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Objective:To investigate the efficacy of tyrosine kinase inhibitors (TKI) in the treatment of metastatic renal cell carcinoma with rhabdoid differentiation(mRCC-R) or sarcomatoid differentiation(mRCC-S)and the survival of the patients.Methods:The clinicopathological and postoperative follow-up data of 5 patients with mRCC-R and 9 with mRCC-S confirmed by pathology from February 2016 to December 2018 in Tianjin Medical University Cancer Hospital were reviewed. There were 3 male and 2 female patients in mRCC-R group, with the average age of (60.2±7.1)years old. The clinic manifestation included back or abdominal pain in 2 cases, loss of appetite and weight in one case and founding during physical examination in 2 cases, with the average maximum diameter was (8.8±4.1)cm. The site of tumor included left kidney in 3 cases and right kidney in 2 cases. Lung metastasis was found in 4 cases. Lung and peritoneum metastasis was found in one case. There were 8 male and 1 female patients in mRCC-S group, with the average age of (58.0±8.0)years old. The clinic manifestation included back or abdominal pain in one case, loss of weight in one case, gross hematuria in one case and founding during physical examination in 6 cases. The average diameter of tumor was (8.9±3.5)cm. The site of tumor included left kidney in 4 cases and right kidney in 5 cases. Postoperative metastasis included lung in 3 cases, bone in one case, retroperitoneal lymph node in one case, brain in one case, lung associated with bone in one case. All of the patients were pathologically diagnosed with renal clear cell carcinoma. After metastasis, 5 cases of mRCC-R and 6 cases of mRCC-S were treated with Sorafenib, 2 cases of mRCC-S were treated with Sunitinib, and 1 case of mRCC-S was treated with Axitinib. The efficacy of TKI for the two specific pathological types and for single pathological type at the early postoperative period (within 3 months) and 3 months later was compared. Meanwhile, subgroup analysis was performed on the efficacy of TKI and survival of patients with same metastatic sites in the two groups.Results:The mean overall survival(OS) of mRCC-R and mRCC-S treated with TKI was (26.5±5.5)months and (20.7±4.7) months( P=0.329), and the mean progression-free survival (PFS) was (21.9±5.5) months and (6.3±2.1)months( P=0.013), respectively. Comparing the efficacy of using TKI in the early postoperative period and after 3 months, the mean OS was (27.5±6.5)months and (16.8±6.1)months ( P=0.619), and the mean PFS was (12.3±3.3)months and (3.3±1.7)months ( P=0.096), respectively. There was only 1 patient with mRCC-R who used TKI within 3 months after surgery, and the result was disease progressed and eventually died, OS was 3 months. Comparing the efficacy of TKI in mRCC-R and mRCC-S with lung metastasis alone, the mean OS was (33.3±2.2) months and (19.5±8.9)months ( P=0.118), and the mean PFS was (27.3±3.1) months and (7.8±4.2) months ( P=0.009), respectively. Patients with liver, bone or brain metastasis only occurred in mRCC-S, so it is unable to identify the efficacy of TKI in the two groups. Conclusions:The efficacy of TKI in the treatment of mRCC-R was better than mRCC-S, and there was statistically significant difference in PFS, especially in patients with lung metastasis alone in the two groups. There was no significant difference in the efficacy between patients with mRCC-R who took TKI in the early postoperative period (within 3 months)and those who took TKI after 3 months.
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<p><b>OBJECTIVE</b>To observe the clinical effects differences and partial mechanism for chronic nonbacterial prostatitis (CNP) among drug oil moxibustion, simple moxibustion, and conventional western medicine.</p><p><b>METHODS</b>A total of 120 patients who met the criteria of inclusion were randomly assigned into a drug oil moxibustion group, a moxibustion group and a western medication group, 40 cases in each one. Moxibustion was used at Guanyuan (CV 4), Zhongji (CV 3), Qihai (CV 6) and bilateral Yinlingquan (SP 9), Sanyinjiao (SP 6), Shenshu (BL 23), Mingmen (GV 4), Pangguangshu (BL 28), Ciliao (BL 32), and Zhibian (BL 54), etc. The same moxibustion was used at the same acupoints in the drug oil moxibustion group after external application of medicated oil. Thirty min treatment was used once a day in alternated abdomen and back. In the western medication group, oral tamsulosin hydrochloride capsules were applied once a day, one capsule at a time. All the treatment was given for 30 days. Chronic prostatitis symptom index from National Institutes for Health (NIH-CPSI), the contents of Zinc (Zn) and C-reactive protein (CRP), as well as the number of white blood cells (WBC) and density of lecithin bodies were observed before and after treatment and 1 month after treatment. The effects were evaluated after treatment.</p><p><b>RESULTS</b>After treatment, the total effective rate of the drug oil moxibustion group was 90.0% (36/40), which was significantly higher than 72.5% (29/40) of the moxibustion group and 62.5% (25/40) of the western medication group (both<0.05). After treatment and at follow-up in the three groups, the NIH-CPSI scores were lower than those before treatment (all<0.05), and those in the drug oil moxibustion group were lower than the results in the moxibustion group and the western medication group (all<0.05). The contents of Zn in the three groups were higher than those before treatment (all<0.05), with better results in the drug oil moxibustion group (all<0.05), and higher Zn contents in the moxibustion group compared with those in the western medication group (both<0.05). The CRP levels were lower than those before treatment (all<0.05), and those in the drug oil moxibustion group were better than those in the moxibustion group and western medication group (all<0.05). The CRP contents in the moxibustion group were lower than those in the western medication group (both<0.05). The number of WBC were lower than those before treatment (all<0.05), with better results in the drug oil moxibustion group (all<0.05). The concentrations of lecithin were higher than those before treatment (all<0.05), with better results in the drug oil moxibustion group (all<0.05).</p><p><b>CONCLUSIONS</b>The clinical effect of drug oil moxibustion is better than those of simple moxibustion and western medicine, which has advantages in improving clinical symptoms, Zn, the density of lecithin body and decreasing CRP content and the number of WBC.</p>
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Background:Functional gastrointestinal disorders(FGIDs)is a common disease of digestive system which severely affects the quality of life. Recently,more and more attentions have been paid to the relationship between FGIDs and psychological factors. Aims:To investigate the relationship between FGIDs and psychological factors and related treatment. Methods:A total of 270 patients with FGIDs admitted from Sept. 2013 to Sept. 2014 at Anhui No. 2 Province People’s Hospital were enrolled. Hamilton Anxiety Scale(HAMA)and Hamilton Depression Scale(HAMD)were used to evaluate the mental state of patients,and symptom severity of digestive system was scored. Patients with psychological abnormalities received conventional therapy to relieve digestive symptoms,and those who failed from conventional therapy were assigned into refractory group and others were assigned into response group. Patients in refractory group were further divided into conventional therapy group and combined therapy group for receiving paroxetine in addition to conventional therapy. Results:The rates of anxiety and depression were 61. 5%(166 / 270)and 57. 0%(154 / 270),respectively. The scores of HAMA and HAMD were positively correlated with the score of digestive symptoms(r = 0. 585,P < 0. 01;r = 0. 584,P <0. 01)in patients with anxiety and depression in response group. The scores of HAMA,HAMD and digestive symptoms in response group after conventional therapy were significantly decreased(P < 0. 05),while the scores of HAMA and HAMD in refractory group after therapy were significantly higher than those in response group before therapy(P < 0. 05). The scores of HAMA,HAMD and digestive symptoms in combined therapy group were significantly lower than those in conventional therapy group(P < 0. 05). Conclusions:Relationship is found between FGIDs and psychological factors,and antidepressants might contribute to the amelioration of symptoms of FGIDs.
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Objective To investigate the effect and mechanism of anti-tumor necrosis factor (TNF)-α on the intestinal mucosal permeability in dextran sulfate sodium (DSS) induced colitis mice.Methods Eighteen C57BL/6J mice were evenly divided into healthy control group,model group and anti-TNF-α treated group.The mice of model group and anti-TNF-α treated group were fed with 5％DSS solution for 7 days.The mice of anti-TNF-α treated group were injected anti-TNF-α (5 mg/kg)intraperitoneally on the first and fourth day; control group and model group were substituted with equal volume saline injection.The mice were sacrificed at 7 days after modeling.The disease activity index (DAI) score was evaluated everyday.The intestinal permeability was examined by Evan′s blue (EB) method and FITC-dextran (FITC-D) method.The colon tissue was collected for observation under microscope and histological index (HI).The small intestinal tissues were examined under electron microscope.The 10％ homogenate of colon and intestinal mucosa was prepared,the activity of myeloperoxidase (MPO),the content of TNF-α and epithelial myosin light chain kinase (MLCK) concentration were determined with kits respectively.The expression of MLCK in intestinal mucosa was tested by Western blot assay.Single factor of variance between groups were analyzed.Results Compared with control group,the DAI of model group increased daily.Compared with model group,the DAI of anti-TNF-α treated group improved.In model group,mice intestinal epithelial cells junctional complex shortened and widened and the cell gap expanded.In anti-TNF-α treated group,the connection structure of mice intestinal epithelial cells was tighter.The activity of HI and MPO and the content of TNF-α of model group were higher than those of control group (P ＝ 0.008,0.006 and 0.001,respectively),all of those of anti-TNF-α treated group were lower than those of model group (P=0.004,0.008 and 0.005,respectively).The F value of three groups was 131.98,218.28 and 58.93,respectively.The contents of EB in mice intestinal wall and serum FITC-D of model group were higher than those of control group (P=0.003 and 0.010),and those of anti-TNF-α treated group were lower model group (P＝0.001 and 0.009).The F value of three groups was 69.36 and 17.96.The MLCK concentration in mice intestinal mucosa of model group [(71.10± 7.52) ng/g] was higher than that of control group [(18.56±9.92) ng/g,P＜0.01],that of anti-TNF-α treated group [(37.56±15.84) ng/g] was lower than model group (P=0.008),and the difference among these three groups was statistically significant (F＝ 17.23).The Western blot results indicated the expression of MLCK in intestinal mucosa of model group was higher than that of control group,and that of anti-TNF-α treated group was lower than model group.Conclusions Anti-TNF-α play an important role in improving colitis,and the intestinal mucosal permeability.The mechanism may be related with the regulation of MLCK expression.
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Objective To validate the 2010 Edition kidney cancer TNM staging in China.Methods Data were collected from 695 operated kidney cancer patients from Jan.1981 to Dec.2003.These patients were staged based on the 6th Edition and 7th Edition kidney cancer TNM staging system,respectively.The Kaplan-Meier method,log-rank test and Cox regression models were used to analyze survival functions.Results Compared to the 6th edition staging system,the number of patients with stage T3a,T4changed from 98 to 88,from 29 to 42 in new staging system,respectively.According to the 6th edition staging system,there was significant difference comparing perirenal fat invasion only with adrenal gland only ( P =0.08 ),there was no significant difference comparing Gerota fascia invasion ( stage T4 ) only with adrenal gland invasion only (P =0.412).According to the new staging system,there was no significant difference comparing stage T2b with stage T3a ( P =0.714). Conclusion The new kidney cancer staging system has better staging specificity and clinical application results in high accuracy.
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ObjectiveTo retrospectively analyze the relationship between clinicopathological,biological characteristics and the outcome of renal cell carcinoma(RCC) and evaluate the risk factors related to metastasis in young patients.MethodsThe data of 83 RCC patients younger than 40-year-old, treated from January 1986 to December 2007 in Tianjin Cancer Hospital,were analyzed retrospectively.The complete follow-up data of the 83 cases were collected.The operative methods included partial and radical surgery.Clinical staging were consistent with the 2004 UICC TNM classification criterion.The histological sections were reviewed.Various biological factors including VEGFR-1, VEGFR-2, VEGFR-3, PDGFR-α, PDGFR-β, c-kit and PCNA were tested by immunohistochemistry staining.The adjuvant radiation therapy, chemotherapy and immunotherapy after operation were carried out on the basis of pathological and biological features.The 83 cases were divided into two groups according to metastasis and non-metastasis status within 5 years.The prognosis related factors including clinical factors, pathological and biological factors were evaluated.Chi-square test was used for the analysis of 5-years metastasis status; and multivariate analysis was carried out using Cox proportional hazards models to assess the independent effect of the metastasis factors (the test standard α = 0.05).ResultsThe 5-year follow-up data showed that the metastasis rate in the 83 cases was 16.87％ (14/83).The Chi-square test results indicated that the patients with clinical stage Ⅲ and grade 3 had the highest metastasis rate (57.14％ and 78.57％respectively,x2 =38.042, x2 = 9.820; Ps ＜ 0.01) .The VEGFR-3 and PCNA positive expression rates were 92.86％ and 85.71％ respectively in metastasis group.The metastatic risk of early stage patients was 3.444 times as much as the advanced stage patients.ConclusionThe young patients with clinical advanced renal cell carcinoma had worse outcome.The stage,grade, VEGFR-3 and PCNA expression were the risk factors correlated with the metastasis risk for young RCC patients.TNM stage was an independent predictive risk factor of metastasis in young patients.
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Objective To investigate the expression of c-kit and analyze its relationship with proliferating cell nuclear antigen (PCNA) in RCC subtypes and its clinical progression. Methods Expression of c-kit protein was retrospectively studied with immunohistochemistry in paraffin sections from 137 cases of clear renal cell carcinoma (CCRCC), 82 papillary renal cell carcinoma (PRCC), 51 chromophobe renal cell carcinoma (ChRCC). Results The positive rate of c-kit in ChRCC was 94.1%(48/51), it was statistically higher than that in CCRCC (16. 1%, 22/137) and PRCC (28.1 %, 23/82)(P=0. 001 ). In ChRCC, the positive expression of c-kit was related with TNM stages. The positive expression of PCNA was related with the grade in CCRCC and PRCC. But there was no relationship between PCNA expression and grade of ChRCC. It also had the relationship with the metastasis in CCRCC. Conclusions The expression of c-kit in ChRCC is higher than in other subtype of RCC, and associated with tumor local progression. That makes c-kit as a helpful marker to discriminate different subtypes of kidney cancer.
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<p><b>OBJECTIVE</b>To detect the expression of VEGF receptors in papillary renal cell carcinoma and to explore the correlation between their expression and clinical prognosis.</p><p><b>METHODS</b>Expression of VEGF receptors and PCNA (proliferating cell nuclear antigen) were evaluated in 82 patients with papillary renal cell carcinoma using tissue microarray and SP immunohistochemical staining.</p><p><b>RESULTS</b>The expression of VEGFR-1 in papillary renal cell carcinoma was 82.93%, VEGFR-2 63.41%, VEGFR-3 34.15% and PCNA 67.07%, respectively. Increased VEGFR-2 expression was significantly correlated with tumor size (P = 0.016), histological grade (P = 0.034) and distant metastasis (P = 0.002). VEGFR-3 expression was correlated with histological grade (P = 0.028), lymph node status (P = 0.010) and distant metastasis (P = 0.018), but not correlated with gender, age, location, tumor size and TNM staging. VEGFR-1 expression had no correlation with any clinic and pathologic factors. PCNA expression was correlated with histological grade (P = 0.011), but not correlated with other factors. The expression of VEGFR-2 and VEGFR-3 in death cases were higher than that in surviving patients.</p><p><b>CONCLUSION</b>Both VEGFR-2 and VEGFR-3 can serve as markers for prognosis of papillary renal cell carcinoma. Differently, VEGFR-3 is a predictor of lymph node metastasis, increased VEGFR-2 expression could be used to predict a potential blood dissemination.</p>