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Objective: To investigate the impact of gallbladder cholesterolosis on the morphology of gallstones. Methods: The patients with gallstone who underwent cholecystectomy at the Gallstone Disease Center of East Hospital Affiliated to Tongjin University from December 2020 to October 2021 were retrospectively included. The patients were divided into the case group (sludge-like) and the control group (non-sludge-like stone), based on gallstone morphology. Clinical baseline characteristics between the two groups were compared. The related factors influencing gallstone morphology were analyzed using multivariate logistic regression analysis. Results: A total of 110 patients were included, with 30 cases in the case group (13 males, 17 females), aged 26-73 (54±14) years, 80 cases in the control group (24 males, 56 females), aged 18-75 (45±13) years. The age of the case group was higher than that of the control group ( P =0.003). The occurrence rate of occult pancreaticobiliary reflux (OPBR) was higher in the case group compared to the control group [33.3% (10/30) vs 13.8% (11/80), P =0.020]; the occurrence rate of gallbladder cholesterolosis was lower in the case group compared to the control group [30.0% (9/30) vs 73.8% (59/80), P <0.001]. The results of multivariate logistic regression analysis showed that gallbladder cholesterolosis ( OR =0.19, 95% CI : 0.07-0.49, P =0.001) was a significant factor associated with sludge-like stones. Conclusion: Gallbladder cholesterolosis can cause the formation of different forms of cholecystolithiasis, and promote the occurrence and development of "solid stones".

Acute respiratory distress syndrome (ARDS) continues to cause significant morbidity and mortality worldwide. However, there are currently no corresponding specific medications. Lung, right heart, and diaphragm protective therapy is the cornerstone of ARDS management. Non-invasive, radiation-free, and transportation-free point-of-care ultrasound enables for real-time dynamic evaluation of the lung, right heart, and diaphragm. It is an essential tool for the diagnosis, monitoring, and clinical decision-making of ARDS patients. However, ultrasound has several limitations, and its clinical application must be carefully evaluated in conjunction with clinical symptoms and other monitoring techniques. Further research is needed to determine whether clinical decision-making based on point-of-care ultrasound examination can improve the prognosis of ARDS patients.

Objective: To develop a simple screening questionnaire for persistent postural-perceptual dizziness (PPPD) and evaluate its screening ability. Methods: A convenience sample of 296 individuals who met the inclusion criteria between November 2021 and January 2023 were prospectively selected for three rounds of screening at the Vertigo Specialty Clinic of the Department of Otorhinolaryngology-Head and Neck Surgery in the First Hospital of Shanxi Medical University. In conjunction with expert opinion and statistical analysis, the first and second rounds of screening were used to modify and finalize the questionnaire entries, and the third round of screening was used to evaluate the questionnaire's screening ability. Independent sample t -test was used for inter group comparison, reliability and validity indicators were employed to screen and evaluate questionnaire entries, and the receiver operating characteristic (ROC) curve was plotted to determine the optimal cut-off value and corresponding sensitivity and specificity. Results: The final PPPD screening questionnaire entries included 21 items. In evaluating the reliability of this questionnaire, the Cronbach's alpha coefficient was 0.831, the half folding coefficient was 0.742, the content validity was 0.86, and the Kaiser-Meyer-Olkin (KMO) value in the structural validity was 0.811. Additionally, there were six factors with characteristic root>1 and a cumulative contribution rate of 62.62%. The area under the ROC curve of the screening questionnaire was 0.935 (95% CI : 0.877-0.992), and the optimal cut-off value was 8.5, with a sensitivity of 85.0%, a specificity of 85.5%, and a Kappa value of 0.653. Conclusion: The PPPD simple screening questionnaire designed in this study has a high sensitivity and specificity, making it a useful tool for identifying PPPD patients.

Objective: To explore the association between gallbladder adenomyomatosis (GA) and occult pancreaticobiliary reflux (OPBR). Methods: A total of 81 patients with GA who underwent cholecystectomy in Shanghai East Hospital from December 2020 to January 2022 were enrolled, including 48 cases of fundal type, 28 cases of segmental type and 5 cases of diffuse type. Patient's intraoperative bile was coltected and tested for amylase. According to gallbladder bile amylase level, patients were divided into OPBR group (bile amylase>110 U/L) and the control group (bile amylase≤110 U/L). Results: Among 81 patients, 32 were male and 49 were female, and aged (49.1±13.2) years; there were 66 cases in control group, including 27 males and 39 females, and aged (50.0±12.9)years; there were 15 patients in the OPBR group, including 5 males and 10 females, and aged (45.1±14.2) years. In terms of the clinical features of the two groups, there was no significant difference (all P >0.05), except for a significant increase in biliary amylase in the OPBR group compared with the control group ( P <0.001). However, the incidence of OPBR was significantly different in the three types of GA, with a lower incidence of OPBR in the fundal type (10.4%, 5/48) than in the segmental type (28.6%, 8/28) and diffuse type (2/5) ( P =0.038). In addition, segmental GA was more likely to be combined with gallbladder stones (85.7%, 24/28) than fundal GA (58.3%, 28/48) and diffuse GA (3/5) ( P =0.031). Univariate and multivariate logistic regression analyses showed OPBR [ OR (95% CI )=3.410 (1.010 to 11.513), P =0.048] and combined gallbladder stones [ OR (95% CI )=2.974 (1.011 to 8.745), P =0.048] indepenclently correlated with segmental and diffuse GA. Conclusions: The incidence of OPBR is higher in segmental and diffuse GA, and gallstones and OPBR are independently associated with the occurrence of segmental and diffuse GA. These results suggest that OPBR may be the initiating factor for the occurrence and carcinogenesis of segmental and diffuse GA.

Objective: To study the diagnostic value of lipoprotein-associated phospholipase A2(LP-PL-A2) in occult pancreaticobiliary reflux(OPBR) combined with gallbladder cholesterol deposition. Methods: This was a case-control study. Forty-six patients with OPBR who underwent gallbladder surgery at Shanghai East Hospital from December 2020 to October 2021, with gallbladder cholesterol deposition as the case group and the remainder as the control group, were included for analysis of their clinical data. Results: There were 21 cases in the case group, with 10 males and 11 females, and aged (57±12) years; 25 cases in the control group, with 11 males and 14 females, and aged (56±10) years. Serum LP-PL-A2 [(551.62±128.69) U/L] was significantly higher in the case group than in the control group [(436.70±135.88) U/L] ( t =-2.80, P <0.01).Univariate analysis showed that LP-PL-A2 was a risk factor for OPBR combined with gallbladder cholesterol deposition, OR (95% CI ):1.007(1.002-1.012), P =0.011. The area under the receiver operating characteristic curve (ROC) curve was 0.742, P= 0.005. Conclusion: LP-PL-A2 is of diagnostic value in OPBR combined with gallbladder cholesterol deposition.

Sepsis is a critical medical problem that needs to be solved urgently worldwide. Some patients with sepsis have refractory shock or/and severe respiratory failure, which may require supporting with extracorporeal membrane oxygenation (ECMO). Particularly, it is important to choose the optimal mode and grasp the optimal timing of the initiation in the experienced ECMO center. The choice of mode is mainly based on the patient's condition of oxygenation and hemodynamics. During the management of ECMO support, some issues like blood flow, anticoagulation and therapy of antibiotics should be noted. Thus far, the research of ECMO in adult patients with sepsis and septic shock are mainly retrospective, observational and with small sample size. Further exploration is needed in the future.

Objective: To analyze the effects of the sequence of radiotherapy and chemotherapy on the efficacy of early-stage extranodal NK/T-cell lymphoma (nasal type, ENKTCL) patients, and to provide a quantitative evaluation method for individualized radiotherapy and chemotherapy. Methods: The Chinese Lymphoma Collaborative Group (CLCG) collected the clinical data of 2 008 patients with early-stage Ⅰ/Ⅱ ENKTCL who received radiotherapy and chemotherapy from January 2000 to early September 2019 from 21 hospitals across the country, including 1 417 males and 591 females, aged 2 to 83 (42±14) years. According to the sequence of radiotherapy and chemotherapy, patients were divided into radiotherapy-first group (388 cases) and chemotherapy-first group (1 620 cases). Survival rate was estimated using Kaplan-Meier method, and multivariate Cox proportional risk model was used to screen and identify independent prognostic factors. The prognostic prediction models of the two therapies were constructed separately, and the models were used to predict the individualized mortality risk of all patients to determine the appropriate radiotherapy and chemotherapy regimen for each patient. Results: The 5-year overall survival rate was 74.2% (95% CI : 69.6%-79.2%) in the radiotherapy-first group and 69.7% (95% CI : 67.1%-72.4%) in the chemotherapy-first group. Although the 5-year overall survival rate of patients in the radiotherapy-first group was numerically higher than that of the chemotherapy-first group, the difference was not statistically significant (χ 2 = 2.26, HR =0.84 (95% CI : 0.68-1.05), P =0.133). Six variables including age, gender, ECOG score, LDH, Ann Arbor staging, and PTI (primary tumor invasion) were screened out as independent prognostic factors (the chemotherapy-first group: HR were 1.01, 1.25, 2.07, 0.77, 1.34, 1.49, respectively, all P<0.05; radiotherapy-first group: HR were 1.02, 1.31, 1.66, 0.78, 1.37, 1.29, all P >0.05). The mean 5-year predicted mortality risk for all patients receiving radiotherapy-first regimen was lower than those receiving chemotherapy-first regimen (26.8% vs 30.2%, P <0.001). There were individualized differences in the predicted mortality risk of patients with different clinical characteristics who received radiotherapy-first regimen or chemotherapy-first regimen. Conclusion: Patients with stage Ⅰ/Ⅱ ENKTCL treated with radiotherapy-first regimen had a better expected prognosis than patients treated with chemotherapy-first regimen. The quantitative assessment of the differential effects of the sequence of radiotherapy and chemotherapy on the mortality risk of individual patients based on their clinical characteristics was helpful for the clinical development of the optimal radiotherapy and chemotherapy plan for each patient.

Objective: To explore the effect of toxicity of sunitinib on the clinical outcome of patients with advanced renal cell carcinoma (RCC) ., Methods: A total of 136 patients with advanced RCC were treated with sunitinib from 2008 to 2011. There were 91 males and 45 females with an average age of 56 years. Their 6-week therapy cycle was 4 weeks of sunitinib 50 mg daily followed by 2-week off-treatment (schedule 4/2). The median follow-up time was 15 months. Correlation between toxicities and overall survival (OS) was evaluated in a Cox model using log-transformed levels after adjusting for MSKCC model.Log-rank test and Cox proportional hazard model were used to assess the value of drug toxicity as the prognostic factors., Results: The increased hemoglobin on cycle 1 day 14 (HR:0.950, 95%CI:0.923-0.978) and the increased lymphocytes on cycle 1 days 28 and 42 (HR:0.405, 95%CI:0.203-0.809, HR:0.394, 95%CI:0.179-0.867) were significantly associated with OS (P adj = 0.001, 0.014 and 0.022 respectively). Hypertension class III/IV (HR:0.066, 95%CI:0.008-0.582), and the number of neutrophils screening and lymphocyte count ratio (HR:2.537, 95%CI:1.182-5.404) were the survival prognosis independent predictors., Conclusion: Early hematopoietic toxicities may potentially predict the outcomes of advanced RCC after a therapy of sunitinib.

Objective: To explore the cognitive function, emotional status and activities of daily living in patients with multiple system atrophy (MSA)., Methods: Thirty-two MSA patients and 38 healthy controls from October 2009 to November 2012 were recruited from our hospital. Their cognitive function, emotional status and activities of daily living were assessed. Cognitive function was assessed by Montreal cognitive assessment (MoCA) and mini-mental state examination (MMSE); emotional status by self-rating depression scale (SDS) and self-rating anxiety scale (SAS); daily living and activities by activities of daily living scale (ADL). Data analysis was performed with SPSS 19.0. And the results were presented as the mean ± standard deviation. Comparison of means was performed with independent sample t test. And Pearson's correlation test was used for correlation analysis. A P-value <0.05 was considered significant., Results: Mild or moderate cognitive impairment was documented in 71.9% of MSA patients. The scores of MoCA and MMSE in the MSA group were significantly lower than those in the control group. And the scores of ADL, SDS and SAS in the MSA group were significantly higher than those in the control group (P < 0.05). MoCA subitems such as space/executive function, attention, abstraction, language and delayed memory of the MSA group were significantly lower than those of the control group (P < 0.05). A negative correlation existed between the scores of MoCA and MMSE with disease duration (P < 0.01). There was a positive correlation between the scores of SDS and SAS with ADL and disease duration (P < 0.05). And the relationship was significant between the scores of SDS and SAS (P < 0.01). A positive correlation existed between scores of ADL with disease duration (P < 0.05)., Conclusion: MSA patients have certain degrees of cognitive impairment, emotion disorders and impaired ADL. Cognitive impairment in MSA patients may be more common than previously. Furthermore, the clinical features of cognitive impairment in these patients may have some clinical values for references.

Objective: To explore the hematologic adverse effects in patients with renal cell carcinoma treated with sunitinib., Methods: A total of 136 patients with advanced renal cell carcinoma were treated with sunitinib at our hospital from 2008 to 2011. There were 91 males and 45 females with an average age of 55.5 years. They received sunitinib in repeated 6-week cycles consisting of 4 weeks of sunitinib 50 mg per day followed by 2 weeks of treatment (schedule 4/2). The hematologic toxicities, collected at baseline and 14, 28, 42 (after a 2-week rest period) days, were graded according to the National Cancer Institute common terminology criteria for adverse events version 3.0. The paired Wilcoxon test was used to evaluate the kinetics of hematologic adverse effects at days 14, 28, and 42 post-treatment., Results: The hematologic toxicities included leukopenia (n = 91, 66.9%), neutropenia (n = 95, 69.8%), lymphopenia (n = 58, 46.2%), thrombopenia (n = 89, 65.4%) and hypohemoglobinemia (n = 48, 35.3%). Among them, 31 cases (22.8%) had the high-grade (including grades 3 and 4) toxicity of thrombopenia. There were depressions in hematopoietic cell populations including leukocytes, neutrophils, and platelets at days 14, 28 and 42 versus the baseline level (all P < 0.05). The median hemoglobin level transiently increased at days 14 and 28 (both P < 0.01) and returned to the level of baseline at days 42 (P = 0.754)., Conclusions: The incidence of hematologic adverse effects of sunitinib slightly varies with what have been observed in previous studies. And the incidence of high-grade toxicity of thrombocytopenia is higher than that reported in studies conducted in the US and Europe.

Objective: To construct a classification and regression tree (CART) to predict the occurrences of bone metastases in patients with newly diagnosed prostate cancer so as to reduce unnecessary bone scans., Methods: CART analyses were performed in 501 subjects from 2005 to 2011 of Fudan University Shanghai Cancer Center to establish Fudan CART model and externally validate Briganti's CART model. The both models were compared with regards to the area under the curve (AUC) and their clinical values., Results: The rate of bone metastasis was 27.5% (138/501). The predictive accuracy of Fudan CART model, Briganti's CART model and skeleton-related events (SRE) model was 0.813, 0.691 and 0.645 respectively. There were statistically significant differences (P < 0.05). Fudan CART model had a lower missed diagnosis and an over-examination rate of bone scan within the probability threshold (Pt) range of 24.2% to 36.8%., Conclusion: With a higher predictive value, Fudan CART model may be employed to reduce the unnecessary bone scans for Chinese patients with newly diagnosed prostate cancer.

Objective: To summarize the clinical features and neuroimaging findings of the patients with acute disseminated encephalomyelitis (ADEM) involved in corpus callosum (CC) so as to distinguish it from other diseases., Methods: A total of 12 ADEM patients with the involvement of CC during the period of 2010-2012 were recruited. There were 9 males and 3 females with a mean age of 31±14 years (range: 10-54). Their clinical and neuroimaging features were retrospectively reviewed and all data analyzed by SPSS 18.0., Results: (1) All of them had an acute or subacute onset. Two patients had a history of vaccination and 5 suffered upper respiratory tract infection or diarrhea. (2) The presenting symptoms included fever (n=5), headache (n=4), unsteady gait (n=2), urinary retention (n=1), indifference (n=1) and delirium (n=1). (3) The main clinical symptoms included memory loss (n=9), delirium (n=5), somnolence (n=4), urinary retention (n=9), paraplegia (n=4) and unsteady gait (n=5). (4) The examinations of cerebrospinal fluid (CSF) revealed increased intracranial pressure (n=4), leucocytosis (n=3) and increased protein (n=7) of 7 cases. All oligoclonal bands were negative. (5) The lesions were involved in bilateral CCs in 12 patients. Among them, splenium was the most commonly affected (n=9), secondly stem (n=5) and lastly genu (n=4). For 6 patients, the intracranial lesions were all in their CCs. And among them, 2 cases were involved in spinal cord. Except for CC, there were other focal lesions in brain stem and cerebellum (n=4) and spinal cord (n=6). (6) On magnetic resonance imaging (MRI), all cases showed long T2 signal intensity with blurred images. And among them, 2 cases' lesions in brain were discerned only by diffuse weighing imaging (DWI) or T2 fast fluid-attenuated inversion recovery (T2FLAIR) instead of T2-weighted. The lesions of CCs showed on gadolinium-enhanced MRI were significantly enhanced and the shapes were sheet-like (4/6). Spinal cord lesions was found in 6 cases and most spinal cord lesions were discontinuous. And the number of spinal cord segments with lesions was from 4 to 8. The shapes of lesions of spinal cord showed on enhanced MRI were like thin line. (7) Most of them were misdiagnosed as viral encephalitis (n=5), tuberculous meningoencephalitis (n=1) and brain neoplasms (n=2). And another case was admitted into urology surgery ward due to urinary retention., Conclusion: There are three key points about the characteristics of the ADEM patients with CC lesions: (1) They may have an adult male preponderance. The distinctive symptoms include fever, headache, delirium, somnolence, memory loss, unsteady gait and urination disorders, etc.. (2) The number of lesions on brain MRI can be multiple or single, especially the lesions of CC (mostly in splenium). On MRI, all cases showed long T2 signal intensity with blurred images so that DWI and T2 FLAIR may have a higher efficiency of detecting the lesions. In particular, multiple lesions may be all enhanced or not enhanced at equal pace on enhanced MRI. (3) In ADEM patients with CC lesions, many indices of CSF chemical examination, such as increased intracranial pressure, leucocytosis, increased protein, low sugar and low chloride, indicate the presence of intracranial infective diseases. Therefore they are most likely to be misdiagnosed as viral encephalitis or tuberculous meningoencephalitis. However, CC is not the predilection site for viral encephalitis since CC belongs to white matter but not gray matter. So ADEM should be a more appropriate diagnosis for these cases.

Objective: To retrospectively analyze the clinical value of diffusion-weighted magnetic resonance imaging (MRDWI) in the detection of prostate cancer in suspected patients., Methods: Between January 2009 and December 2010, 141 patients with suspected prostate cancer underwent MRDWI and transrectal ultrasound (TRUS) guided prostate biopsy. They were divided into 4 groups by prostate surface antigen (PSA) < 10 µg/L, 10 µg/L ≤ PSA < 20 µg/L, 20 µg/L ≤ PSA < 50 µg/L and PSA ≥ 50 µg/L. Then the diagnostic accuracy of MRDWI was tested., Results: The diagnostic rate of patients with PSA < 10 µg/L, 10 µg/L ≤ PSA < 20 µg/L, 20 µg/L ≤ PSA < 50 µg/L and PSA ≥ 50 µg/L were 23.7%, 35.5%, 66.7% and 96.3% respectively. The sensitivity of MRDWI was significantly better than TRUS. In patients with PSA < 10 µg/L, 10 µg/L ≤ PSA < 20 µg/L, 20 µg/L ≤ PSA < 50 µg/L and PSA ≥ 50 µg/L, the patient-based sensitivities were 85.7%, 72.7%, 97.8%, 100.0% respectively; when based by segment of specimen, the sensitivities were 85.5%, 71.9%, 91.5% and 94.4% respectively., Conclusion: The sensitivity of MDWI is significantly better than TRUS in the diagnosis of prostate cancer. The combined use of MDWI and TRUS has the benefit of guiding the biopsy of cancer foci in patients with suspected prostate cancer.

Objective: To assess the efficacy of low dose ketoconazole therapy for Chinese patients with castration resistant prostate cancer (CRPC) and explore possible prognosis factors., Methods: From August 2006 to August 2011, 71 patients with CRPC were analyzed retrospectively, who received oral ketoconazole 200 mg, three times a day with prednisone 5 mg, twice a day. Prostate specific antigen (PSA) response rate was defined as the percentage of patients with PSA decline ≥ 50% compared to baseline PSA level during low dose ketoconazole therapy. Multivariate Logistic regression analysis and receiver operating characteristic curve were used to assess the prognostic factors and their accuracy., Results: The mean initial serum PSA level was (205 ± 38) ng/ml for these patients with mean age (69 ± 1) years old. After first androgen deprivation therapy failure, the prostate cancer progressed into castration resistant stage. The baseline PSA was (93 ± 24) ng/ml and the baseline serum testosterone was (0.13 ± 0.02) ng/ml. During the low dose ketoconazole therapy, 31 patients (43.7%) had PSA decrease and 22 cases (31.0%) were effective with PSA decline more than 50%. PSA doubling time and baseline serum testosterone were positive correlation with PSA response rate by multivariate Logistic regression analysis. Patients with PSA doubling time of ≥ 3.0 months had a PSA response rate of 64.3% and the PSA response rate in those with < 3.0 months decreased to 22.8%, hazard rate (HR) = 0.149 (95% confidence interval [CI] 0.029 - 0.766), P = 0.023, area under the curve (AUC) = 0.707. The PSA response rate for patients with baseline serum testosterone ≥ 0.1 and < 0.1 µg/L were 55.6% and 5.7%, respectively, HR = 0.068 (95%CI 0.012 - 0.380), P = 0.002, AUC = 0.749. The common adverse reactions included liver dysfunction (17.9%), renal dysfunction (16.4%), fatigue (11.9%), nausea (6.0%) and anorexia (4.5%) and so on., Conclusions: Low dose ketoconazole therapy was a moderate, low toxicity hormonal therapy option for patients with CRPC. PSA doubling time ≥ 3 months and baseline serum testosterone ≥ 0.1 µg/L were predictors of desired effect for low dose ketoconazole therapy.

Objective: There are many causative factors for the occurrence of post-prostatectomy incontinence. Objective clinical characteristics, surgical techniques and pelvic floor muscle therapy are the most important ones. The present study was to identify the risk factors associated with urinary incontinence after radical retropubic prostatectomy (RRP)., Methods: A total of 263 patients were recruited for this multivariate analysis. After a close follow-up, a series of pre-, peri- and post-operative factors were recorded and analyzed., Results: Urinary continence after radical prostatectomy was 14.8% at 4 weeks and 94.7% at 16 weeks. The most important recovery interval for urinary continence was 4 - 16 weeks post-operation. Multivariate analysis revealed that age (P = 0.015), blood transfusion (P = 0.017), previous TURP (transurethral resection of the prostate) (P = 0.006) and neoadjuvant hormonal therapy (P = 0.005) were the important risk factors for urinary incontinence., Conclusion: During RRP, optimized preservation of urethral rhabdosphincter length, nerve sparing and early postoperative functional exercises can improve the recovery of urinary continence. Age, blood transfusion and previous TURP are the independent prognostic factors. Neoadjuvant hormonal therapy may improve urinary continence through increasing the preoperative length of membranous urethra.

Objective: To establish the regression model predicting the probability of the capsular penetration according to the Chinese prostate cancer samples., Methods: Men enrolled in the Fudan University Shanghai Cancer Centre and undergoing radical prostatectomy between January 2006 and April 2010 were used to establish the predicting model. According to the pathology after radical prostatectomy, all cases were divided into two groups: organ confined disease group and locally advanced disease group, the difference of which were whether had the capsular penetration. The cases with regional lymph node metastasis were excluded. Serum prostate specific antigen level, Gleason grade, clinical stage were collected. Multiple Logistic regression model was established according to preoperative clinical data and postoperative pathological data to predict the incidence of capsular penetration. Receiver operating characteristic curve was used for the internal validation of the model., Results: 83 Chinese men were identified in the organ confined disease group with the age of 66.8 ± 5.8 years, and 36 in the locally advanced disease group with the age of 66.0 ± 6.8 years. The difference of the age between the two groups were of no statistic significance (t = 0.650, P = 0.517). The serum prostate specific antigen level (Wilcoxon W = 4562.0, P = 0.016), Gleason score (Wilcoxon W = 4586.5, P = 0.016), and clinical stage (Wilcoxon W = 4444.5, P = 0.001) of the locally advanced disease group were higher than the other group. The equation of the multiple Logistic regression model was Logit P = 0.488 × Gleason score + 0.104 × clinical stage -6.187, with the freedom degree of two and the likelihood ratio χ(2) test of 11.263 (P = 0.001). The area under the ROC curve (AUC) for capsular penetration was 0.696 (P = 0.001), with the 95% confidence interval of 0.598 - 0.793., Conclusion: The multiple Logistic regression model based on the Chinese population can accurately predict the probability of capsular penetration of the prostate cancer and work on well with high internal accuracy when clinical decisions are made.

Objective: To evaluate the effect of technical improvements of transperitoneal radical nephrectomy on the patients with large renal cell carcinoma., Methods: From May 2002 until May 2009, 45 patients with large (> 12 cm) renal cell carcinoma underwent transperitoneal radical nephrectomy. A subcostal incision was selected to expose the extraperitoneal area. The modified operative methods included exposing the operative field via a liver retractor and initially ligating renal artery to block the blood supply of kidney and tumor. The method of tumor-free tissue dissociation was applied. Hem-o-lock was employed for clipping so as to avoid hemorrhage. This modified technique was evaluated in respects of operating time, estimated blood loss, intra-operative complications, postoperative complications, length of hospital stay and pathological diagnoses., Results: The tumor diameter was from 12.2 cm to 28.3 cm with a mean of 14.5 cm. The mean operative time was (150 +/- 58) min and the average estimated blood loss (350 +/- 180) ml. Three cases received blood transfusion. The average length of hospital stay was (12 +/- 6) days. Three cases developed complications, including spleen injury in 2 and pancreatic injury in 1. The treatment modalities were splenectomy and resection of pancreatic tail respectively. The pathological diagnoses were all of renal cell carcinoma. The pathological stage included T(2)N(0 approximately 1)M(0 approximately 1)(n = 13), T(3)N(0 approximately 1)M(0 approximately 1)(n = 23), T(4)N(0 approximately 1)M(0 approximately 1)(n = 9). After a follow-up period of 3 - 63 months, 3 cases of tumor recurrence were found in primary renal clutch., Conclusion: Improved radical nephrectomy is feasible for large renal cell carcinoma. And it can reduce the volume of blood loss and decrease the occurrence of complications.

Objective: To investigate the expression of DNA dependent protein kinase catalytic subunit (DNA-PKcs) and P16 (multiple tumor suppressor 1) genes in colorectal carcinoma and clinical significance thereof., Methods: 359 specimens of colorectal carcinoma obtained during operation and 35 specimens of normal mucosa beside the carcinoma underwent immunohistochemical examination and Western blotting to detect the expression of DNA-PKcs and P16., Results: The positive expression rates of DNA-PKcs and P16 of the colorectal carcinoma specimens were 63.5% (228/359) and 53.2% (191/359) respectively, both significantly higher than those of the para-cancer normal tissues (both P < 0.05). DNA-PKcs and P16 expression were both related to the clinical stage, lymphatic invasion, and distant metastasis (all P < 0.05). The 5-year survival rates of the patients positive in DNA-PKcs and P16 expression were significantly lower than those of the patients negative in DNA-PKcs and P16 expression (both P < 0.05). The DNA-PKcs positive rate of the P16-positive patients was 78.6%, significantly higher than that of the P16-negative patients (55.3%, r = 0.149, P = 0.036)., Conclusion: DNA-PKcs and P16 play a significant role in the carcinogenesis and evolution of colorectal carcinoma and may be used as one of the useful indicators for clinical assessment of tumor biological behavior and prognosis of colorectal carcinoma.

Objective: To study role of external signal regulated kinase (ERK) and transforming growth factor beta(1) (TGF-beta1) in asthma airway remodeling and to explore the regulation of glucocorticoids on ERK, TGF-beta1, and airway remodeling., Methods: Thirty SD rats were randomly divided into 3 equal groups: control group; asthma group, undergoing intra-peritoneal injection of ovalbumin (OVA) on days 1 and 8 and inhalation of OVA every other day for 8 weeks since day 15 to establish chronic asthma models; dexamethasone (DM) intervention group, undergoing intra-peritoneal injection of DM 30 min before every inhalation instigation; and control group, receiving normal saline instead of DM. 1 - 2 hours after the last instigation the left lungs were taken out. The total bronchial wall thickness (Wat) and smooth muscle thickness (Wam) were measured by image analysis system. Phosphorylated ERK (P-ERK) was detected by immunohistochemistry. 1 - 2 hours after the last instigation blood samples were collected from the femoral artery. The concentration of transforming growth factor (TGF)-beta1 in the serum was measured by sandwich ELISA. Rat airway epithelial cells were cultured, stimulated with platelet-derived growth factor-BB (PDGF-BB, 1, 10, 25, or 50 microg/L), U0126 (specific inhibitor of phosphorylation of ERK), or budesonide (BUD). Western blotting was used to detect the P-ERK level. The level of TGF-beta1 in the cell culture supernatant was detected by sandwich ELISA., Results: The Wat and Wam of the asthma group was significantly higher than those of the control group (both P < 0.01), and the Wat and Wam of the DM group were both significantly lower than those of the asthma group (both P < 0.01). The mean optical density of P-ERK and concentration of TGF-beta1 in the serum of the asthma group were 31.1 +/- 2.2 and 28.1 +/- 7.4 microg/L respectively, both significantly higher than those of the control group (12.8 +/- 2.4 and 13.6 +/- 2.7 microg/L respectively, both P < 0.01), and the mean optical density of P-ERK and concentration of TGF-beta1 in the serum of the DM group were 18.7 +/- 3.1 and 15.0 +/- 3.2 microg/L respectively, both significantly lower than those asthma group (both P < 0.01). In the PDGF-BB (25 microg/L) stimulated cells marked phosphorylation of ERK occurred 15 min later, the level of P-ERK remained high up to 8 hour later, and the maximal activation occurred at the period of 2 h - 4 h later, 6.5 +/- 0.4 times that of the control value (P < 0.01). The phosphorylation levels of ERK depended on the concentration of PDGF-BB and the maximal level phosphorylation was detected with the concentration of PDGF-BB of 50 microg/L, which was 4.1 +/- 0.3 times that of the control value (P < 0.01). U0126 and BUD inhibited the phosphorylation of ERK in the cells stimulated by PDGF-BB of the concentration of 25 microg/L. there was no difference in the level of TGF-beta1 in the cell culture supernatant among different groups., Conclusion: Phosphorylation of ERK and TGF-beta1 have an important role in asthma airway remodeling; PDGF-BB does not induce normal rat airway epithelial cells to product or release TGF-beta1 by phosphorylation of ERK. Glucocorticoids can inhibit phosphorylation of ERK.

Objective: To compare the efficacy and safety of daily administration of recombinant human granulocyte colony-stimulating factor (rhG-CSF), and a single subcutaneous injection of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF), a sustained-duration rhG-CSF, in chemotherapy-induced neutropenia., Methods: In the present randomized, open-label, match and cross-over study, enrolled 104 patients with previously untreated non-small cell lung cancer (NSCLC), breast cancer or non-Hodgkin's lymphoma and with normal bone marrow function from 13 centers were randomly divided into 2 matched groups, AB and BA group. Each patient received two cycles of chemotherapy of identical regimen. In the study cycle, the patients received a single subcutaneous injection of PEG-rhG-CSF 100 microg/kg on day 3; and in control cycle, daily subcutaneous infection of rhG-CSF 5 microg x kg(-1) x d(-1) began on day 3 and continued for 14 days or until the absolute neutrophil count (ANC) became > or = 5.0 x 10(9)/L twice after it decreased to the nadir. Efficacy and safety parameters were monitored., Results: The incidence rates of ANC < 1.5 x 10(9)/L in the 103 evaluable study cycles and 100 evaluable control cycles were 30.00% and 20.00% with the duration of 2.39 days and 2.35 days respectively. The incidence rates of grade 3 neutropenia were 7.77% and 7.00%; and that of grade 4 neutropenia were 5.80% and 4.00% respectively in the trial and control cycles. However, all the difference mentioned above did not reached statistical significance. None of the patients experienced febrile neutropenia. The ANC nadir was (7.55 +/- 5.25) x 10(9)/L and (8.42 +/- 5.57) x 10(9)/L (P = 0.257) respectively after receiving PEG-rhG-CSF and rhG-CSF. Compared with that of rhG-CSF group, the ANC profile of PEG-rhG-CSF group exhibited limited "overshoot" of neutrophils after the nadir. Subgroup analysis according to disease type yielded similar results. The safety profiles of the PEG-rhG-CSF and rhG-CSF groups were similar. Musculoskeletal pain or arthralgia occurred in 16.5% of the study cycles and 26.00% of the control cycles (P = 0.963), mostly mild or moderate. Other adverse effects such as fever, fatigue, dizziness, gastrointestinal effects and injection-site pain, were transient and easily manageable., Conclusion: A single subcutaneous injection of PEG-rhG-CSF 100 microg/kg provides neutrophil support and a safety profile comparable to regimen of daily subcutaneous injection of rhG-CSF 5 microg x kg(-1) x d(-1) in Chinese patients receiving a variety of myelosuppressive chemotherapy regimens.

Objective: To study the effects of glucocorticoid on airway mucus secretion in asthma., Methods: Twenty-four BALB/c mice were randomly divided into 3 equal groups: asthma group [ovalbumin (OVA) and aluminum hydroxide were injected intraperitoneally on day 0 and day 14 so as to establish mouse asthma model and aerosol inhalation of OVA PBS was conducted for 30 min on the days 21, 22, and 24], asthma + dexamethasone group (OVA and aluminum hydroxide were injected intraperitoneally on days 0 and 14, aerosol inhalation of OVA PBS was conducted for 30 min on the days 21, 22, and 24, and dexamethasone was injected intraperitoneally 1 hour before the aerosol inhalation), and control group (aerosol inhalation of PBS was conducted instead). Twenty-fours hours after the last exposure the mice were anesthetized deeply and their left lungs were excised to collect the bronchoalveolar lavage fluid (BALF) to calculate the numbers of total cells and eosinophils, then Alcian blue/periodic acid-Schiff staining and immunohistochemistry of the air passage were conducted to measure the expression levels of MUC5AC mRNA and protein and interleukin-4 (IL-4) mRNA., Results: The numbers of total cells in the BALF of the asthma group were (12.50 +/- 0.14) x 10(9)/L and (1.12 +/- 0.10) x 10(9)/L respectively, both significantly higher than those of the control group, (6.49 +/- 0.05) x 10(9)/L and (0.05 +/- 0.02) x 10(9)/L respectively (both P < 0.01), and were significantly higher than those of the asthma + dexamethasone group, (6.68 +/- 0.03) x 10(9)/L and (0.06 +/- 0.01) x 10(9)/L respectively too (both P < 0.01). The levels of MUC5AC mRNA, MUC5AC protein, and IL-4 mRNA of the asthma group were 0.5341 +/- 0.303, 0.1906 +/- 0.0008, and 0.6265 +/- 0.0932 respectively, all significantly higher than those of the control group (0.1994 +/- 0.0128, 0.1194 +/- 0.0007, and 0.2389 +/- 0.0289 respectively, all P < 0.01), and those of the asthma + dexamethasone group (0.2729 +/- 0.0345, 0.1456 +/- 0.0003, and 0.2424 +/- 0.0260, all P < 0.05). The MUC5AC protein expression and mRNA expression, and IL-4 mRNA expression of the asthma group were 0.1906 +/- 0.0008, 0.5341 +/- 0.0303, and 0.6265 +/- 0.0932 respectively, all significantly higher than those of the control group (0.1194 +/- 0.0007, 0.1994 +/- 0.0128, and 0.2398 +/- 0.0289 respectively, all P < 0.01). The MUC5AC protein expression and mRNA expression, and IL-4 mRNA expression of the asthma + dexamethasone group were 0.1456 +/- 0.0003, 0.2729 +/- 0.0345, and 0.2424 +/- 0.0260 respectively, all significantly lower than those of the asthma group (all P < 0.01). The MUC5AC protein expression and mRNA expression of the asthma + dexamethasone group were still significantly higher than those of the control group (both P < 0.01), however, the IL-4 mRNA expression of the asthma + dexamethasone group was not significantly different from that of the control group (P > 0.05)., Conclusion: Relieving the inflammation, glucocorticoid may play a role in the treatment of excessive mucus production through down-regulating the expression of MUC5AC and of IL-4.

Objective: To investigate the effects of treatment of malignant lymphoma (ML) by autologous hematopoietic stem cell transplantation (AHSCT) combined with high dose radiotherapy and chemotherapy., Methods: From June 1991 to October 2002, 56 patients, aged 9 - 65 years, with ML, 44 non-Hodgkin's lymphoma (NHL) and 12 Hodgkin's disease (HD) were treated with AGSCT combined with high dose radiotherapy and chemotherapy. Among them, 12 received autologous bone marrow transplantation (ABMT) and 44 received autologous peripheral blood stem cell transplantation (APBSCT), In the latter the APBSCs were mobilized by carboplatin and etoposide (CE) or CHOP (CTX, ADM, VCR, PDN) plus granulocyte-colony stimulating factor (G-CSF) and/or granulocyte-macrophage colony stimulating factor (GM-CSF) 10 micro g/kg/d. Pretreatment included BEAM (BCNU, Vp-16, AraC, MEL) or MEL 140 mg/m(2) + Vp-16,200 mg/L total body irradiation (TBI) 8 Gy. The patients were flowed up for 40 - 4,310 days with a median of 1,820 days., Results: Hematopoietic reconstruction was observed in all patients. The 1, 2, and 5-year disease-free survival rates were 87.5%, 60.7%, and 57.1% respectively, with the longest survival of 11 years. Fourteen patients developed relapse. No transplantation-related death was seen., Conclusion: Autologous hematopoietic stem cell transplantation combined with high dose radiotherapy and chemotherapy is effective on Ml. AHSCT shows a more rapid effect on hematopoietic reconstruction than ABMT.

We observed the changes of CSF secretion from lung cells and thymocytes and the number of G-CSF receptors on bone marrow cells (BMC) in mice after single whole-body X-irradiation in the dose range of 25-250 mGy. The results showed that the CSF secretion from lung cells increased only after 75 mGy (P < 0.05). The response of thymocytes to low dose radiation was more sensitive and the increase of secretion reached its maximum at the dose of 50 mGy and was still higher than normal after dose up to 250 mGy X-rays (P < 0.05 or P < 0.01). The reaction equilibrium of 125I-G-CSF binding to BMC at 37 degrees C was obtained in 60 minutes, and the maximum binding (Bmax) to 3 x 10(6) BMC was 15.1 pmol, the dissociation constant(Kd) was 78.6 pmol, and the number of G-CSF receptors per cell was estimated to be about 3,100. The number of G-CSF receptors on BMC in mice 48 hours after exposure to dose of 50, 75 and 100 mGy X-rays increased significantly, being 161%, 169% and 342% of control, respectively. The results demonstrated that not only CSF production from lung cells and thymocytes was stimulated, but also the expression of G-CSF receptors on BMC was enhanced, the two factors acting together resulting in hematopoietic stimulation after low dose whole-body irradiation.