The efficacy of different treatment modes for locoregional recurrence after nephrectomy in patients with renal cell carcinoma / 中华泌尿外科杂志

Objective:To investigate the efficacy of different treatment modes for locoregional recurrence after nephrectomy in patients with renal cell carcinoma.Methods:A total of 106 patients with locoregional recurrence after nephrectomy without distant metastasis (77 males and 29 females) admitted to Sun Yat-sen University Cancer Center from October 2001 to July 2020 were retrospectively analyzed. The median age was 51 (40, 60) years old. Radical nephrectomy was performed in 90 patients with primary tumor and partial nephrectomy was performed in 16 patients. Pathological diagnosis showed that 54 cases were clear cell carcinoma and 52 cases were non-clear cell carcinoma. 53 cases were in stage T 1-2 and 53 cases in stage T 3-4. The median diameter of recurrent lesions was 3.2 (2.0, 6.3) cm, and the median number was 2 (1, 4). The recurrence sites were divided into renal fossa recurrence (33 cases), renal fossa±retroperitoneal lymph node recurrence (38 cases), and intra-abdominal spread (35 cases). The median duration from primary surgery to local recurrence was 14.8 (7.3, 35.8) months. Two treatment groups were identified as systemic therapy alone (Group A) and local therapy with or without systemic therapy (Group B). The Kaplan-Meier method was used to compare the progression free survival (PFS) and overall survival (OS) between Group A and Group B. The Cox model was used to perform univariate and multivariate analysis. Results:Of all the 106 patients, 33 patients were in Group A and 73 patients were in Group B. In Group A, 29 patients (87.9%) received targeted therapy, and 4 patients (12.1%) received targeted therapy combined with immunotherapy. In Group B, 34 patients (46.6%) received surgery or ablation and 39 patients (53.4%) received SBRT, of which 62 patients (84.9%) received concurrent systemic therapy. Among them, 58 patients (93.5%) received targeted therapy, and 4 patients (6.5%) received targeted therapy combined with immunotherapy. The median follow-up period was 29.0 (15.4, 45.9) months, 64 patients progressed on tumor including 28 patients died. The median PFS and OS were 15.6 (7.1, 35.2) months and 66.9 (37.8, not reached) months. The median PFS of Group A and Group B were 7.6(5.0, 17.2)months and 22.2(9.6, 63.9)months respectively ( P=0.001), median OS of Group A and Group B were 45.7 (23.4, 62.8)months and 71.0(50.6, not reached)months respectively, and the 2-year OS were 70.6% and 85.5% in Group A and Group B respectively ( P=0.023). The univariate analysis showed local therapy with or without systemic therapy was significantly reduced 56% risk of tumor progression ( HR=0.44, P=0.003) and reduced 60% risk of death ( HR=0.40, P=0.028). The multivariate analysis showed that the OS was associated with ECOG score( HR=10.20, 95% CI 4.13-25.30, P<0.001)and local therapy( HR=0.23, 95% CI 0.09-0.58, P=0.002). Conclusion:Compared with systemic therapy alone, local therapy with or without systemic therapy can effectively improve the PFS and OS of patients with locoregional recurrence after nephrectomy.

Cell-loaded hydrogel microspheres based on droplet microfluidics: a review / 生物工程学报

Droplet microfluidics technology offers refined control over the flows of multiple fluids in micro/nano-scale, enabling fabrication of micro/nano-droplets with precisely adjustable structures and compositions in a high-throughput manner. With the combination of proper hydrogel materials and preparation methods, single or multiple cells can be efficiently encapsulated into hydrogels to produce cell-loaded hydrogel microspheres. The cell-loaded hydrogel microspheres can provide a three-dimensional, relatively independent and controllable microenvironment for cell proliferation and differentiation, which is of great value for three-dimensional cell culture, tissue engineering and regenerative medicine, stem cell research, single cell study and many other biological science fields. In this review, the preparation methods of cell-loaded hydrogel microspheres based on droplet microfluidics and its applications in biomedical field are summarized and future prospects are proposed.

Chaperone-mediated Autophagy Regulates Cell Growth by Targeting SMAD3 in Glioma / 神经科学通报·英文版

Previous studies suggest that the reduction of SMAD3 (mothers against decapentaplegic homolog 3) has a great impact on tumor development, but its exact pathological function remains unclear. In this study, we found that the protein level of SMAD3 was greatly reduced in human-grade IV glioblastoma tissues, in which LAMP2A (lysosome-associated membrane protein type 2A) was significantly up-regulated. LAMP2A is a key rate-limiting protein of chaperone-mediated autophagy (CMA), a lysosome pathway of protein degradation that is activated in glioma. We carefully analyzed the amino-acid sequence of SMAD3 and found that it contained a pentapeptide motif biochemically related to KFERQ, which has been proposed to be a targeting sequence for CMA. In vitro, we confirmed that SMAD3 was degraded in either serum-free or KFERQ motif deleted condition, which was regulated by LAMP2A and interacted with HSC70 (heat shock cognate 71 kDa protein). Using isolated lysosomes, amino-acid residues 75 and 128 of SMAD3 were found to be of importance for this process, which affected the CMA pathway in which SMAD3 was involved. Similarly, down-regulating SMAD3 or up-regulating LAMP2A in cultured glioma cells enhanced their proliferation and invasion. Taken together, these results suggest that excessive activation of CMA regulates glioma cell growth by promoting the degradation of SMAD3. Therefore, targeting the SMAD3-LAMP2A-mediated CMA-lysosome pathway may be a promising approach in anti-cancer therapy.

Multi-disciplinary management for metastatic renal cell carcinoma in the ear of targeted therapy: a single center experience / 中华泌尿外科杂志

Objective@#To report the experience on the multi-disciplinary management of metastatic renal cell (mRCC) patients in a single center.@*Methods@#Data of 168 mRCC patients treated by multi-disciplinary team (MDT) at Sun Yat-sen University Cancer Center from December 2007 to February 2019 was retrospectively analyzed.Three treatment groups were identified, including 76 patients with 55 males and 21 females, received anti-angiogenic agents alone (Group A), 66 patients with 55 males and 11 males, received anti-angiogenic agents plus local therapy (Group B)and 26 patients, with 19 males and 7 females, received anti-angiogenic agents plus immunotherapy and local therapy (Group C). The Sunitinib, Sorafenib, Axitinib were chosen for the TKI. The Pembrolizumab was used for immunotherapy. The stereotactic body radiation therapy and surgical excision were considered as the local therapy. The study aims to compare the age, gender, IMDC score, pathology, nbephrectomy, adverse events, progression-free survival and overall survival (OS).@*Results@#Of all patients, the median follow-up duration was 23 months (ranging 6-117 cmonths). The PFS was 18.3 months and median OS was 33.5 months. The 2 years and 5 years survival rate was 66% and 35%, respectively. The median OS of Group A, B and C were 29.8 months, 44.6 months and not reached. 2y-OS was 58%, 67% and 89%, while 5y-OS 12%, 46% and 57%.There was no difference in age, gender, IMDC score, pathology, synchronous metastases or nephterectomy between the three groups. The prognostic result in TKI based combination therapy was superior to TKI therapy alone, which the 5y-OS was 51% and 11%, respectively. The prognostic result in group C's moderate-high risk mRCC patients was superior to group A and B. The median OS in TKI+ DC and CIK+ Pembrolizumab was 49.1 months and 53.1 months. On univariate analyses, IMDC score, nephrectomy and treatment group was associated with OS (P<0.05). On multivariate analyses, treatment group, nephrectomy was associated with OS (P<0.05). The risk of death of Group C decreased about 60% [HR 0.39 (0.17, 0.89), P=0.026]. 78 (46.4%) patients on TKI alone and 16 (61.5%) patients treated with TKI plus immunotherapy had Grade 3 or 4 adverse events. 16 (20.3%) patients had Clavien Ⅲ-Ⅳ toxicity after surgical procedures. 6 (5.7%) patients had Grade 3 toxiciy after SBRT.@*Conclusions@#Patients treated with combined therapy had better survival than those treated with anti-angiogenic agents alone. MDT approach could bring survival benefit to mRCC patients.

Clinical analysis of TKIs combined with SBRT in the treatment of renal cell carcinoma with bone metastasis / 中华泌尿外科杂志

Objective:To evaluate the efficacy and safety of Tyrosine Kinase Inhibitors (TKIs) combined with stereotactic body radiation therapy(SBRT) in the treatment of renal cell carcinoma (RCC) patients with bone metastasis.Methods:The clinical data of 80 RCC patients with bone metastasis in Sun Yat-sen University Cancer Center from April 2010 to April 2020 were analyzed retrospectively. Among them, 64 patients were medium or high risk according to the International Metastatic Renal Cell Carcinoma Database Consortium(IMDC) score. Twenty-four patients received TKI therapy alone(Group A), and the other 56 cases received TKIs combined with SBRT to bone metastastic lesions (Group B).Results:The median follow-up period was 20.7 months (4.8-115.6 months), 70 patients received second or third-line targeted drug therapy, and 4 patients in group A and 15 patients in group B received TKI plus immunotherapy. Fifty-four patients had symptoms of bone pain before radiotherapy, 46 patients were satisfied with the analgesic effect after SBRT treatment. Twelve patients got complete response (CR) after bone lesions, and 32 patients achieved partial response (PR). Forty patients died of disease progression during follow-up. The median OS was: 20.7 months vs not reached(Group A vs. Group B), and the 2-y OS and 5-y OS were 50% vs. 62%, and 19% vs. 56%, respectively ( P=0.006). There were only 2 patients (3.6%) had grade 3 SBRT related adverse events. Conclusions:SBRT combined with TKIs improved the quality of life and prolonged the overall survival of RCC patients with bone metastasis.

Factors predicting 2014 ISUP pathology grade upgrading from prostate biopsy to radical prostatectomy pathology / 中华泌尿外科杂志

Objective To investigate the risk factors predicting pathology grade upgrading after radical prostatectomy using the 2014 International Society of Urologic Pathology (ISUP) grading system.Methods A total of 205 patients who underwent biopsy and radical prostatectomy from January 2017 to December 2018 were reviewed retrospectively.The median and range of the patients' age,PSA level,prostate volume,number of biopsy core examined,Gleason score and ISUP grade were 66 (45-81) years old,17.16(0.89-1254.00)ng/ml,36.4(4.1-152.1) rnl,10(1-15),7(6-10),and 3(1-5) respectively.The patients were divided into group of upgrading ISUP grade and group without upgrading ISUP grade.Multivariate Logistic regression analysis and receiving operating characteristic curve analysis were performed to identify predictors of ISUP upgrading and determine the optimal cut off value respectively.Result The median and range of Gleason score and ISUP grade after radical prostatectomy were 7 (6-10),and 3 (1-5) respectively.The radical prostatectomy ISUP grade upgraded in 73 (35.6％) out of 205 cases when compared with biopsy ISUP grade.Radical prostatectomy ISUP grades were concordant in 91 cases (44.4％) and downgraded in 41 cases(20.0％).Of 101 with biopsy ISUP grades less than or equal to 2,the ISUP grade of radical prostatectomy upgraded in 58 cases (57.4％),while radical prostatectomy ISUP grade upgraded in only 18 (26.9％) of 67 patients with biopsy ISUP grades of 3 or 4.Biopsy ISUP grades represent an independent predictor for ISUP grade upgrading after radical prostatectomy (OR =0.496,P ＜ 0.001).Conclusion Patients with biopsy ISUP grades less than or equal to 2 are at great risk of ISUP grade upgrading after radical prostatectomy.

Multi-disciplinary management for metastatic renal cell carcinoma in the ear of targeted therapy: a single center experience / 中华泌尿外科杂志

Objective To report the experience on the multi-disciplinary management of metastatic renal cell (mRCC) patients in a single center.Methods Data of 168 mRCC patients treated by multidisciplinary team (MDT) at Sun Yat-sen University Cancer Center from December 2007 to February 2019 was retrospectively analyzed.Three treatment groups were identified,including 76 patients with 55 males and 21 females,received anti-angiogenic agents alone (Group A),66 patients with 55 males and 11 males,received anti-angiogenic agents plus local therapy (Group B)and 26 patients,with 19 males and 7 females,received anti-angiogenic agents plus immunotherapy and local therapy (Group C).The Sunitinib,Sorafenib,Axitinib were chosen for the TKI.The Pembrolizumab was used for immunotherapy.The stereotactic body radiation therapy and surgical excision were considered as the local therapy.The study aims to compare the age,gender,IMDC score,pathology,nbephrectomy,adverse events,progression-free survival and overall survival (OS).Results Of all patients,the median follow-up duration was 23 months (ranging 6-117 cmonths).The PFS was 18.3 months and median OS was 33.5 months.The 2 years and 5 years survival rate was 66％ and 35％,respectively.The median OS of Group A,B and C were 29.8 months,44.6 months and not reached.2y-OS was 58％,67％ and 89％,while 5y-OS 12％,46％ and 57％.There was no difference in age,gender,IMDC score,pathology,synchronous metastases or nephterectomy between the three groups.The prognostic result in TKI based combination therapy was superior to TKI therapy alone,which the 5y-OS was 51％ and 11％,respectively.The prognostic result in group C's moderate-high risk mRCC patients was superior to group A and B.The median OS in TKI + DC and CIK + Pembrolizumab was 49.1 months and 53.1 months.On univariate analyses,IMDC score,nephrectomy and treatment group was associated with OS (P ＜ O.05).On multivariate analyses,treatment group,nephrectomy was associated with OS (P ＜ O.05).The risk of death of Group C decreased about 60％ [HR O.39 (0.17,0.89),P =O.026].78 (46.4％)patients on TKI alone and 16 (61.5％) patients treated with TKI plus immunotherapy had Grade 3 or 4 adverse events.16 (20.3％) patients had Clavien IⅢ-V toxicity after surgical procedures.6 (5.7％) patients had Grade 3 toxiciy after SBRT.Conclusions Patients treated with combined therapy had better survival than those treated with anti-angiogenic agents alone.MDT approach could bring survival benefit to mRCC patients.

Clinical characteristic and prognosis of primary renal sarcoma in adults / 中华泌尿外科杂志

Objective To investigate the clinical manifestations,imaging and pathological features and treatment prognosis of primary renal sarcoma in adults.Methods A retrospective analysis was performed on the clinical data of 48 patients with primary renal sarcoma from January 2009 to December 2018 in the first affiliated hospital and cancer center of Sun Yat-Sen university.There were 30 males and 18 females.Their aged ranged from 27 to 76 yrs with an average age of 50 yrs.A total of 24 patients presented with lumbar and abdominal pain.Abdominal mass was found in 2 cases.Gross hematuria was noticed in 4 cases.Febrile was recorded in 2 cases and 21 cases were diagnosed by physical examination.31 tumors located in the left kidney and 17 tumors located in the right kidney.The tumor diameter ranged from 3 to 16 cm with an average diameter of 8 cm.All patients underwent ultrasound or CT/MRI examination of the urinary system before surgery.The ultrasound showed the undistributed echo inside the tumor with the undistinguished border.The image of necrosis and liquefaction could be seen in some cases.The CT/MRI examination showed the lesion site with the necrosis,liquefaction or cystic changing.The mass exhibited the unregular enhancement with undistinguished border line.The mean diameter of liposcarcoma was 10.2 cm.CT scan demonstrated the relative low density of tumor,which was hard to be identified with AML.The average diameter of leiomyosarcoma was 6.5 cm.The enhanced CT scan showed the low density of tumor,compared with renal parenchyma.46 patients underwent radical nephrectomy,2 patients underwent renal tumor biopsy.And postoperative follow-up was performed.Results Pathological diagnosis revealed that 19 cases with liposarcoma,9 cases with leiomyosarcoma and 4 cases with synovial sarcoma,especially 4 cases with Ewing' s sarcoma and 12 cases with other sarcoma.36 cases were followed up and survived for 4 to 64 months.The average survival time was 28 months.The longest mean survival time was seen in patients with liposarcoma,which was 32 months (ranging 11 to 64 months).The mean survival time of synovial sarcoma group was 25 months (ranging 5-58 months).The mean survival time of Ewing's sarcoma group was 22 months(ranging 12-46 months).and the survival time of leiomyosarcoma group was the shortest 20 months (ranging 4-36 months).Conclusion Renal sarcoma is rare and highly malignant.It needs to be diagnosed with clinical manifestations,imaging and pathological data together.

Comparison of clinical values in decision making between cone beam CT and conventional approach in furcation involvement of maxillary molar / 中华口腔医学杂志

Objective@#To compare the use of cone beam computed tomography (CBCT) and conventional approach (clinical probing and periapical radiograph) in assessing furcation involvement (FI) of maxillary molars and making treatment decisions.@*Methods@#Thirty-two subjects were selected from the pool of patients at the Department of Periodontology, Tianjin Stomatology Hospital & Hospital of Stomatology, NanKai University from January 2015 to December 2016. All the patients have a diagnosis of generalized chronic periodontitis. Ninety-five maxillary molar with FI from the radiography database were analysed. Two doctors used conventional approach and CBCT images to assess FI and make treatment decision respectively. If the clinical and radiographic findings did not clearly indicate a distinct periodontal therapy, two treatment options were considered.@*Results@#There was statistical difference of the FI diagnosis between traditional group and CBCT group assessment of the 95 molars (P=0.000). Thirty-five maxillary molars (36.8%, 17 patients) got two treatment recommendations by conventional approach but 7 (7.4%, 5 patients) by CBCT-based approach. When with the less invasive treatment recommendation, there was statistical difference between conventional approach and CBCT-based approach (P=0.001). An agreement was observed in 63.2% (60/95) of the teeth, while in another 29.5% (28/95) the CBCT-based treatment decision was more invasive than the conventional approach. When with the more invasive treatment recommendation, there was also statistical difference between two approaches (P=0.045). An agreement was observed in 86.3% (82/95) of the teeth, while in another 3.2% (3/95) the CBCT-based treatment decision was more invasive than the conventional approach.@*Conclusions@#CBCT images of maxillary molars may provide detailed information of FI and a reliable basis for treatment decision.

A exploration of the optimization for dispensing speed of automatic dispensing machine in outpatient pharmacy / 中国医学装备

Objective:To optimize the storage placement of drug in automatic dispensing machine so as to increase the dispensing speed and work efficiency.Methods: The drugs were dispensed on the up and down side of the center of axle wire from high to low according to the dispensed frequency. The application regularity of various drugs was analyzed by using a number of prescription information and the relevant drugs were stored in nearest tank aroundthe drug outlet as the principle of minimum time algorithm. Through optimizing the storage placement of automatic dispensing machine and applying average dispensing time as evaluation index, the change of average dispensing time between before and after 3 months of the optimization of storage placement was analyzed.Results: After the storage placement was optimized, average dispensing time was shortened 2.0s. And the difference of the time between before and after optimization was statistically significant (t=11.92,P<0.05). Conclusion: Through applying minimum time algorithm, the optimized storage placement of automatic dispensing machine shortens the dispensing time of prescription and increases work efficiency.

Clinical outcome of postchemotherapy retroperitoneal lymph node dissection and predicting retroperitoneal histology in advanced nonseminomatous germ cell tumours of the testis / 中华外科杂志

Objective@#To explore the clinical outcome of advanced testicular nonseminomatous germ cell cancer patients undergoing post chemotherapy retroperitoneal lymph node dissection (PC-RPLND), and to analyze the relevant prognostic factors of lymph node pathological.@*Methods@#A total of 43 consecutive testicular nonseminomatous germ cell cancer patients underwent PC-RPLND between March 2001 and December 2014 in Department of Urology at Sun Yat-sen University Cancer Center were retrospectively reviewed. The average age of the patients was (29.0±11.5) years (ranging from 12 to 58 years). Before PC-RPLND, 22 patients were classified as phase Ⅱ, while 21 were phase Ⅲ. Primary tumor histology revealed seminomatous elements in 19 cases, embryonal cell carcinoma in 22 cases, yolk sac tumor in 13 cases, chorionic carcinoma in 3 cases, mature teratomatous elements in 11 and immature teratomatous elements in 2 cases. Patients were treated with cisplatin-based chemotherapy after orchectomy and then underwent surgical resection of retroperitoneal lymph nodes.After PC-RPLND, all patients underwent a periodic review including the blood routine, biochemistry routine and computed tomography or ultrasonograph of the chest, the abdomen and the pelvis. The association of pathological data with patient′s clinic features and the correlations between molecular features detected with each other were assessed by the t test, χ2 and Fisher′s exact test. Multivariate logistic regression were used to assess prognostic factors.@*Results@#The median operative time was 278 minutes (ranging from 50 to 715 minutes). Median blood loss was 425 ml (ranging from 50 to 5 000 ml). Eight patients received blood transfusion intra-operatively, 2 patients underwent adjunctive surgical procedures, 4 patients developed ileus and 4 had an ascites chylosus following PC-RPLND, 1 patient had a postoperative hyperthermia and retrograde ejaculation was present in 10 patients. The transverse diameter of the residual tumor in patients ranged from 0.8 to 18.2 cm. Necrosis, teratoma and viable germ cell tumors were found in 15, 17 and 11 of all patients. The median follow-up time was 46 months (ranging from 6 to 169 months). There were 39 patients had no tumor recurrence, 7 patients were found recurrence after PC-RPLND, 5 died of malignant germ cell tumor. The normal serum lactate dehydrogenase (LDH) level before chemotherapy (HR=25.811, 95%CI: 0.678 to 982.624, P=0.017) and relative changes more than 50% in retroperitoneal lymph node size (HR=0.016, 95%CI: 0 to 0.698, P=0.032) were statistically significant prognostic factors of the presence of necrosis.@*Conclusions@#Since most residual masses are not sensitive to chemotherapy, PC-RPLND is still an essential part of the treatment of metastatic testicular nonseminomatous germ cell cancer. Patients with the normal serum LDH level before chemotherapy and a shrinkage of 50% or more in retroperitoneal mass have a considerably chance of having necrosis in the retroperitoneum resection. This may help to refine the selection of candidates for PC-RPLND.

Accuracy of computer aided measurement for detecting dental proximal caries lesions in images of cone-beam computed tomography / 中华口腔医学杂志

Objective@#To establish and validate a computer program used to aid the detection of dental proximal caries in the images cone beam computed tomography (CBCT) images. @*Methods@#According to the characteristics of caries lesions in X-ray images, a computer aided detection program for proximal caries was established with Matlab and Visual C++. The whole process for caries lesion detection included image import and preprocessing, measuring average gray value of air area, choosing region of interest and calculating gray value, defining the caries areas. The program was used to examine 90 proximal surfaces from 45 extracted human teeth collected from Peking University School and Hospital of Stomatology. The teeth were then scanned with a CBCT scanner (Promax 3D). The proximal surfaces of the teeth were respectively detected by caries detection program and scored by human observer for the extent of lesions with 6-level-scale. With histologic examination serving as the reference standard, the caries detection program and the human observer performances were assessed with receiver operating characteristic (ROC) curves. Student t-test was used to analyze the areas under the ROC curves (AUC) for the differences between caries detection program and human observer. Spearman correlation coefficient was used to analyze the detection accuracy of caries depth. @*Results@#For the diagnosis of proximal caries in CBCT images, the AUC values of human observers and caries detection program were 0.632 and 0.703, respectively. There was a statistically significant difference between the AUC values (P=0.023). The correlation between program performance and gold standard (correlation coefficient rs=0.525) was higher than that of observer performance and gold standard (rs=0.457) and there was a statistically significant difference between the correlation coefficients (P=0.000). @*Conclusions@#The program that automatically detects dental proximal caries lesions could improve the diagnostic value of CBCT images.

The value of early electronic bronchoscopy on patients with nonresponding pneumonia / 实用医学杂志

Objective To investigate the effect and safety of early electric bronchoscope on patients with nonresponding pneumonia. Method Seventy non responding pneumonia patients were selected from our hospital , who received treatments from January 2015 to April 2016.According to the random table ,patients were randomly divided into the observation group(34 cases)and the control group(36 cases). According to the experience and sputum culture results,patients in the control group were given the conventional therapy,and patients in the observation group were given bronchoscope and transbronchil lung biopsy(TBLB). The effect of bronchoscopy,the treatment curative effect,duration of fever,the period of the elevated CRP dropped to baseline,the length of hospital stay and medical costs were compared between the two groups. Results The diagnostic rate of bronchoscopy and the positive rate of airway suction bacterial culture in the observation group were similar with those in the control group,with no significant differences. The positive rate of airway suction bacterial culture was significantly higher than that of sputum culture in the observation group. The positive rate of airway suction bacterial culture was higher than that of sputum culture in the control group ,but with no significant difference.The total effective rate in the observation group(87.1%)was significantly higher than that in the control group(58.8%). The duration of fever and the time of the elevated CRP dropped to baseline in the observation group were significantly shorter than those in the control group. The hospital stay and hospital costs in the observation group were also significantly lower than those in the control group. Conclusion Early bronchoscopy can obtain diagnosis evidence of etiology and histology and improve the diagnostic rate,meanwhile,it also has a therapeutic effect.It can improve the clinical treatment effect and shorten the healing time and the cost of hospitalization. In addition , early electronic bronchoscopy has fewer adverse reactions and it may play an important role in diagnosis and treatment on nonresponding pneumonia patients.

Clinicopathologic and prognostic analysis of papillary renal cell carcinoma / 中华泌尿外科杂志

Objective The aim of this study is to summarize the clinicopathologic characters and factors associated with prognosis of papillary renal cell carcinoma.Methods We treated 72 papillary renal cell carcinoma by surgery from August 2001 to February 2013,which account for 7.2％ of all renal cancer patients (72/1005 cases).There were 60 male and 12 female patients included in this study,with a median age of 50 (ranging from 21-75).The median tumor diameter was 5.8cm (ranging from 4 to 8cm).Fifth-two patients were asymptomatic,14 patients presented with hematuria and 6 presented with backache.In the 72 patients,63 received (87.5％) open surgery and 9 cases (12.5％) underwent laparoscopic surgery.Fortyeight patients (66.7％) were treated with radical nephrectomy and 24 patients (33.3％) were treated with partial nephrectomy.In the current study,we summarized the clinical and pathological records and follow-up data.Cox regression analysis were performed to identify the independent predictors for cancer specific survival.Results Local lymph nodes were involved in 16 cases and distal metastasis was found in 2 cases.There were 11 cases (15.3％) of type Ⅰ papillary renal cell carcinoma and 61 cases (84.7％)of type Ⅱ.All type Ⅰ cases were determined as Fuhrman grade Ⅰ and all type Ⅱ tumor were determined as Fuhrman grade Ⅱ-Ⅳ,including grade Ⅱ in 36 cases,grade Ⅲ in 15 cases and grade Ⅳ in 30 cases.With a median follow-up duration of 35 months (ranging from 7 to 146 months),10 patients died due to renal cancer,1 died due to heart failure and the rest 61 was alive.The cancer specific survival at five years for the whole group was 78.6％ (100.0％ in type Ⅰ and 75.5％ in type Ⅱ).The 5 year cancer specific survival rate for patients with Fuhrman grade Ⅰ-Ⅳ was 100.0％,83.5％,78.8％ and 31.3％,respectively.Cox regression analysis revealed that tumor diameter (hazard ratio 1.141,P =0.019) and Fuhrman grade (hazard ratio 3.034,P =0.004) were independent prognostic factors for cancer specific survival.Conclusions Type Ⅱ papillary renal cell carcinoma has more aggressive characters and poorer prognosis compared with type Ⅰ.Tumor diameter and Fuhrman grade were independent prognostic factors for cancer specific survival.

One case of chromosome 4q21/22 deletion syndrome / 临床儿科杂志

Objective To enhance the understanding of clinical characteristics and genetic testing of chromosome 4q21/q22 deletion syndrome. Methods Chromosomal microarray analysis was used to detect genetic change in a child with special facial appearance and development delay. Results A 15.26-Mb deletion containing 76 geinges in chromosome 4q21.21q22.2 was identiifed. Thus, this girl was diagnosed as chromosome 4q21/q22 deletion syndrome. Conclusions Chromosome 4q21/q22 deletion syndrome has varied clinical manifestations including typical characteristics (such as absolute or relative macrocephaly, megalencephaly with a characteristic head shape and facial appearance, profound hypotonia, small hands and feet, short limbs, feeding difficulties), mental retardation/severe developmental delay, and other system abnormalities ( such as congenital heart disease, seizure, kidney cysts, etc). The diagnosis of chromosome 4q21/q22 deletion syndrome relies on chromosomal microarray analysis.

Use of posterior or anterior renal lip incision for partial nephrectomy in the treatment of renal hilum endophytic renal cell carcinoma / 中华泌尿外科杂志

Objective To introduce our experience of performing posterior or anterior renal lip incision for partial nephrectomy in the treatment of renal hilum endophytic renal cell carcinoma.Methods From Jan.2010 to Jan.2014,five female patients with renal hilum tumors were treated in our institute.The median age was 54 (51-72) years.The median tumor diameter was 4.0 (2.8-4.8) cm.The median preoperative creatinine was 53.9 (52.6-75.4) μmol/L.One of them was solitary kidney with absolute indication; three cases had basic disease with relative indication; one was with selective indication.The patients were put in supine or lateral position.After general anesthesia,we preformed partial nephrectomy by cutting posterior renal lip in 3 cases and the anterior lip in 2 cases.We clamped the renal artery,opened the renal posterior or anterior lip,then dissected the tumor beside the pseudo-capsule.After removing the tumor,we used 3-0 absorption suture to control bleeding and repair the opened collecting system.Finally,we used 2-0 absorption suture to close the renal defect.Results The median operation time was 195 (155-215) min; the median renal warm ischemia time was 35 (15-70) min; the median postoperative hospital stay was 8 (7-9) d.There was no secondary bleeding and urine leakage happened.The pathological results showed that 3 cases with clear cell carcinoma,1 with papillary carcinoma and 1 with renal medullary interstitial cell tumor.All patients showed normal kidney shape.The median postoperative creatinine was 63.0 (59.4-75.4) μmol/L.After a median follow up of 24.2 mon,all patients survive without tumor recurrence.Conclusions The short-term result of posterior or anterior renal lip incision partial nephrectomy in treating endophytic renal hilum endophytic renal cell carcinoma is safe and feasible.

EnCor vacuum assisted minimally invasive rotary cutting technology in the ultrasonic BIRADS 2~3 level analysis of diagnosis and treatment of breast diseases / 中国医师杂志

Objective To study the EnCor vacuum negative pressure rotary system in ultrasonic BI-RADS 2~3 scale mammary gland disease application value.Methods Under the guidance of ultrasound, the application EnCor vacuum negative pressure rotary cutting system for 142 patients, 366 cases of breast lesion resection, specimens sent to pathological examination.Results A total of 366 breast lesions, 359 complete resection, the success rate was 98.1%, 2 transit operation, and transfer rate was 0.5%, 5 partial nephrectomy, residual rate was 1.4%.359 complete resection of the pathological results for breast malignant lesions in 4, the infiltrating ductal carcinoma 1, 3 ductal carcinoma in situ;breast benign lesions in 355, of which 132 breast fibroadenoma, adenosis with adenoma formation of 60, 99 breast adenosis, breast adenosis with duct expansion 43, 11 breast intraductal papilloma, one with four individual catheter atypical increase the living.Two transit operation pathological results were fibroadenoma, 5 disease of partial nephrectomy for adenosis with duct expansion.Conclusions The excision of breast neoplasm EnCor vacuum negative pres-sure rotary cutting system, not only small trauma, good cosmetic effect, and reduce misdiagnosis and im-prove the patients'satisfaction.

Outcomes of percutaneous coronary intervention for intermediate coronary artery disease guided by intravascular ultrasound or fractional flow reserve / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the long-term clinical outcomes of fractional flow reserve (FFR)-guided versus intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) for intermediate coronary lesions.</p><p><b>METHODS</b>A total of 226 patients with 293 intermediate coronary artery lesions (stenosis of 40%-70%) confirmed by coronary angiography were randomized into 3 groups to undergo PCI for a minimal lumen cross sectional area (MLA)<4 mm(2) (IVUS group, 98 lesions) or for a FFR<0.80 (FFR group, 101 lesions), or to receive standard medical treatment (medication group, 94 lesions). The primary outcome was major adverse cardiac events including death, myocardial infarction, and ischemia-driven target vessel revascularization at 1 year after the index procedure.</p><p><b>RESULTS</b>The baseline percent diameter stenosis and lesion length were similar between the 3 groups, but more patients in IVUS group than in FFR group received PCI (P<0.001). No significant difference was found in the incidence of major adverse cardiac events between the 3 groups (P=0.182).</p><p><b>CONCLUSION</b>Both FFR- and IVUS-guided PCI strategy for intermediate coronary artery disease are associated with favorable outcomes, but IVUS-guided PCI based on the single index of MLA can increase the rate of revascularization therapy.</p>

Efficacy of radical cystectomy plus adjuvant intraarterial chemotherapy with gemcitabine and cisplatin on locally advanced bladder cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Bladder cancer is the ninth most common cancer in the world; fewer than 15% of transitional-cell carcinoma patients survive 2 years if left untreated. Although radical cystectomy is the standard treatment of choice, much of them relapse and the necessity of adjuvant chemotherapy is still under debate. The aim of the study was to evaluate the efficacy of adjuvant intraarterial chemotherapy (IAC) with gemcitabine and cisplatin (GC) on locally advanced bladder cancer.</p><p><b>METHODS</b>This is a retrospective study on 60 patients with locally advanced bladder carcinoma who underwent radical cystectomy between May 2000 and June 2011. Patients were studied in two groups based on IAC and followed up for up to 5 years.</p><p><b>RESULTS</b>Among 60 patients, there were 25 patients who underwent IAC (GC) after radical cystectomy (the IAC group) and 35 patients who underwent radical cystectomy alone (the control group). Although not significant, the relapse rates were slightly reduced in the IAC group than in the control group. Patients with IAC had a reduction in mortality compared with patients without IAC over 5 years. Specifically, IAC significantly reduced about 82% of mortality within the first year (hazard ratio = 0.18, 95% CI 0.03-0.97, P = 0.04). Additionally, IAC was well tolerated and safe. The most common adverse effect was transient myelosuppression (10/25, 40%), which was resolved by various medical treatments.</p><p><b>CONCLUSIONS</b>Compared with radical cystectomy alone, radical cystectomy in combination with adjuvant IAC moderately but significantly reduces 1-year mortality. Our preliminary data showed only marginal benefit for the early survival. However, a randomized clinical study is needed to determine the long-term survival benefit.</p>

Dynamic changes of tear fluid matrix metralloproteinase-9 within 1 year after laser in situ keratomileusis / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the dynamic changes of matrix metalloproteinase-9 (MMP-9) level in tear fluid within 12 months after laser in situ keratomileusis (LASIK).</p><p><b>METHODS</b>Twenty-two myopic patients undergoing uneventful LASIK were enrolled in this study. Tear fluid samples were collected from the patients for measurements of MMP-9 level using Western blotting preoperatively, at 7 and 14 days, and at 1, 2, 3, 6, and 12 months after the surgery.</p><p><b>RESULTS</b>MMP-9 concentrations in the tear fluid of post-LASIK patients showed a time-dependent variation pattern. MMP-9 reached its peak level in the tear fluid at 14 days postoperatively, which was 2.70 times the preoperative level; it gradually decreased thereafter but was still 1.38 times the preoperative level at 12 months after the surgery.</p><p><b>CONCLUSIONS</b>MMP-9 concentrations in the tear fluid of post-LASIK patients show a time-dependent variation pattern and remains higher than the preoperative level even at 12 months after the surgery, suggesting that corneal wound healing after LASIK lasts for more than 12 months.</p>