探讨老年肺炎患者临床诊断中检验血清C反应蛋白(CRP)、血沉(ESR)、以及D-二聚体(D-D)水平的临床价值

目的探讨老年肺炎患者临床诊断中检验血清C反应蛋白(CRP)、血沉(ESR)、以及D-二聚体(D-D)水平的临床价值。方法随机选择该院2015年1月—2016年12月期间收治的50例老年肺炎病例为观察组研究对象,并以同期自愿参与研究的50名健康老年体检者为对照组研究对象,比较两组血清C反应蛋白(CRP)、血沉(ESR)、以及D-二聚体(D-D)水平。结果观察组老年患者血清CRP(103.2±23.4)mg/L、ESR(35.8±6.5)μg/L、D-D(1 152.4±43.1)mm/h水平均显著高于对照组(8.9±1.2)mg/L、(10.2±1.4)μg/L、(182.6±14.8)mm/h,差异有统计学意义(P<0.05)。将观察组以80岁为临界值分组,80岁以上患者CRP(102.4±21.8)mg/L、ESR(34.8±5.8)μg/L、D-D(1 148.7±45.2)mm/h与80岁以下患者(103.8±22.1)mg/L、(35.4±6.2)μg/L、(1 142.3±43.9)mm/h,差异无统计学意义(P>0.05)。结论临床上可行血清C反应蛋白、血沉及D-二聚体检测来诊断老年肺炎的情况,为治疗和预后提供有效依据。

Correlation of transient elastography with hepatic venous pressure gradient in patients with cirrhotic portal hypertension: A study of 326 patients from India

AIMTo study the diagnostic accuracy of transient elastography (TE) for detecting clinically significant portal hypertension (CSPH) in Indian patients with cirrhotic portal hypertension.METHODSThis retrospective study was conducted at the Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, on consecutive patients with cirrhosis greater than 15 years of age who underwent hepatic venous pressure gradient (HVPG) and TE from July 2011 to May 2016. Correlation between HVPG and TE was analyzed using the Spearman&#x02019;s correlation test. Receiver operating characteristic (ROC) curves were prepared for determining the utility of TE in predicting various stages of portal hypertension. The best cut-off value of TE for the diagnosis of CSPH was obtained using the Youden index.RESULTSThe study included 326 patients [median age 52 (range 16-90) years; 81% males]. The most common etiology of cirrhosis was cryptogenic (45%) followed by alcohol (34%). The median HVPG was 16.0 (range 1.5 to 30.5) mmHg. Eighty-five percent of patients had CSPH. A significant positive correlation was noted between TE and HVPG (rho 0.361, P &#x0003c; 0.001). The area under ROC curve for TE in predicting CSPH was 0.740 (95%CI: 0.662-0.818) (P &#x0003c; 0.01). A cut-off value of TE of 21.6 kPa best predicted CSPH with a positive predictive value (PPV) of 93%.CONCLUSIONTE has a fair positive correlation with HVPG; thus, TE can be used as a non-invasive modality to assess the degree of portal hypertension. A cut-off TE value of 21.6 kPa identifies CSPH with a PPV of 93%.

Origin of beaded tafoni in cliffs of Danxia landscapes,Longhushan Global Geopark, South China

The tafoni that develop in sandstone cliffs have attracted the interest of both scientists and the general public. A necklace-like tafone system, referred to here as beaded tafoni, has developed in the prominent cliffs of the Danxia landscapes within the Longhushan Global Geopark in the subtropical zone of South China. This paper presents a new model of the formation of this system of extraordinary beaded tafoni. The cliffs of the Danxia landscapes of the study area are composed of an alluvial conglomerate(i.e.,red beds). These Danxia landscapes have subrounded summits that are covered by vegetation and experience a nearly vertical water flow induced by gravity. Erosion and collapse of the outsized gravels and concentrated pebbles in the red beds give rise to the initial development of the beaded tafoni. The tafoni then become rounded and beaded as a result of reworking and decay by fluvial outwash. During storms, intense water flows run vertically down the cliffs and generate a whirling motion in the tafoni.Consequently, the inside walls of the tafoni gradually become wider and smoother. During the late development stage, the beaded tafoni tend to become indistinct or disappear because of the interconnection of the tafoni and subsequent merging with the bedding-controlled cavities.

Hypoxia upregulates hypoxia inducible factor(HIF)-3α expression in lung epithelial cells: characterization and comparison with HIF-1α

The role of the hypoxia-inducible factor(HIF)subunits 1α and 2α in response to hypoxia is well established in lungepithelial cells,whereas little is known about HIF-3α with respect to transcriptional and translational regulation by hy-poxia.HIF-3α and HIF-1α are two similar but distinct basic helix-loop-helix-PAS proteins,which have been postulatedto activate hypoxia responsive genes in response to hypoxia.Here,we used quantitative real time RT-PCR and immu-noblotting to determine the activation of HIF-3α vs.HIF-1α by hypoxia.HIF-3α was strongly induced by hypoxia(1%O_2)both at the level of protein and mRNA due to an increase in protein stability and transcriptional activation,whereasHIF-1α protein and mRNA levels enhanced transiently and then decreased because of a reduction in its mRNA stabilityin A549 cells,as measured on mRNA and protein levels.Interestingly,HIF-3α and HIF-1α exhibited strikingly similarresponses to a variety of activating or inhibitory pharmacological agents.These results demonstrate that HIF-3α is ex-pressed abundantly in lung epithelial cells,and that the transcriptional induction of HIF-3α plays an important role in theresponse to hypoxia in vitro.Our findings suggest that HIF-3α,as a member of the HIF system,is complementary ratherthan redundant to HIF-1α induction in protection against hypoxic damage in alveolar epithelial cells.

Strength reduction method for slope based on a ubiquitous-joint criterion and its application

In order to expand the application of strength reduction methods with the ubiquitous-joint criterion, the corresponding program is compiled using FLAC3D software. A procedure for strength reduction in the ubiquitous-joint criterion is proposed to study the safety factor of slopes as well as the relationships of the bedding plane inclination angle β and the safety factor F. The results show that： 1） for the bedding rock slope, the various failure modes cause different variations of the safety factor F; 2） a bed- ding rock slope can be divided into two types by the angle between the bedding plane inclination and slope surface inclination a; when a_〈45~, the bedding slope can be strictly defined as the subsequent bedding rock slope; when 45°〈α〈90°, the bedding slope is defined as an oblique bedding slope; 3） for bedding rock slopes, the safety factor increases with an increase in a; for inverse bed- ding slopes, when the bedding plane inclination angle fl is small, the safety factor F of the slope increases at first, then decreases with an increase in a; when β is large, the safety factor F increases with an increase in α.

Strength and deformation behaviors of bedded rock mass under bolt reinforcement

The mechanism of bolt support is an important topic in mining engineering and slope treatment. The artificial material and loading system were self-developed to study the influence of bedding cohesion and bolt number on the anchoring behavior of bedded rock mass. The results show that, both peak strength and elasticity modulus increase gradually with the increase of bedding cohesion and bolt number. The axial stress–strain curve of bedded rock mass under the reinforcement of bolts presents the features of strain-softening and secondary strengthening. Finally, anchoring behavior of bedded rock mass with different bolt numbers was simulated by using FLAC3 D numerical program and the results were compared with the experimental results. This study can provide certain bases to the stability control and support design of bedded rock mass in roadway.

Involvement of P53 and Bax/Bad triggering apoptosis in thioacetamide-induced hepatic epithelial cells

AIM： Thioacetamide （TAA） has been used in studying liver fibrosis and cirrhosis, however, the mechanisms of TAA-induced apoptosis in liver are still unclear. The hepatic epithelial cell line clone 9 was cultured and treated with TAA to investigate the causes of cell death. METHODS： The cell viability of TAA-induced clone 9 cells was determined using MTT assay. Total cellular GSH in TAA-induced clone 9 cells was measured using a slight modification of the Tietze assay. The activity of caspase 3 in TAA-induced clone 9 cells was monitored by the cleavage of DEVD-p-nitroanaline. TUNEL assay and flow cytometry were applied for the determination of DNA fragmentation and the proportion of apoptosis in TAA- induced clone 9 cells, respectively. The alterations of caspase 3, Bad, Bax and Phospho-P53 contents in TAA- induced clone 9 cells were measured by Western blot. RESULTS： The experimental data indicated that TAA caused rat hepatic epithelial cell line clone 9 cell death in a dose-and time-dependent manner; 60% of the cells died （MTT assay） within 24 h after 100 rag/1 TAA was applied. Apoptotic cell percentage （TUNE1 assay） and caspase 3 activities were highest after 100 rag/1 TAA was added for 8 h. The release of GSH and the elevation in caspase content after TAA treatment resulted in clone 9 cell apoptosis via oxidative stress and a caspasedependent mechanism. The phospho-p53, Bax and Bad protein expressions in clone 9 cells were increased after TAA treatment. CONCLUSION： These results reveal that TAA activates p53, increases caspase 3, Bax and Bad protein contents, perhaps causing the release of cytochrome c from mitochondria and the disintegration of membranes, leading to apoptosis of cells.

On the initiation,movement and deposition of a large landslide in Maoxian County,China

At 5 am 24 th June 2017, a catastrophic landslide hit Xinmo Village, Maoxian County, Sichuan Province, China. The slide mass rushed down from an altitude of 3400 m and traveled 2700 m in a high velocity. The 13 million m^3 deposition buried the whole village and caused about 100 deaths. The source area of the landslide is located in a high steep slope, average slope angle is 40o and maximal angle is 65o. The strata are interbedded Triassic Zagunao Formation metamorphic sandstone and slate with the dip slope angle of 45°. Based on high-resolution satellite remote sensing image, UAV image, DEM data, and field investigation, failure mechanism, travel features, and deposit characteristics were analyzed. The results showed that this landslide was influenced by Songpinggou Fault zone. According to the topography before the failure, the landslide is located in the back scarp of an antecedent landslide induced by Diexi Earthquake in 1933. The bedding slope provided potential rupture surface. Historical seismic activities and long-term gravitational deformation caused rock mass accumulated damages. Weathering and precipitation weakened the rock mass and finally induced shearing and tension failure. A huge block detached from the top rock slope, pushed the past landslide deposits in the middle part, rushed out of the slope bottom in a high velocity and buried the Xinmo Village. The rapid movement entrained and brought the soil into the Songping Gully which recoiled with and bounced back from the opposite mountain.

Experimental study on dynamic elastic parameters of coal samples

Dynamic elastic parameters of coal are closely linked to crack characteristics and are lithology indicators in seismic exploration. This experimental study measured ultrasonic wave velocity of coal samples considering both parallel(90°) and perpendicular(0°) to bedding planes, and then calculated the dynamic elastic parameters(Edand ld) and their anisotropy values(AEdand Ald). The variations of Edand ld,as well as AEdand Aldwere analyzed under various confining stresses. The results show that: Firstly, a critical confining pressure exists, and significant variation in the parameters can be seen below this point and weak variation appears above it. Secondly, a positive correlation exists between Edand the square of P-wave velocity(VP2), and between AEdand the P-wave velocity anisotropy(AEP) as well; however, there is no clear correlation between ldand P-wave velocity(VP). Thirdly, according to the major controlling factors of anisotropy, the coal samples with different Edand ldas well as AEdand Aldcan be divided into two types: one is mainly controlled by bedding and cracks and the other one is mainly controlled by differences of mineral compositions in directions. Consequently, this study can provide theoretical basis for future research on the dynamic elastic parameters and anisotropy of coal.

Clinical presentation and endoscopic management of Dieulafoy's lesions in an urban community hospital

AIM:To identify rates of occurrence,common clinical and endoscopic features,and to review the outcome of endoscopic management of Dieulafoy's lesions in the upper gastrointestinal (GI) tract in an urban community hospital setting. METHODS:Endoscopic data from esophagogastroduo denoscopies (EGDs),done at Wyckoff Heights Medical Center,Brooklyn,NY between 2000 and 2006 were reviewed to identify patients with Dieulafoy's lesions. Demographic data,medical history,examination findings,lab data,endoscopic findings and details of therapy for patients treated for Dieulafoy's lesions were reviewed retrospectively. RESULTS:Dieulafoy's lesions were documented to be the cause of bleeding in approximately 1% of patients presenting with upper gastrointestinal bleeding,while they were detected in only 2 patients when the indications for EGDs were different from active GI bleeding. When we analyzed EGDs performed in patients above age 65 years presenting with gastrointestinal bleeding,prevalence of Dieulafoy's lesions approached 10 percent. The most common location of the lesion was the body of stomach (7),followed by the cardia (4) and the esophagus (2). One patient had this lesion in the fundus and one patient in the duodenal apex. All patients were initially treated endoscopically with epinephrine injection,in eight cases heater probe was applied following epinephrine and endoscopic clips were applied in two cases. All but one of the patients did well in near and intermediate term follow-up (average follow-up period of 18 mo). One patient died of multi-organ failure during the same hospital stay. Average length hospital stay was 7 d.CONCLUSION:Community hospital gastroenterologists and endoscopists should be aware that Dieulafoy's lesions are an uncommon cause of upper GI bleeding among elderly patients. Early accurate diagnosis through emergent endoscopy and endoscopic therapy,especially in patients with multiple co-morbid conditions,can be very effective and life saving.

Experimental study on influence of coal structural anisotropy to gas permeation

Based on ＂true triaxial coal rock permeability of coal sample test system , the permeability under different gas pressure to coal specimen in bedding plane and the vertical bedding directions are tested. The results show that coal structural anisotropy has a greater impact on gas permeability properties, differences in experimental coal permeability are roughly one order of magnitude. In view of the differences of the gas flow characteristics in the coal bedding plane and vertical bedding, established series and parallel choked flow model of coal sample gas seepage, and made a theoretical analysis to the influences of the bedding structure to gas permeability properties.

Clinical features of upper gastrointestinal serrated lesions: An endoscopy database analysis of 98746 patients

AIM To analyse the clinical features of patients with the serrated lesions in the upper gastrointestinal tract(UPGI) tract.METHODS Patients who underwent routine esophagogastroduodenoscopy(EGD) at the Digestive Endoscopy Centre of General Hospital, Tianjin Medical University between january 2011 and December 2015 were consecutively recruited. Patients with UPGI serrated lesions were consecutively identified. The patients' demographics and histopathology were recorded. The colorectal findings for patients who underwent colonoscopy simultaneously or within six months were also extracted from the colonoscopy database. In addition, we analyseddifferences in colorectal neoplasia detection between the study patients and randomly selected patients matched for age and gender who did not exhibit serrated lesions and who also underwent colonoscopy in the same period.RESULTS A total of 21 patients out of 98746 patients(0.02%) who underwent EGD were confirmed to have serrated lesions with predominantly crenated, sawtooth-like configurations. The mean age of the 21 patients was(55.3 ± 17.2) years, and 11 patients were male(52.4%). In terms of the locations of the serrated lesions, 17 were found in the stomach(including 3 in the cardia, 9 in the corpus and 5 in the antrum), 3 were found in the duodenum, and 1 was found in the esophagus. Serrated lesions were found in different mucosal lesions, with 14 lesions were detected in polyps(8 hyperplastic polyps and 6 serrated adenomas with low grade dysplasia), 3 detected in Ménétrier gastropathy, 3 detected in an area of inflammation or ulcer, and 1 detected in the intramucosal carcinoma of the duodenum. In addition, colonoscopy data were available for 18 patients, and a significantly higher colorectal adenoma detection rate was observed in the UPGI serrated lesions group than in the randomly selected age- and gender-matched group without serrated lesions who also underwent colonoscopy in the same period(38.9% vs 11.1%, OR = 5.091, 95%CI: 1.534-16.890, P = 0.010). The detection rate of advanced adenoma was also higher in the UPGI serrated lesions group(22.2% vs 4.2%, OR = 6.571, 95%CI: 1.322-32.660, P = 0.028).CONCLUSION Serrated lesions in the UPGI were detected in various mucosal lesions with different pathological morphologies. Moreover colonoscopy is recommended for the detection of concurrent colorectal adenoma for these patients.

Seismic volcanostratigraphy of large, extrusive complexes in continental rift basins of Northeast China：Analysis of general bedding patterns in volcanostratigraphy and their seismic reflection configurations

The aim of this work is to establish volcanic seismic reflection configuration models in the rift basins of Northeast China from a new perspective,the volcanostratigraphic structure.Accordingly,the volcanostratigraphic structure of an outcrop near the Hailaier Rift Basin was analyzed to understand the characteristics and causal factors of physical boundaries.Further,3D seismic reflection data and analysis of deep boreholes in the Songliao Rift Basin were used to establish the relationship between volcanic seismic reflection configurations and volcanostratigraphic structures.These studies suggested that in volcanic successions,physical boundaries coincide with volcanic boundaries,and their distributions are controlled by the stacking patterns of volcanic units.Therefore,volcanic seismic reflection configurations can be interpreted in terms of the stacking patterns of volcanic units.These are also referred to as general bedding patterns in volcanostratigraphy.Furthermore,four typical seismic reflection configurations were identified,namely,the chaotic,the parallel continuous,the hummocky,the multi-mound superimposed and the composite.The corresponding interpretation models comprised single massive unit,vertical,intersectional,lateral multi-mound,and composite stacking patterns.The hummocky and composite reflection configurations with intersectional and composite stacking patterns are the most favorable for the exploration of volcanic reservoirs in rift basins.

Cell sheet technology for regeneration of esophageal mucosa

The progress of tissue-engineering technology has realized development of new therapies to treat various disorders by using cultured cells. Cell-and tissue-based therapies have been successfully applied to human patients, and several tissue-engineered products have been approved by the regulatory agencies and are commercially available. In the review article, we describe our experience of development and clinical application of cell sheet-based regenerative medicine.Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been shown to be useful for removal of gastrointestinal neoplasms with less invasiveness compared with open surgery, especially in esophageal surgery. However, postoperative inflammation and stenosis are major complications observed after intensive mucosal resection. Therefore, we have developed novel regenerative medicine to prevent such complications and promote wound healing of esophageal mucosa after EMR or ESD. Transplantable oral mucosal epithelial cell sheets were fabricated from patients' own oral mucosa. Immediately after EMR or ESD, fabricated autologous cell sheets were endoscopically transplanted to the ulcer sites. We performed a preclinical study with a canine model. In human clinical settings, cell culture and cell sheet fabrication were performed in clean rooms according to good manufacturing practice guidelines, and pharmaceutical drugs were used as supplements to culture medium in place of research regents used in animal study. We believe that cell-based regenerative medicine would be useful to improve quality of life of patients after EMR or ESD.

Watery diarrhea,hypokalemia and achlorhydria syndrome due to an adrenal pheochromocytoma

Watery diarrhea, hypokalemia and achlorhydria (WDHA) syndrome caused by vasoactive intestinal polypeptide (VIP) -producing tumor only rarely occurs in patients with nonpancreatic disease. A 49-year-old woman was referred for evaluation of a right adrenal tumor incidentally diagnosed by abdominal ultrasound during the investigation of chronic watery diarrhea. Laboratory findings showed hypokalemia and excessive production of VIP and catecholamines. After surgical resection of the tumor, diarrhea subsided and both electrolytes and affected hormone levels normalized. Immunohistochemical examination confirmed a diagnosis of pheochromocytoma, which contained VIP-positive ganglion-like cells. We herein present the clinical and histogenetic implications of this rare clinical entity, with literature review.

A Combined Clinicopathologic Analysis of 658 Urothelial Carcinoma Cases of Urinary Bladder

Objective To study the clinicopathological features of patients with urothelial carcinoma of the urinary bladder (UCB), and analyze the association of clinicopathological characteristics with tumor recurrence and progression. Methods Altogether 658 UCB cases in Fudan University Shanghai Cancer Center were collected from January 2006 to December 2010. The histopathologic materials and the clinical records were reviewed. Univariate and multivariate analyses were preformed to detect the association. Results The mean age of the patients was 61.97±12.97 years (range, 20-90 years). Male to female ratio was about 5:1. A total of 517 cases (78.6%) were superficial at the time of diagnosis (stage Ta/T1). The mean follow-up period was 22.36±24.92 months. Twenty-five patients lacking follow-up information were excluded in calculating recurrence and progression rates, the recurrence rate was about 37.0% (234/633), and progression rate about 6.2% (39/633). Three variables (grade, tumor growth pattern, and pathological stage) were found to be significant risk factors for tumor progression in univariate and multivariate analyses (P<0.05). Conclusions Most of the newly diagnosed UCB cases may be superficial diseases. Grade, tumor growth pattern, and pathological stage are associated with tumor progression of UCB.

Natural history of Barrett's esophagus

The natural history of Barrett's esophagus (BE) is difficult to quantify because,by definition,it should describe the course of the condition if left untreated.Pragmatically,we assume that patients with BE will receive symptomatic treatment with acid suppression,usually a proton pump inhibitor,to treat their heartburn.This paper describes the development of complications of stricture,ulcer,dysplasia and adenocarcinoma from this standpoint.Controversies over the definition of BE and its implications in clinical practice are presented.The presence of intestinal metaplasia and its relevance to cancer risk is discussed,and the need to measure the extent of the Barrett's epithelium (long and short segments) using the Prague guidelines is emphasized.Guidelines and international consensus over the diagnosis and management of BE are being regularly updated.The need for expert consensus is important due to the lack of randomized trials in this area.After searching the literature,we have tried to collate the important studies regarding progression of Barrett's to dysplasia and adenocarcinoma.No therapeutic studies yet reported show a clear reduction in the development of cancer in BE.The effect of pharmacological and surgical intervention on the natural history of Barrett's is a subject of ongoing research,including the Barrett's Oesophagus Surveillance Study and the aspirin and esomeprazole cancer chemoprevention trial with interesting results.The geographical variation and the wide range of outcomes highlight the difficulty of providing an individualized risk profile to patients with BE.Future studies on the interaction of genome wide abnormalities in Barrett's and their interaction with environmental factors may allow individualization of the risk of cancer developing in BE.

Juvenile polyposis syndrome

Juvenile polyposis syndrome is a rare autosomal dominant syndrome characterized by multiple distinct juvenile polyps in the gastrointestinal tract and an increased risk of colorectal cancer.The cumulative life-time risk of colorectal cancer is 39% and the relative risk is 34.Juvenile polyps have a distinctive histology characterized by an abundance of edematous lamina propria with inflammatory cells and cystically dilated glands lined by cuboidal to columnar epithelium with reactive changes.Clinically,juvenile polyposis syndrome is defined by the presence of 5 or more juvenile polyps in the colorectum,juvenile polyps throughout the gastrointestinal tract or any number of juvenile polyps and a positive family history of juvenile polyposis.In about 50%-60% of patients diagnosed with juvenile polyposis syndrome a germline mutation in the SMAD4 or BMPR1A gene is found.Both genes play a role in the BMP/TGF-beta signalling pathway.It has been suggested that cancer in juvenile polyposis may develop through the socalled "landscaper mechanism" where an abnormal stromal environment leads to neoplastic transformation of the adjacent epithelium and in the end invasive carcinoma.Recognition of this rare disorder is important for patients and their families with regard to treatment,follow-up and screening of at risk individuals.Each clinician confronted with the diagnosis of a juvenile polyp should therefore consider the possibility of juvenile polyposis syndrome.In addition,juvenile polyposis syndrome provides a unique model to study colorectal cancer pathogenesis in general and gives insight in the molecular genetic basis of cancer.This review discusses clinical manifestations,genetics,pathogenesis and management of juvenile polyposis syndrome.

Role of endoscopic ultrasound fine-needle aspiration evaluating adrenal gland enlargement or mass

AIM： To report the clinical impact of adrenal endoscop-ic ultrasound fine-needle aspiration （EUS-FNA） in the evaluation of patients with adrenal gland enlargement or mass.METHODS： In a retrospective single-center case-series, patients undergoing EUS-FNA of either adrenal gland from 1997-2011 in our tertiary care center were included. Medical records were reviewed and results of EUS, cytology, adrenal size change on follow-up imag-ing ≥ 6 mo after EUS and any repeat EUS or surgery were abstracted. A lesion was considered benign if： （1） EUS-FNA cytology was benign and the lesion remained 〈 1 cm from its original size on follow-up computed tomography （CT）, magnetic resonance imaging or repeat EUS ≥ 6 mo after EUS-FNA; or （2） subsequent adrenalectomy and surgical pathology was benign. RESULTS： Ninety-four patients had left （n = 90） and/or right （n = 5） adrenal EUS-FNA without adverse events. EUS indications included： cancer staging or suspected recurrence （n = 31）, pancreatic （n = 20）, medi-astinal （n = 10）, adrenal （n = 7）, lung （n = 7） mass or other indication （n = 19）. Diagnoses after adrenal EUS-FNA included metastatic lung （n = 10）, esophageal （n= 5）, colon （n = 2）, or other cancer （n = 8）; benign primary adrenal mass or benign tissue （n = 60）; or was non-diagnostic （n = 9）. Available follow-up confrmed a benign lesion in 5/9 non-diagnostic aspirates and 32/60 benign aspirates. Four of the 60 benign aspirates were later confrmed as malignant by repeat biopsy, follow-up CT, or adrenalectomy. Adrenal EUS-FNA diagnosed metastatic cancer in 24, and ruled out metastasis in 10 patients. For the diagnosis of malignancy, EUS-FNA of either adrenal had sensitivity, specifcity, positive predic-tive value and negative predictive value of 86%, 97%, 96% and 89%, respectively.CONCLUSION： Adrenal gland EUS-FNA is safe, mini-mally invasive and a sensitive technique with signifcant impact in the management of adrenal gland mass or enlargement.

Maintenance Chemotherapy of Stage Ⅲ Epithelial Ovarian Carcinoma-Focusing on Individualized Maintenance Chemotherapy

OBJECTIVE To investigate the role of maintenance chemotherapy on stage Ⅲ ovarian carcinoma. METHODS A retrospective analysis was conducted of 47 stage Ⅲ ovarian carcinoma patients with clinical complete remission after first-line chemotherapy. Among these patients, 21 cases were treated with maintenance chemotherapy, while the other 26 cases were free of treatment until progression. The 2 groups were compared with respect to progression-free survival （PFS） and overall survival（OS）. RESULTS The median PFS and OS were not significantly different between the 2 groups. For those patients, in a subgroup of suboptimal surgery （residual disease 〉2 cm）, the median PFS was 110 weeks and 56 weeks and the median OS was 223 weeks and 157 weeks for the maintenance and non-treated respectively. Both PFS and OS values favoured the maintenance group, P=0.004 and P=0.015 respectively. In a subgroup of optimal surgery （residual disease ≤2 cm）, the differences were not significant. CONCLUSION Patients with stage III ovarian carcinoma with clinical complete remission may benefit from maintenance chemotherapy, if the residual disease is 〉2 cm. To those with a residual disease ≤2 cm, the maintenance chemotherapy maybe of no value. So “individualized maintenance chemotherapy” should be conducted in the clinical setting.