0.01).The expression of Bcl-2 mRNA in model group changed unnoticeable.The positive correlation between variations in number of CD18 positive cells and expression of TIMP-1 mRNA was found in model group (r =0.426,P ＜ 0.01).Conclusions The increase in expression of TIMP-1 mRNA in lungs is closely associated with the lung injury of sepsis.The mechanism of lung injury is likely attributed to the preservation of inflammatory cells from apoptosis,and the persistent inflammation response causes tissue damage,leading to organ dysfunction.
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Objective To investigate the risk factors of acute kidney injury following coronary artery bypass graft(CABG).Methods Twenty-six patients suffering from acute kidney injury following CABG as the patient group and 59 individuals without impairment of renal function as the control from January 2008 to September 2012 in the First People's Hospital of Yichang according to a retrospective case-control study and nonconditional multivariable Logistic regression analysis method..Results Among the 85 patients undergoing CABG,26 suffered acute kidney injury following CABG with a morbidity rate of 30.59％.Identified risk factors for acute kidney injury following CABG included pre-operative mederale-sever cardiac insufficiency,prolonged mechanical ventilation,prolonged stay in ICU and anemia before surgery.The identified independent risk factor of acute kidney injury following CABG was pre-operative mederale-sever cardiac insufficiency (OR =3.206,95％ CI:1.067-9.631).Condusion Pre-operative mederale-sever cardiac insufficiency was an independent risk factor of acute kidney injury following CABG.
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Objective To compare clinical outcome of intracytoplasmic sperm injection(ICSI)cycle by using fresh and cryopreserved-thawed testicular and epididymal spermatozoa in azoospermic patients.Methods Between September 2006 and May 2007,208 azoospermic patients underwent in vitro fertilization(IVF)were treated in Center of Reproductive Medicine,Peking University Third Hospital.Those couples were divided into two groups based on their wishes,including 171 cases in fresh group and 37 cases in cryopreserved-thawed group.The cryopreserved testicular or epididymal spermatozoa were thawed and recovered before ICSI procedure iu thawed group.The outcomes of ICSI in each group were compared.including clinical outcomes(two pronuclear fertilization,high quality embryo,clinical pregnancy and embryo implantation)and pregnancy outcomes(spontaneous miscarriage,gestational weeks and neonatal birth weight).Results (1),The utilization rate were 92%(23/25)in cryopreserved-thawed testicular spermatozoa and 100%(12/12)in epididymal spermatozoa.(2)Between fresh and cryopreserved-thawed groups,no statistical difference was observed in two pronuclear fertilization rate[62.25%(973/1563)vs.64.53%(282/437),P=0.960],high quality embryo rate[78.9%(768/973)vs.79.1%(223/282),P=0.985],clinical pregnancy rate per embryo transfer[44.4%(60/135)vs.46.9%(15/32),P:0.688]and embryo implantation rate[29.3%(84/287)vs.33.3%(23/69),P=0.508].(3)No significant difference between flesh and cryopreserved group was found in spontaneous miscarriage rate (11%vs.7%,P＝1.000),gestational weeks(single birth:39.0 weeks vs.38.7 weeks,P:0.538;twins:36.8 weeks vs.36.3 weeks,P=0.571)and birth weight(single birth:3409 g vs.3350 g,P=0.699;twins:2584 g vs.2635 g,P=0.703).Conclusion It suggested that tissue from the azoospermic patients who underwent diagnostic testieular and epididymal biopsy should be eryopreseved for IVF-ET.
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Objective To investigate the changes in the serum MMP-9 (matrix metalloproteinase-9) and the expressions of MMP-9 in lung, kidney and intestine in rats with multiple organ dysfunction syndrome (MODS) and confirm extracellular matrix injuries being the mechanism in MODS in order to propose a novel theoretical basis for cfinical treatment of MODS. Method Forty wister rats were randomly divided into two groups: control group (n=8) and MODS model group (n=32). The rats of model group were further divided into four subgroups ac-cordingto the time elapsed after modelling: 12 h (n=8), 24 h(n=8) ,48 h(n=8) and 72 h (n=8), and were modelled by celiac injection of mixed liquid of zymosan-paraffin (4 mL/100 g) after blood loss (1mL/100 g) by extirpating their left eyes. Blood,lung, kidney and intestine were sampled 12,24,48 and 72 hours after models were established. The histological changes in the lung, kidney and intestine of the rats were observed by light mi-croscope. The serum MMP-9 were measured by enzyme-linked immunosorbent assay (ELISA). The immunohisto-chemistry was used to observe the expression of MMP-9 in lung,kidney and intestine during different phases of MODS. The data were processed by one-way ANOVA and Bivariate analysis. Results Compared with control group, the organs were injured by congestion, edema and inflammatory cells infiltration to a certain extent in model groups. The serum MMP-9 increased markedly 12 hours after modelling (P<0.01 ) and peaked 48 hours later. The expressions of MMP-9 in lung, kidney and small intestine significantly increased from 12 h to 72 h after mod-elling (P<0.01 or 0.05). Conclusions The MMP-9 increased both in serum and tissue are closely associated with the pathological process of MODS. The mechanism of organ damage probably attributes to the damage of extra-celluar matrix and tissue construction.