盖诺加顺铂适形放疗治疗Ⅲa期非小细胞肺癌疗效观察

目的观察盖诺加顺铂联合三维适形放射治疗(3DCRT)局部晚期非小细胞肺癌的耐受性及近期疗效。方法36例局部晚期非小细胞肺癌(Ⅲa期)患者进入化疗加三维适形放射治疗组,全部患者均行盖诺加顺铂方案(盖诺25mg/m2第1,8天给予;顺铂25mg/m2第1～3天给予;21d为1个周期)化疗加3DCRT同步治疗。结果36例均完成治疗患者,肺原发灶CR占16.7%,PR占75.0%,NR+PD占8.3%,总有效率为91.7%;纵隔转移淋巴结CR占36.4%,PR占63.6%,NR+PD占0%,总有效率为100%;白细胞下降发生率为95.8%,其中3,4级白细胞下降为36.1%;放射性食管炎和放射性肺炎的发生率分别为54.2%和12.5%,均为1,2级。结论盖诺加顺铂联合适行放疗治疗局部晚期非小细胞肺癌能为绝大多数患者耐受,有较好的近期疗效。

Effect of Platelet Activation and Endothelial Cell Injury on Malignant Cancer

Objective: To study the effects of platelet activation and endothelial cell injury on the patients with malignant tumor and their prognoses.Methods: Radioimmunity and ELISA methods were employed to detect the TXB2, GMP-140, vWF, cGMP and FN in 78 cases of malignant tumor and 40 healthy control persons.Results: The levels of TXB2, MP-140 and cGMP were increased in intestinal cancer group, lung cancer group and hepatic cancer group, while FN decreased in intestinal cancer and lung cancer group. cGMP was positively related to TXB2, GMP-140, vWF in malignant tumor group. FN was decreased in the group complicated with infection and the group with metastasis, while the other indexes increased. GMP-140, vWF and cGMP was decreased after operation except for the increasing of FN.Conclusion: Activations of platelet and injury of endothelial cells developed in patients with malignant tumor, and both of them affected the metastasis and prognosis of malignant tumor. Key words platelet activation - epithelium injury - malignant tumor - metastasis This work was supported by grants from Guangdong Medical Science foundation (A2000633).

Telomerase Activity in Human Renal Cell Carcinoma with Reference to Clinicopathologic Features

Objective: To study the telomerase activity in human renal cell carcinoma and to evaluate the correlation with the clinicobiologic features of the neogrowth.Methods: The telomerase activity was studied by means of a modified telomeric repeat amplification protocol (TRAP) in 32 renal cell carcinoma tissues, 32 normal renal tissues and 32 paracancer tissues and its correlation with the clinicopathologic features of the tumor was evaluated.Results: Telomerase activity was strongly positive in 17, positive in 12 and negative in 3 cases of renal cell carcinoma tissues, the total positive rate being 91%. Telomerase activity was weakly positive (6%) in only 2 out of 32 samples of normal renal cortex tissues and positive in 6 paracancer tissues (19%), the difference was conspicuous (P<0.01).Conclusion: The positive rate of telomerase activity was significantly higher in renal cell carcinoma tissues and might serve as a prognostic marker for estimating the biologic characteristics of renal cell carcinoma.

Clinical Value of Ultrosound in the Diagnosis of Testicular Tumor

Objective: To summarize the clinical experience of diagnosis and treatment of the testicular tumors.Methods: Retrospective analysis of 42 adult patients with testicular cancers was carried out.Results: Ultrasonography (B-ultrasound and color Doppler flow imaging) was performed on 37 cases. One case was misdiagnosed. Surgical management was carried out in 42 cases and postoperational radiation therapy or chemotherapy was performed. The 1–5 year postoperative survival rate was totally 100%.Conclusion: B-ultrasound, especially color Doppler flow imaging, with the advantages of noninvasiveness and inexpensiveness was most useful and should be firstly employed in diagnosing the testicular tumor. The favorable prognosis can be obtained if an early diagnosis is made and the early treatment is performed. Key words testicular tumor - B-ultrasound - color Doppler flow imaging

Measurement of Serum Total and Free Prostate-Specific Antigen for Breast Cancer Diagnosis in Women

Objective: To investigate the diagnostic value and the relationship between the clinicopathological features and the levels of total and free prostate-specific antigen (PSA) in women with breast cancer.Methods: Using the microparticle enzyme immunoassay system, we measured the concentrations of these markers in the sera of 85 women with breast cancer and in 30 healthy women.Rseults: The lowest detection level for both markers was 0.01 ng/ml. Free PSA levels were significantly higher in women with breast cancer than that in healthy women (P<0.05). The percentage of free PSA predominant subjects was 37.6% in breast cancer patients and 3.3% in healthy women. Cut-off values were 0.36 ng/ml for total PSA and 0.02 ng/ml for free PSA. In women with breast cancer, total PSA positivity was 23.5% and free PSA positivity was 27.1%. Compared to negatives, total PSA positive patients had a higher percentage of lymph node involvement tumours (P>0.05). However, patients with predominant free PSA had a higher percentage of early stage than patients with predominant PSA-ACT.Conclusion: Although the sensitivity of free PSA predominance is low (37.6%) in distinguishing women with breast cancer from healthy women, its specificity is high (97.0%).Free PSA predominance tends to be present in early stage tumours. These findings may indicate clinical significance of preoperative measurement of serum total and free PSA in women with breast cancer.

Effect of lymph node micrometastases on prognosis of gastric carcinoma

AIM： To evaluate the relationship between lymph node micrometastases and prognosis of patients with gastric carcinoma and to evaluate the significance of the new assessment of nodal status in determining the pN categories in the 5th edition of the UICC TNM classification.METHODS： A total of 850 lymph nodes from 30 patients with gastric carcinoma who underwent gastrectomy with lymphadenectomy were assessed by reverse transcription polymerase chain reaction assay in addition to histologic examination. Cytokeratin-20 gene marker was used in this assay.RESULTS： Routine examination by HE staining confirmed metastasis in 233 lymph nodes from 20 patients. All these 233 lymph nodes were oltokeratin-20 positive. Moreover, lymph node micrometastases were detected in an additional 67 lymph nodes in 12 of these 20 patients. Lymph node micrometastases were also detected in t0 lymph nodes from 2 of 10 patients who had no obvious metastases identified by HE staining. Totally, lymph node micrometastases were identified by the reverse transcription polymerase chain reaction assay in 77 （12.5%） lymph nodes from 14 （46.7%） patients with gastric carcinoma. Of 27 patients who underwent curative resection, 7 （25.9%） were up-staged （from Ⅰ B stage to Ⅱ stage in 1 patient, from IB stage to ⅢA stage in 1 patient, from Ⅱ stage to ⅢA stage in 1 patient, from ⅢA stage to ⅢB stage in 1 patient, from ⅢA stage to Ⅳ stage in 1 patient, from ⅢB stage to Ⅳ stage in 2 patients）. In a median follow-up of 32 （range 8-36） too, Kaplan-Meier survival analysis showed significant improvements in median survival （22.86 ± 3.17 mo, 95% CI： 16.64-29.08 mo vs 18.00 ± 7.4 mo, 95% CI： 3.33-32.67 mo） of patients with negative lymph node micrometastases over patients with positive lymph node micrometastases （log-rank, P 〈 0.05）.CONCLUSION： Lymph node micrometastases have a significant impact on the current staging system of gastric carcinoma, and are significant risk factors for prognosis of patients with gastric carcinoma.

基础地下室混凝土施工中的裂缝控制

着重分析了基础大体积混凝土及地下室外墙混凝土的施工裂缝产生的原因,从施工角度讨论预拌混凝土在大体积基础及地下室外墙控制裂缝应注意的事项,并提出几点体会。

Surgical management of gastric stump cancer:a report of 37 cases

Objective:To observe the clinicopathological characteristics of gastric stump cancer(GSC)and evaluate the benefitsof radical surgery of GSC.Methods:The clinicopathological characteristics and postoperative survival time of 37 GSC patientswho underwent surgery were investigated retrospectively.The survival time was compared according to the type of surgicaloperation(radical resection vs palliative operation).Twenty-one cases that received radical resection were analyzed based on thepTMN stage.Survival curves were traced by using Kaplan-Meier methods.Results:Most GSC(32/37)was detected in patientswho had received Billroth Ⅱ reconstruction after partial gastrectomy for benign gastric disease.The lesser curvature side and thesuture line of anastomosis were the most frequent sites where GSC occurred(27/37).Differentiated adenocarcinoma was thedominant histopathological type(24/37).The postoperative 5-year survival rate of early stage GSC patients(n=9)was significantlyhigher than advanced stage GSC(n=12)(55.6% vs 16.5%,x_L^2=11.48,P<0.01).Five-year survival rate of 21 GSC patients withradical resection were 75%(3/4)for stage Ⅰ,60%(3/5)for stage Ⅱ,14.2%(1/7)for stage Ⅲ,and 0%(0/5)for stage Ⅳ respectively.The median survival time of 21 GSC patients who underwent radical resection was longer than those undergoing palliative op-eration(43.0 m vs 13.0 m,X_L^2=36.31,P<0.01),the median survival time of stage Ⅳ patients with radical resection was 23.8months.Conclusions:Without remote metastasis,radical resection for GSC is possible,and is an effective way to improve theprognosis of GSC.Even in stage Ⅳ GSC,radical resection can still prolong the survival time.It is necessary for the patients withbenign gastric diseases who received partial gastrectomy to carry out the endoscopy follow-up,especially in patients with BillrothⅡ reconstruction procedure at 15-20 years.

Overexpression of lysine specific demethylase 1 predicts worse prognosis in primary hepatocellular carcinoma patients

AIM:To investigate the clinicopathological features and prognostic value of lysine specific demethylase 1(LSD1) in hepatocellular carcinoma(HCC).METHODS:We examined LSD1 expression in 60 paired liver cancer tissues and adjacent noncancerous tissues by quantitative real time polymerase chain reaction(qRT-PCR) and Western blotting.In addition,we analyzed LSD1 expression in 198 HCC samples by immunohistochemistry.The relationship between LSD1 expression,clinicopathological features and patient survival was investigated.RESULTS:Immunohistochemistry,Western blotting,and qRT-PCR consistently confirmed LSD1 overexpression in HCC tissues compared to adjacent non-neoplastic tissues(P < 0.01).Additionally,immunostaining showed more LSD1-positive cells in the higher tumor stage(T3-4) and tumor grade(G3) than in the lower tumor stage(T1-2,P < 0.001) and tumor grade(G1-2,P < 0.001),respectively.Moreover,HCC patients with high LSD1 expression had significantly lower 5-year overall survival rates(P < 0.001) and lower 5-year disease-free survival rates(P < 0.001),respectively.A Cox proportional hazards model further demonstrated that LSD1 over-expression was an independent predictor of poor prognosis for both 5-year disease-free survival [hazards ratio(HR) = 1.426,95%CI:0.672-2.146,P < 0.001] and 5-year overall survival(HR = 2.456,95%CI:1.234-3.932,P < 0.001) in HCC.CONCLUSION:Our data suggest for the first time that the overexpression of LSD1 protein in HCC tissues indicates tumor progression and predicts poor prognosis.

Multidisciplinary approach to understand the pathogenesis of gastric cancer

Gastric carcinoma remains a common disease worldwide with a dismal prognosis. Therefore, it represents a very important health problem. It occurs with a high incidence in Asia and is one of the leading causes of cancer death in the world. Although the incidence and mortality of gastric carcinoma are decreasing in many countries,gastric cancer still represents the second most frequent malignancies in the world and the fourth in Europe. The 5-year survival rate of gastric carcinoma is low. The etiology and pathogenesis are not yet fully known. The study of gastric cancer is important in clinical medicine as well as in public health. Over the past 15 years,integrated research in molecular pathology has clarified the details of genetic and epigenetic abnormalities of cancer-related genes in the course of the development and progression of gastric cancer. Gastric cancer, as all cancers, is the end result of the interplay of many risk factors as well as protective factors. Although epidemiological evidence indicates that environmental factors play a major role in gastric carcinogenesis, the role of immunological, genetic, and immunogenetic factors are thought to contribute to the pathogenesis of gastric carcinoma. Among the environmental factors,diet and Helicobacter pylori are more amenable to intervention aimed at the prevention of gastric cancer.The aim of the present paper is to review and include the most recent published evidence to demonstrate that only a multidisciplinary approach will lead to the advancement of the pathogenesis and prevention of gastric cancer. On the immunogenetic research it is clear that evidence is accumulating to suggest that a genetic profile favoring the proinflammatory response increases the risk of gastric carcinoma.

Expressions of Survivin and Caspase-3 in human hepatocellular carcinoma and the relationship with prognosis

Objective: The aim of our study was to investigate the expressions of Survivin and Caspase-3 in the hepatocellular carcinoma (HCC) and the paracancerous liver tissues, and define the relationship between the expression and the patients survival rate after surgery. Methods: The expressions of PCNA, Survivin and Caspase-3 were detected by immunohistochemistry. PCNA positive level was used to account proliferating cell nuclear antigen proliferating index (PCNA-PI). The apoptosis index of HCC tissues was detected by TUNEL. Results: The expression of Survivin in HCC tissue was higher than that in paracancerous tissue (P < 0.05), while it was related with portal vein thrombosis, tumor size and histological differentia- tion (P < 0.05). In HCC tissues, the PCNA-PI of the Survivin positive group was higher than the negative (P < 0.05) group, and the AI of the Survivin positive group was lower than the negative group (P < 0.05). The expression of Caspasse-3 in HCC tissue was lower than that in paracancerous tissue (P < 0.05), while it was related with HBsAg and histological differentiation (P < 0.05). In HCC tissues, the average PCNA-PI of the Caspase-3 positive group was lower than that of the negative group (P < 0.05), and the average AI of the Caspase-3 positive group was higher than that of the negative group (P < 0.05). There was negative correlation between the expressions of Survivin and Caspase-3 in HCC (r = -0.242, P < 0.05). The survival rate of the Survivin positive group was lower than that of the negative group (P < 0.05), while that of the Caspase-3 positive patients was higher than that of the negative group (P < 0.05). Conclusion: The expressions of Survivin and Caspase-3 in HCC can reflex the biological behavior of HCC and patients prognosis, they may be new targets of tumor diagnosis and treatment.

Methodology for high-quality studies on course and prognosis of inflammatory bowel disease

Inflammatory bowel diseases(IBDs) are characterized by a chronic course with an alternation of relapses and remissions.Questions about prognosis are important for the patient who wants to know how the disease will affect his/her life and also for clinicians to make management decisions.Correct selection of the patients is the basis for good methodological studies on the course of IBD.A great proportion of data on the course of IBD is derived from a limited number of cohort studies.Studies help to define the endpoints for clinical trials and to identify subsets of patients in whom the prognosis of the disease can be stratified according to clinical features.Specific scientific requirements for high-quality studies on prognosis are the following:use of inception cohort,description of referral patterns,completeness of follow-up,objective outcome criteria,blind outcome assessment,adjustment for extraneous prognostic factors and statistical issues.We analyzed each of these requirements in studies on IBDs.To date,prospective and populationbased cohort studies are the standard for an unbiased assessment of prognosis.A better knowledge of the course of disease of chronic disorders ideally requires:(1) data from population-based studies,to avoid selection bias from referral centers in which patients with a more severe disease are usually treated;(2) inclusion of patients seen at the onset of the disease excluding misdiagnosed cases;and(3) follow-up from the onset of the disease to the end without dropouts.

Levels of v5 and v6 CD44 splice variants in serum of patients with colorectal cancer are not correlated with pT stage,histopathological grade of malignancy and clinical features

AIM:This study was designed to compare the levels of v5 and v6 splice variants of CD44 evaluated using EITSA test in the serum of patients with colorectal cancer in different stages of progression of the disease estimated in pT stage according to WHO score,histopathological grade of malignancy and some clinicopathological features. METHODS:The serum obtained from 114 persons with colorectal adenocarcinomas was examined using ELISA method,pT stage and grade of malignancy of the tumour were examined in formalin fixed and paraffin embedded materials obtained during operation. RESULTS:Only the level of CD44 v5 in the serum of patients before operation with G2 pT4 tumour was lower than that in other probes and the difference was statistically significant. We did not find any other correlations between the level of v5 and v6 CD44 variants and other evaluated parameters. CONCLUSION:The level of CD44 v5 and v6 estimated by ELISA test in the serum can not be used as a prognostic factor in colorectal cancer.

Value of COX-2 and HER-2 in Judging Condition and Prognosis in Non-Small Cell Lung Cancer Patients

OBJECTIVE To investigate the expressions of cyclooxygenase 2 （COX-2） and human epidermal growth factor receptor-2 （HER-2） in non-small cell lung cancer （NSCLC） and their clinical significance in identifying the progression and prognosis of the NSCLC patients. METHODS Immunohistochemical indirect method was used to detect the expressions of the COX-2 and HER-2 protein in 54 NSCLC specimens, 16 paraneoplastic specimens, and 10 normal tissue specimens. RESULTS The positive rates of COX-2 and HER-2 protein expressions were respectively 75.9% and 40.7% in the NSCLC specimens, 25% and 12.5% in the paraneoplastic specimens, and 0 in the normal tissue. The COX-2 protein expression in lung cancer （LC） was not only related to the smoking habit of the patients and histological grades of LC, but also to the TNM stages, and lymphatic metastasis （P 〈 0.05）. HER-2 protein expression closely correlated to the pathologic types, histological grades, TNM stages, and lymphatic metastasis （P 〈 0.05）. The result of univariate analysis showed that all the histological grades, TNM stages, lymphatic metastasis, and expressions of COX-2/HER-2 correlated to the prognosis of NSCLC patients （mean of P value 〈 0.01）. The multivariate survival analysis indicated that there were signi.cant di.erences in comparison of the survival time between the COX-2 （＋＋/＋＋＋） /HER-2 （＋＋/＋＋＋） and the COX-2 （-/＋）/HER-2 （-/＋） groups （P〈 0.001）, suggesting the COX-2/HER-2 was a negative prognostic factor. CONCLUSION COX-2 and HER-2 are valuable in identifying the progression of NSCLC and predicting the prognosis of NSCLC patients. COX-2 and HER-2 are useful for judging the NSCLC patient＇s condition, and are of great value to the decision of NSCLC prognosis.

Comparison of surgical methods and prognostic factors in T4 gastric cancer

Objective： In advanced gastric carcinomas that have invaded adjacent organs, the prognosis is poor. When combined resections are performed in T4 gastric cancers, it is inconclusive as to whether or not there is an improvement in the survival rate. We compared with gastrectomy alone to analyze the prognostic factors in T4 gastric cancers. Methods： Between January 1997 and December 2004, 115 patients underwent surgery for T4 gastric cancer; we divided them into two groups： combined resections in group Ⅰ, gastrectomy alone in group Ⅱ. Surgical outcomes and clinicopathologic factors were compared and prognostic factors were evaluated. Results： Among the two groups, statistically significantly different factor was Borrmann type. The most commonly resected organ was the transverse colon, and no one post-operative morbidities developed. In the multivariate analysis, the treatment group and curability were proved to be independent prognostic factors. Conclusion： In patients with T4 gastric carcinoma, surgical gastrectomy alone approach can be beneficial. Compared with the group I, non-resection （gastrectomy alone） can be performed for a better surgical approach.

Unanticipated Bond Failure over Supporting Band Beams in Grouted Post-Tensioned Slab Tendons with Little or No Initial Prestress

After grouting the ducts in a large band beam and one-way slab post-tensioned floor system in a large shopping mall （in excess of 1.5 km2 in plan）, doubts arose concerning the level of initial prestress and the strength and serviceability of the slabs was questioned. To assess the strength of the slabs, it was assumed, as a worst case scenario, that some spans may have been constructed with zero initial prestress. Load tests on prototype specimens, with similar dimensions and reinforcement quantities as the floor slabs, were performed to assess the stress development in initially unstressed, but fully grouted, tendons. Unexpected bond failures occurred at the junctions of slab and band beam where the abrupt change in section depth caused a sudden change in tendon stress. The maximum stress that was developed in the initially unstressed tendons at these locations was about 60% of the strength of the tendons.

Aeroengine Performance Parameter Prediction Based on Improved Regularization Extreme Learning Machine

Performance parameter prediction technology is the core research content of aeroengine health management,and more and more machine learning algorithms have been applied in the field.Regularized extreme learning machine(RELM)is one of them.However,the regularization parameter determination of RELM consumes computational resources,which makes it unsuitable in the field of aeroengine performance parameter prediction with a large amount of data.This paper uses the forward and backward segmentation(FBS)algorithms to improve the RELM performance,and introduces an adaptive step size determination method and an improved solution mechanism to obtain a new machine learning algorithm.While maintaining good generalization,the new algorithm is not sensitive to regularization parameters,which greatly saves computing resources.The experimental results on the public data sets prove the above conclusions.Finally,the new algorithm is applied to the prediction of aero-engine performance parameters,and the excellent prediction performance is achieved.

1093例初治鼻咽癌的疗效和预后分析

目的报道21世纪初中山大学肿瘤防治中心初治鼻咽癌的放疗现状及比较不同放疗技术对预后和生存质量的影响。方法对根治性放疗的1093例初治鼻咽癌患者的资料进行回顾性分析。按2002年UICC分期标准，I、Ⅱ、Ⅲ、IVa＋IVb期分别为63、439、358、233例。812例采用x线透视模拟定位常规设野放疗（CR），155例采用CT模拟定位常规设野放疗（CT-sim CR），69例采用三维适形放疗（3DCRT），57例采用调强放疗（IMRT）。放疗鼻咽部中位剂量为70Gy。结果全组5年局部控制率、区域控制率和无远处转移率分别为86．8％、95．3％和83．2％，5年无进展生存率和总生存率分别为66．9％和77．9％。CR、CT-sim CR、3DCRT、IMRT组5年总生存率和局部控制率分别为75．9％、83．5％、87．2％、86．6％（P=0.014）和84．5％、96．4％、91.0％、91．7％（P=0．006）。3DCRT、IMRT组口干和张口困难发生率和程度较CR、CT-sim CR组明显减低（P=0．000和0．023）。结论采用CT模拟定位、3DCRT及IMRT技术能提高局部控制率和生存率，且3DCRT和IMRT技术能提高患者生活质量。

INHBA在肝细胞癌中的表达及临床意义

目的探讨抑制素β-A(INHBA)在肝细胞癌(HCC)中的表达及其与预后的关系。方法本研究对象为2009年2月至2013年11月在广州医科大学附属第一医院行手术切除的81例患者HCC组织,并选取30例癌旁组织作为对照。患者均签署知情同意书,符合医学伦理学规定。其中男74例,女7例;年龄32~81岁,中位年龄53岁。采用免疫组化法检测INHBA的表达。肝癌与癌旁组织中INHBA表达率比较及INHBA的表达与HCC患者临床病理参数关系的分析采用χ^(2)检验。生存分析采用Kaplan-Meier法和Log-rank检验。采用Cox比例风险回归模型分析影响HCC患者预后的危险因素。结果HCC组织中INHBA的表达率为42%(34/81),明显高于癌旁组织的13%(4/30)(χ^(2)=9.276,P<0.05)。INHBA的表达与肿瘤分化程度和美国癌症联合委员会(AJCC)分期有关(χ^(2)=15.499,9.100;P<0.05)。生存分析显示,INHBA高表达患者的预后较低表达患者差(χ^(2)=11.721,P<0.05)。Cox回归分析显示,AJCC分期Ⅲ期和INHBA高表达均为HCC患者预后的独立危险因素(HR=4.316,2.612;P<0.05)。结论INHBA在HCC组织中高表达,其表达水平与肿瘤分化程度和AJCC分期相关,INHBA高表达的HCC患者预后较差。

Treatment of 209 cases of liver injury

Objective: To summarize the experience of the treatment of traumatic hepatorrhexis. Methods: The clinical data of 209 cases of liver trauma treated in the three affiliated hospitals of the Third Military Medical University from 1989 to 1999 were retrospectively analyzed. Among the 209 patients, 108 ( 51.7 %) had Grade III or more severe liver injury. Operative treatment was performed in 186 cases and preservative treatment in 23. Results: In the operated group, 169 patients were cured. The complications occurred in 18 patients and 17 of them died. In the non operated group, the complications occurred in 22 patients and only 1 of them died. Conclusions: Severe injury and delayed treatment are two major factors leading to death from liver injuries. Surgical intervention is still the principal measure to treat traumatic hepatorrhexis. The indications for non operative treatment should be carefully selected.