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Objective:To investigate the relationship between RAS, BRAF gene mutations and HER2 gene amplification and clinicopathology and prognosis of colorectal cancer.Methods:The clinical data of 268 patients with colorectal cancer were retrospectively analyzed. KRAS, NRAS and BRAF gene mutations and the HER2 gene amplication were detected.Results:The mutation rates of KRAS, NRAS and BRAF were 53.4% , 2.6% and 3.0%, respectively. The amplification rate of HER2 was 6.7%. KRAS gene mutation tended to occur in the right side colon and rectal cancers( χ2=10.824, P=0.004). BRAF gene mutation mainly occurred in the right side colon cancer ( P=0.044). HER2 gene amplification tended to occur in colorectal cancer patients with RAS/BRAF wild-type ( OR=0.322,95% CI:0.117-0.887, P=0.027). Univariate analysis showed that the progress-free survival of colorectal cancer patients with RAS mutation was significantly shorter than that of the patients with wild( χ2=6.153, P=0.013), and there was no significant difference in overall survival time( χ2=1.938, P=0.164).The progress-free survival and overall survival time were shorter in BRAF mutation than in the wild type( χ2=8.090, P=0.004; χ2=11.125, P=0.001). Multivariate analysis showed that BRAF gene mutation was independent risk factor for survival of colorectal cancer patients ( HR=3.536,95% CI:1.305-9.583, P=0.013). Conclusion:BRAF gene mutations was independent risk factor for poor prognosis of colorectal cancer patients.
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Objective:To explore the screening scheme of gastric cancer in large-scale natural population in Wuxi.Methods:From December 2016 to December 2019, 105 865 residents of 19 communities (villages) in six streets of Xinwu District, Wuxi were randomly enrolled in this study by random number table. A household epidemiological questionnaire survey was conducted among 50 063 target population subjects (aged 40-69), and then, respondents were divided into four categories, category Ⅰ: HP (-), PG (-); category Ⅱ: HP (+ ), PG (-); category Ⅲ: HP (+ ), PG (+ ); category Ⅳ: HP (-), PG (+ )according to the serological Helicobacter pylori ( HP) antibodies and pepsinogen (PG) test results. People in category Ⅲ and Ⅳ were all selected into group C and group D respectively, then individuals 3 times of group D were randomly selected from category Ⅰ to assign to group A, and individuals 3 times of group C from category Ⅱwere assigned to group B in the same way. Remaining individuals in category Ⅰ and Ⅱ who had first-degree family history of gastric cancer were also included in group A and group B, respectively. Endoscopic and pathological examination were performed on the above enrolled subjects for high grade intraepithelialneoplasia (HGIN), early gastric cancer and gastric cancer. Results:Of the 50 063 target subjects, 31 508 questionnaires were finally collected, with a participation rate of 62.9%. A total of 19 745 people were tested for serology, and the participation rate was 39.4% (19 745/50 063). Serological results showed that there were 11 152 people (56.48%) in category Ⅰ, 8 170 (41.38%) in category Ⅱ, 124 (0.63%) in category Ⅲ, and 299 (1.51%) in category Ⅳ. According to the exclusion criteria and principle of voluntariness, 3 400 individuals were candidates to undergo gastroscopy. Finally, a total of 2 389 people came to the hospital for gastroscopy, 1 263 in group A, 814 in group B, 86 in group C and 226 in group D, with an overall response rate of 70.3% (2 389/3 400), target population participation rate of 4.8% (389/50 063), and the overall population participation rate of 2.3% (2 389/105 865). In the 2 389 cases, there were 32 cases (1.34%) of HGIN and gastric cancer by gastroscopy and biopsy pathology, among which 1 case (3.125%) aged 40-49, 9 (28.125%) aged 50-59, and 22 (68.750%) aged 60-69. Among the 32 cases, 25 cases (78.13%)were pathologically confirmed as having HGIN or early gastric cancer by endoscopic submucosal dissection or surgical operation. By eliminating 810 people (including 3 gastric cancer) without first-degree family history with gastric cancer in group Ⅰ and Ⅱ, and increasing the gastroscopy screening age to 50 years (exluding 214 people aged 40-49, including 1 gastric cancer), the number of people who should undergo gastroscopy could be reduced from 2 389 to 1 365, and 28 cases of HGIN or gastric cancer were still detected, including 22 HGIN or early gastric cancer.Conclusion:Gastroscopy after the screening with epidemiological, serological tests, age and first-degree relative with gastric cancer family history is suitable for gastric cancer screening in Wuxi. Based on Chinese national conditions, a new community gastric cancer screening program is recommended in Wuxi considering cost-effectiveness, which includes those over 50 years old, serological PG (+ ) and first-degree relatives with family history of gastric cancer.
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Objective To investigate the efficacy of open reduction and osteotomy combined with internal fixation to reconstruct the distal tibial articular surface in the treatment of old pilon fracture.Methods A retrospective case series study was conducted to analyze the clinical data of 20 patients with old pilon fracture admitted to Zhengzhou Orthopaedic Hospital from July 2014 to February 2018.There were 14 males and six females,aged 21-45 years,with an average of 31.5 years.According to AO classification,there were four patients with C1 type,seven with C2 type and nine with C3 type,all of which were closed fractures.Eleven patients received non-operative treatment while nine patients underwent surgeries.After the surgery,malunion was seen in eight patients,and incomplete union in 12 patients.There were eight patients with posterior articular surface collapse of distal tibia,seven patients with anterior articular surface collapse of distal tibia,three patients with varus deformity and two patients with valgus deformity.All patients were treated with open reduction and osteotomy with internal fixation to reconstruct the articular surface of distal tibia.The time of fracture healing was recorded,and the Visual Analogue Scale (VAS),ankle flexion and extension range of motion,and AOFAS ankle-hind foot function score were compared before and at the last follow-up.The complications were recorded.Results All patients were followed up for 7-36 months,with an average of 26.4 months.Fracture healing time was 3-7 months,with an average of 4.1 months.At the last follow-up,VAS,ankle metatarsal flexion,dorsal extension and AOFAS scores were significantly improved compared with those before operation [(1.9 ± 1.0)points vs.(6.6 ± 1.4)points,(31.6 ±2.4)° vs.(18.5 ±4.4)°,(25.7 ±2.7)° vs.(15.6 ±2.7)°,(79.6±7.3)points vs.(42.6 ±5.6)points] (P＜0.05).One patient developed severe ankle traumatic arthritis 7 months after operation and underwent fusion of ankle joint.Conclusion For old pilon fracture,open reduction and osteotomy to reconstruct the distal tibial articular surface can effectively relieve pain,improve joint mobility and restore ankle function.
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Objective@#To investigate the efficacy of open reduction and osteotomy combined with internal fixation to reconstruct the distal tibial articular surface in the treatment of old pilon fracture.@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 20 patients with old pilon fracture admitted to Zhengzhou Orthopaedic Hospital from July 2014 to February 2018. There were 14 males and six females, aged 21-45 years, with an average of 31.5 years. According to AO classification, there were four patients with C1 type, seven with C2 type and nine with C3 type, all of which were closed fractures. Eleven patients received non-operative treatment while nine patients underwent surgeries. After the surgery, malunion was seen in eight patients, and incomplete union in 12 patients. There were eight patients with posterior articular surface collapse of distal tibia, seven patients with anterior articular surface collapse of distal tibia, three patients with varus deformity and two patients with valgus deformity. All patients were treated with open reduction and osteotomy with internal fixation to reconstruct the articular surface of distal tibia. The time of fracture healing was recorded, and the Visual Analogue Scale (VAS), ankle flexion and extension range of motion, and AOFAS ankle-hind foot function score were compared before and at the last follow-up. The complications were recorded.@*Results@#All patients were followed up for 7-36 months, with an average of 26.4 months. Fracture healing time was 3-7 months, with an average of 4.1 months. At the last follow-up, VAS, ankle metatarsal flexion, dorsal extension and AOFAS scores were significantly improved compared with those before operation [(1.9±1.0)points vs. (6.6±1.4)points, (31.6±2.4)° vs. (18.5±4.4)°, (25.7±2.7)° vs. (15.6±2.7)°, (79.6±7.3)points vs. (42.6±5.6)points] (P<0.05). One patient developed severe ankle traumatic arthritis 7 months after operation and underwent fusion of ankle joint.@*Conclusion@#For old pilon fracture, open reduction and osteotomy to reconstruct the distal tibial articular surface can effectively relieve pain, improve joint mobility and restore ankle function.
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Objective@#To study clinicopathological features,diagnosis and differential diagnosis of myxoid lipoblastoma.@*Methods@#Four cases of myxoid lipoblastoma, from 2010 to 2017 at Wuxi People′s Hospital of Nanjing Medical University, the Affiliated Hospital of Xuzhou Medical University and Binhai People′s Hospital, were studied by clinicopathological analysis, immunohistochemistry and in situ hybridization along with a literature review.@*Results@#The age of the patients ranged from 1 to 6 years. Histologically, all tumors had thin fibrous capsule and irregular lobules separated by fibrous septa. The individual lobules consisted of myxoid stroma,prominent plexiform capillary network and stellate or spindle mesenchymal cells. Lipoblasts (S-100 positive) and mature adipocytes varies among different lobules. FISH revealed PLAG1 disruption in all 4 cases. MDM2 or CHOP alterations were not detected. None of the patients had tumor recurrence upon follow up from 12 to 80 months.@*Conclusions@#Myxoid lipoblastoma is a very rare tumor, usually in the first 5 years of life. The clinical features of myxoid lipoblastoma and lipoblastoma are similar, while myxoid lipoblastoma has prominent myxoid change, a plexiform vascular pattern and rare mature fat cells. The patient age,S-100 positive lipoblasts and cytogenetic alteration are the key diagnostic features.
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Objective To report the clinical treatment of chronic malunited ankle fractures by fibular osteotomy and distal tibiofibular joint fusion.Methods A retrospective analysis was done of the 36 patients with chronic malunited ankle fracture who had been treated from March 2013 to January 2016 in our hospital.They were 20 men and 16 women,aged from 25 to 59 years (average,36.7 years).They were treated by open reduction,fibular osteotomy to correct their rotation deformity,and distal tibiofibular joint fusion.The therapeutic efficacy was assessed postoperatively by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.Results They were followed up for 10 to 36 months (average,26.5 months).No nonunion,implant failure or infection was observed.The AOFAS ankle-hindfoot score increased significantly from preoperative 36.4 ± 7.8 to 82.1 ± 9.4 at the final follow-up (t =73.379,P =0.000).An excellent and good rate of 86.1％ was achieved,giving 9 excellent,22 good and 5 fair cases.Mild limitation in ankle flexion and extension was observed in 5 cases.No significant differences were found between final follow-ups and preoperation regarding the ankle plantar flexion (32.0°± 2.4° versus 31.8° ± 3.5°) or the ankle dorsal extension (18.2° ± 1.7° versus 17.4° ± 2.4°) (P ＞ 0.05).Conclusion Fibular osteotomy and distal tibiofibular joint fusion can result in fine clinical effects in the treatment of chronic malunited ankle fractures.
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Objective To report the clinical treatment of chronic malunited ankle fractures by fibular osteotomy and distal tibiofibular joint fusion.Methods A retrospective analysis was done of the 36 patients with chronic malunited ankle fracture who had been treated from March 2013 to January 2016 in our hospital.They were 20 men and 16 women,aged from 25 to 59 years (average,36.7 years).They were treated by open reduction,fibular osteotomy to correct their rotation deformity,and distal tibiofibular joint fusion.The therapeutic efficacy was assessed postoperatively by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.Results They were followed up for 10 to 36 months (average,26.5 months).No nonunion,implant failure or infection was observed.The AOFAS ankle-hindfoot score increased significantly from preoperative 36.4 ± 7.8 to 82.1 ± 9.4 at the final follow-up (t =73.379,P =0.000).An excellent and good rate of 86.1％ was achieved,giving 9 excellent,22 good and 5 fair cases.Mild limitation in ankle flexion and extension was observed in 5 cases.No significant differences were found between final follow-ups and preoperation regarding the ankle plantar flexion (32.0°± 2.4° versus 31.8° ± 3.5°) or the ankle dorsal extension (18.2° ± 1.7° versus 17.4° ± 2.4°) (P ＞ 0.05).Conclusion Fibular osteotomy and distal tibiofibular joint fusion can result in fine clinical effects in the treatment of chronic malunited ankle fractures.
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Objective To discuss the risk in duo paternity testing. Methods 22 fictitious duo families formed by 22 pairs of unrelated individuals having one or zero inconsistent locus were selected after detected by GoldeneyeTM 20A Kit. The 22 fictitious duo families were further tested with STRtyper-10G kit and/or AGCU 21+1 STR kit until there were more than 3 inconsistent loci and the cumulative paternity index(CPI) value was less than 0.0001. According to the three excluding rules, ① number of inconsistent loci>3; ② CPI ≤ 0.0001; ③ accord with both ① and ② , using multiple STR systems, such as 19 STR loci, 26 STR loci, 39 STR loci and 46 STR loci to test and discuss whether there is difference among the excluding result of unrelated individual. Results Among those 22 fictitious duo families, using three excluding rules, None was excluded by 19 STR loci, and all was excluded by 39 STR loci. Conclusion Duo paternity tests may get a wrong result using only 19 loci system. To reduce the error risk 39 STR-loci systems would be suggested.
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Purpose To analyze the clinicopathologic and immunohistochemical features, differential diagnosis and prognosis of papil-lary renal cell carcinoma (PRCC). Methods Thirty-two cases of PRCC diagnosed were reviewed. A retrospective study was per-formed including reviewing the clinical documents, pathological sections and immunohistochemical stainning and follow-up was made of 32 cases of PRCC. Twenty-one patients were treated with radical nephrectomy, eleven patients were treated with partial nephrectomy. Results Among 770 cases of renal epithelial tumors 32(4. 2%) cases of PRCC were detected. Histologically, the PRCC were charac-terized by varying proportions of papillary and tubular architecture covered by single or multiple layer of tumor cells with scanty or volu-minous basophilic or eosinophilic cytoplasm. Foam cells and psammoma bodies were seen in some papillary cores and stroma, and the cytoplasm of some tumor cells contained hemosiderin. Of these 32 patients, 18 and 14 were diagnosed type-Ⅰand type-IIPRCC, re-spectively. Type-I, with small cuboid cell and pale cytoplasm, 16 of them were low in Fuhrman grading, Type-II, with large colunmar cells, rich in eosinophilic cytoplasm, 12 of them were high in Fuhrman grading. Immunohistochemically, the PRCC showed positive immunostaining for vimentin, EMA, CK(AE1/AE3), CK7, CD10 and AMACR. All the tumors studied were negative for CK (34βE12) and TFE-3. Follow-up data were available for 31 cases, 4 patients died of cancer specific causes, 1 with type-Ⅰand 3 with type-II tumors after surgery. The other 27 patients were alive without recurrence or metastasis. High Fuhrman grading, intravascular tumor emboli, lymph node metastasis and high clinical stage were prognostic indicators in PRCC. Conclusions PRCC with unique pathological features is not a common subtype of renal cell carcinoma in China. The presence of higher nuclear grade, sarcomatoid ele-ments or clear cell carcinoma structure may indicate an aggressive biologic behavior and poor prognosis. Close attention to the cytologic and growth pattern characteristics will allow us to arrive at the proper diagnosis in most cases, although sometimes immunohistochemis-try and rarely molecular genetic evaluation may be needed.
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Objective To evaluate the effect of the expression of P-glycoprotein (P-gp) in the tumor tissue on the analgesic efficacy of fentanyl and lornoxicam in patients with cancer pain. Methods One hundred advanced cancer patients with pain aged 49-64 yr weighing $$-65 kg were included in this study. The expression of Pgp was positive in the tumor tissue in 50 patients (groups F1 and L1, n = 25 each) and negative in 50 patients (groups F2 and L2, n = 25 each). The patients in 4 groups received 48 h of pstient-controlled intravenous analgesia (PCIA). A loading dose of fentanyl 0.05 mg was administered before PCIA was started in groups F1 and F2 .The PCIA solution contained fentanyl 1 mg and droperidol 5 mg in 100 ml of normal saline in groups Ft and F2, or lomoxicam 64 mg and droperidol 5 mg in 100 ml of normal saline in groups L1 and L2. The PCA pump was set to deliver a background infusion of 2 ml/h and a bolus dose of 0.5 ml at 15 min lockout interval. Pain was assessed with VAS scores (0 = no pain, 10 = worst pain), and VAS score was maintained at ≤3 during PCIA. Flurbiprofen 50 mg was injected intravenously when VAS score≥4 and the consumption of flurbiprofen was recorded. The consumption of fentanyl and lornoxicam during PCIA was recorded. Blood samples from the internal jugular vein were taken at the beginning of PCIA (T0), and at 4, 12, 24, 48 h of PCIA (T1-4) for determination of blood fentanyl and lornoxicam concentrations. Results Flurbiprofen was not used in groups F2, L1 and L2. The consumption of flurbiprofen was ( 184 ± 41 ) mg in group F1 . There was no significant difference in the consumption of fentanyl during PCIA between groups F1 and F2 ( P ＞ 0.05). Blood fentanyl concentrations were not detected at all the time points in groups F1 and F2 . The VAS score during PCIA ≤ 3 in groups L1 and L2, and there was no significant difference in blood concentrations of lornoxicam at each time point and the consumption of lornoxicam during PCIA between groups L1 and L2 ( P ＞ 0.05). Conclusion Positive P-gp expression in the tunor tissue can decrease the analgesic efficacy of fentanyl, but exerts no effect on the analgesic efficacy of lornoxicam in patients with cancer pain.
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Fifteen cases with atrial myxoma in our hospital from May 2001 to Dec 2008 were retrospectively analyzed.Patients presented with a variety of symptoms mimicking mitral valve disease,including palpitation, shortness of breath and activity intolerance.Pulmonary and systemic embolizations occurred in three patients and sudden syncope in one.Radiograph and echocardiography can help to reveal atrial myxoma.Definite diagnosis was made based on histological examinations.In 6 months - 6 years'follow-up one case recurred.Surgical treatment should be prompted once diagnosis established.Tumor pedicle must be completely removed to prevent recurrence.
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Objective To evaluate the effect of the expression of P-glycoprotein (P-gp) in tumor tissue on analgesic efficacy of morphine and buprenorphine in advanced cancer patients with pain. Methods One hundred and fifty advanced cancer patients with pain aged 51-64 yr weighing 54-65 kg were included in this study. The expression of P-gp was negative in the tumor tissue in 50 patients (group M1 and B1, n = 25 each) and positive in 100 patients (group M2 ,M3 ,and B2 ,B3, n =25 each). The PCA regimen for the 6 groups were listed in the table .Pain was assessed with VAS scores (0 = no pain, 10 = worst pain) and venous blood samples were taken for determination of blood morphine/buprenorphine concentrations at 4, 12, 24 and 48 h of PCIA. Results The six groups were comparable with respect to age, body weight, M/F sex ratio, types of cancer, baseline pain level and education. The analgesic efficacy of morphine and buprenorphine was better ( VAS scores were significantly lower)in P-gp expression negative patients (group M1 and B1 ) than in P-gp expression positive patients (group M2 and B2 ). Higher doses of morphine and buprenorphine provided better analgesic efficacy in P-gp expression positive patients in group M3 and B3 than in group M2 and B2. Plasma morphine and buprenorphine concentrations were comparable between group M1 , B1 and M2, B2 and were significantly higher in group M3 and B3 at each time point. Conclusion Positive P-gp expression in the tumor tissue can decrease the analgesic efficacy of morphine and buprenorphine in advanced cancer patients with pain.
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Objective To explore the mechanisln of action of Jianpiyishen Decotion on renal fibrosis and provide experimental evidence for chnieal application.Methods The Wistar male rats were randomly divided into four groups.They were normal control group(N group),model group(M group),low dose treatment group(L group)and high dose treatment group(H group).AⅡanimal models were made of CRF with subtotal renal ablation except the N group.Interference began at one week after operation.After being interfered for 8 weeks,blood serunl and nephridial tissues were taken out.Serum urea nitrogen(BUN)and creatinine(Scr)and fibronectin(FN)were detected.Results In N group。There were light expression in renal tubniointerstitial substance,cellula epithelialis basal meulbnule and Vascular smooth muscle.In M group,FN was strong expressed in renal tubulointerstitial substance and renal tubde,and also in glomerular mesangium.There was significant difference between N and M group(P<O.01).FN was medium expressed in renal tubuloinlerstitial substanceand renal tubule in L and H group.The expression of FN in L group was higher than that of N group(P<0.01)and lower than that of Mgroup(P<O.01).The expression of FL in H group was lower than that in L group(P<O.05).Condusion Jianpiyishen decotion can decrease eerum BUN and Cr ofCRF rats,restrain the expression of FN in kidney tissue.And it indicates that Jianpiyishen decotion is an effective herbal prescription for the treatment of CRF.The mechanism may be because it can restrain the expression of the cell factor such as FN in rats'kidney,and delay the progress of renal fibrosis and CRF.
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The vertebral artery dissection may be associated with the structural abnormalities of vascular wall or enviromental factors.The symptoms are usually caused by the luminal stenosis or the formation of blood clot,including the pain in posterior neck or mastoid region with local neurological deficits.The diagnostic methods for vertebral artery dissection include digital subtraction angiogaphy,magnetic resonance imaging,CT angiograpby and color Doppler ultrasonography.Anticoagulation is the main treatment option for most patients with vertebral artery dissection.
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Objective To discuss the differences and causes of earlier and later complications of nitinol stent implantation for patients with benign or malignant tracheobronchial stenosis.Methods Sixty patients with tracheobronchial stenosis analyzed retrospectively the incidence of earlier and later complications of nitinol stent implantation.Results In the earlier period,the incidence rate of postoperative hemoptysis of patients with malignant tracheobronchial stenosis was higher than that of benign patients, but its incidence of granulation tissue formation in airway was less than that of benign ones.In the later period, the incidence of pulmonary infection and granulation tissue formation of patients with malignant tracheobronchial stenosis were higher than those of benign ones. Conclusions It is more effective modus with nitinol stent implantation for patients with airway stenosis, but there were great differences of postoperative complications between malignant and benign tracheobronchial stenosis.
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By analyzing the traditional educational mode and subject of the higher medical education, the basic method and emphasis of the experimental class of the clinical medicine educational innovation have been established, and the general frame of the educational innovation content has been constructed, the executive essential point and point in the content of the educational innovation have been made. After several years of the practice and positive exploration, the class has achieved success.