[Objective] To observe the clinical effects of Zhishang Jiaonang on soft tissue injury of chest wall.[Method] A randomized,positive-controlled trial was adopted,120 cases was divide into trial group(n=90) and the control group(n=30).[Result] 60 cases were cured(66.7%),29 better(32.2%),1 had no effect(1.1%) in trial group;14 cases were cured(46.7%),15 better(50.0%),1 had no effect(3.3%) in control group. With marked difference after statistical dealing,P

Objective To investigate effects of pedicle processing methods on the survival and appearance of the pedicle flaps. Methods The study involved 17 patients with soft tissue defects of extremities treated with the “exclamation mark” shaped pedicle flaps from October 2009 to January 2011.The traditional pedicled rotation flaps was designed to be a tennis racket-like shape,then the rotational pedicle was designed to small round tension reduction flap and pedicled rotation flaps,which contributed to formation of the “exclamation mark” shaped pedicle flaps.The soft tissue defects was located at the upper extremity in three patients and at lower extremity in 14,with defect areas of 4.0 cm× 7.2 cm-5.8 cm × 14.0 cm.There used two superficial radial nerve vasotrophic flaps,one ulnar artery supra-carpal cutaneous flap,eight sural neurocutaneous vasotrophic flaps and six saphenous nerve vasotrophic flaps.Results All flaps survived at Ⅰ stage except that one flap had partial distal necrosis postoperatively,which was cured after dress change.The follow-up ranged from six months to one year,which showed unobvious swelling of the survived flaps and good appearance of the rotation point of the pedicle. Conclusion The “ex(c)lamation mark” shaped pedicle flaps can reduce entrapment of the distal pedicle,promote venous drainage,improve survival and modify the appearance of the flaps.

Objective To study the sensitivity and specifity for detection of bladder tumor by Narrow-band imaging flexible cystoscopy compared with WLI flexible systoscopy. Methods Between February 2009 and July 2009, NBI flexible cystoscopy and conventional WLI flexible cystoscopy with the same instrument (Olympus Exera Ⅱ endoscopy system) were both performed on 31 patients highly suspect of bladder neoplasm with same observed time and in a randomized sequenced paradigm. Every suspect mucosa lesion was biopsied in both NBI and WLI image to compare the diagnostic accuracy between them. Results Twenty-eight patients(90%) were pathologically bladder urothelial cell carcinoma (UCC). Of 28 patients 3 were Tis, 15 were Ta, 7 were T1, and 3 were T2. Twenty were low grade carcinom, 8 were high grade carcinoma and 16 had multiple tumors, 12 had a single tumor.Of 73 biopsied lesions, 61 were diagnosed UCC under WLI image with 84% sensitivity, while 80 of 91 diagnosed under NBI image with 88% sensitivity. WLI detected 23 patients with bladder UCC while NBI detected all 28 patients. NBI detected 19 additional UCC lesions in 15 of 28 patients, as compared with WLI(P＜0. 05). Conclusion NBI flexible cystoscopy can detect more bladder urothelial cell carcinoma than WLI flexible cystoscopy.

Objective To introduce the technical improvements in retroperitoneal laparoscopic radical nephrectomy and discuss their roles in decreasing the perioperative complication. Methods Sixty-one patients with localized renal cell carcinoma were treated with retroperitoneal laparoscopic radical nephrectomy from December 2006 to March 2008. Pre-operative CT scan was performed to evaluate the renal vessel status. Thirty degree laparoscope was used together with self-made balloon dilator to establish the retroperitoneal space. Harmonic scalpel was used in dissection and removal of the extra-peritoneal fat. Cautions were taken during the separation of peritoneum. The renal artery and vein were separated and ligated with Hem-o-lok clips. Complications such as vessel split and intes-tinal injury were recorded. Operation time, estimated blood loss, drainage volume, and length of hos-pital stay were analyzed as well. Results The operation time was 50-135 min, estimated blood loss during operation was 20-170 ml, post-operative drainage volume was 20-210 ml, mean post-opera-tive length of hospital stay was 5 d. Two complications occurred during the operation: one was a vena eava injury, and another was a minor duodenum wall perforation. Conclusions Retroperitoneal lapa-roscopic radical nephrectomy is an effective and safe surgical option for localized renal cell carcinoma. Improvements in this surgical technique bring more safety and convenience and could decrease perio-perative complications relatively.

Objective To discuss the function of pelvic lymphadenectomy in radical cystectomy. Methods Ninety-five patients with bladder cancer (76 males and 19 females) underwent radical cys-tectomy. Clinical data were reviewed. Median age was 62 years old (25-78). Among all patients, 49 were newly diagnosed and 46 had recurrent disease. Of 95 patients, 87 were urothelial cell carcinoma, 5 were adenocarcinoma, and 3 were squamous cell carcinoma. Of 87 urothelial cell carcinoma cases, 17 were grade 1, 39 were grade 2, and 31 were grade 3. Of 95 patients, 10 were Ta-T1,54 were T2 ,26 were T3 ,and 5 were T4 according to AJCC classification. All cases accepted bilateral pelvic lymphade-nectomy according to standard protocol. Results Bilateral lymphadenectomy was taken an average time about 20 min. No important vessels and nerves injury occurred and average bleeding volume was 25 ml during procedure. A median of 10 lymph nodes were removed (range, 1-20). The nodal posi-tive rate was 17.9% (17/95) with 58.8% (10/17) bilateral lymph nodes positive. Short-term opera-tion-related complication rate was 12.6% (12/95). No operation-related death happened. Median fol-low up time was 34 months (3 to 64 months). Sixteen cases died during followup and the 3-year over-all survival rate was 84.5%. Conclusions Bilateral pelvic lymphadenectomy should be routinely per-formed during radical cystectomy. Standard lymphadenectomy could document accurately the staging and improve the overall survival in radical cystectomy without severe complications.

Objective To investigate the toxicities of sorafenib in the treatment of advanced re-nal cell carcinoma, and discuss the management. Methods Fifty-eight patients with advanced renal cell carcinoma were treated with sorafenib from March 2006 to February 2008. Of them, 44 were males and 14 were females with the average age of 50 years. Single agent of sorafenib 400 mg twice daily was administrated to 49 patients, and the other 9 patients were given sorafenib and Interferon-a as a combination therapy. The main toxicities such as hand-foot syndrome, alopecia, rash, mucositis, fatigue, diarrhea, weight loss, hypertension, hemoptysis, liver dysfunction, hypophosphatemia and anemia were analyzed for their occurrence time, duration, and grade. Results The toxicities of sor-afenib included hand-foot skin reaction (75.9%), alopecia (67.2%), rash (39.7%), mucositis (24.1%), fatigue (74.1%), hypertension (24.1%), and liver dysfunction (13.8%). Twelve cases (20.7%) experienced grade 3 toxicities and had dose reduced; and two cases encountered grade 4 tox-icities and had permanent withdraw. Conclusions There is peculiarity in treating Chinese advanced renal cell carcinoma patients with sorafenib. The incidences of major toxicities of sorafenib are higher in Chinese patients than what have been observed in studies conducted in US and Europe. Toxicities such as hemorrhage and angina could also appear and need carefully monitored. Generally, most of the toxicities of sorafenib are grade 1 and 2, and easy to be managed in clinic.

Objective To evaluate the clinical efficacy and side effects of sunitinib in the treatment of advanced renal cell carcinoma. Methods Forty-five patients with advanced renal cell carcinoma and an average age of 48.6 yrs were treated with sunitinib. Among the study group, 25 were male and 20 were female. In group one, patients received sunitinib treatment in repeated six week cycles consisting of four weeks of sunitinib 50 mg daily followed by two weeks off treatment (schedule 4/2). In group two, a single daily dose of sunitinib 37.5 mg was administrated to 20 patients without off treatment. A CT scan was used to evaluate the treatment efficacy after each cycle and the side effects were recorded accordingly. Results Clinical efficacy could be evaluated in 40 patients. Of these, two achieved complete response, eight achieved partial response, 27 were stable and the remaining eight experienced disease progression with four patients dying during the study period. The side effects of sunitinib in group one and in group two included hypertension 32% (8/25) and 10% (2/20), P=0.02; liver function impairment 32% (8/25) and 20% (4/20), P=0.011; hand-foot skin reaction 68% (17/25) and 60% (12/20), respectively. The incidence of major side effects of sunitinib were different in Chinese patients than from what had been previously reported in studies conducted in US and Europe. Generally, most of the sunitinib side effects were easy to manage. Conclusions There weredifferences between the two groups of Chinese patients treated with different sunitinib protocols. The protocol of sunitinib 37.5mg daily without off-treatment was better than the protocol of sunitinib 50mg daily (schedule 4/2) in regard to liver function impairment and hypertension.

Objective To analyze prognosic factors for patients with hormone refractory prostate cancer (HRPC) after chemotherapy of docetaxel/mitoxantrone plus prednisone and to explore the relationship between prostate specific antigen (PSA) parameters and prognosis. Methods Data from 68 patients with CRPC after chemotherapy were collected and analyzed retrospectively.The median age of these patients were 65 years old with 28 cases of biopsy Gleason score ＜ 8 and 35 cases of ≥ 8.The median serum PSA at diagnosis,nadir and pre-chemotherapy baseline were 142 ng/ml,0.5 ng/ml and 33.0 ng/ml,respectively.There were 38 patients in docetaxel group and 30 in mitoxantrone group.PSA doubling time ( PSADT),progression free survival (PFS) and overall survival (OS) was calculated.Chi square test was used in analysis of chemotherapy effect and Cox proportional hazards regression model was applied to identify the predictors for PFS and OS.The median value of continuous variable as cutoff point was used to divide patients into two groups to compare.Risk ratio and 95％ confidence interval (CI) was calculated. Results 38 (55.9％)patients experienced effective chemotherapy. The effective rate were 33％ and 74％ for PSADT ＜ 1.6 months and ≥ 1.6 months group,85％ and 49％ for M0 and M1 stage group,and 69％ and 40％ for docetaxel and mitoxantrone group,(P ＜ 0.05).The median PFS was (3.5 ± 0.5) months for all patients,which were (2.7 ±0.4) months and (5.9 ±0.6) months for patients with PSADT ＜ 1.6 months and ≥ 1.6 months group,(5.0 ± 0.6) months and (2.7 ± 0.5 ) months for patients with docetaxel and mitoxantrone group,and (5.7 ± 0.8) months and ( 3.4 ± 0.6) months for patients with Gleason score ＜ 8 and ≥ 8 group (P ＜0.05).26 case died in the end and the median OS was (28.3 ± 2.6) months for these patients,which were (15.7 ± 3.4) months and (31.6 ± 1.2) months for patients with PSADT ＜ 1.6 months and ≥1.6 months group,(29 ± 4.1 ) months and (28 ± 3.2) months for patients with docetaxel and mitoxantrone group,and (28.7 ± 2.6) months and (24.3 ± 5.6) months for patients with Gleason score ＜ 8 and ≥ 8 group (P ＜ 0.05). Conclusions The effective rate of chemotherapy was related with PSADT,chemotherapy strategy and M stage.PSADT,chemotherapy strategy and Gleason score may be independent predictors for patients with HRPC taking chemotherapy.Patients with PSADT ≥ 1.6 months,docetaxel chemotherapy and Gleason score ＜ 8 will have longer PFS and OS.

Objective To investigate the efficacy of Sunitinib in treating metastatic non-clear cell renal cell carcinoma (RCC).Methods Twenty-two metastatic non-clear cell subtype renal cell carcinoma patients with a median age of 46 years (29 -76 years) were treated with Sunitinib.Fourteen cases were found have metastasis post radical nephrectomy,and the remaining eight cases with metastasis received cytoreductive surgery.Pathological diagnosis showed 12 papillary RCCs,one chromophobe RCC,three collecting duct RCCs,and six unclassified RCCs.The metastatic lesions were located in the lung,lymph nodes,adrenal gland,bone,liver,and thyroid gland.The patients were given the treatment of sunitinib 50 mg qd four weeks on and two weeks off.The median time of treatment was 11 months (4.5 - 24 months).Results The objective control rate was 73％.Three papillary RCC and one chromophobe RCC reached partial remission (PR) and 12 cases maintained stable disease (SD) for more than 12 weeks.And the remaining six cases progressed (PD).Conclusions Sunitinib has definitive efficacy in metastatic papillary RCC,chromophobe RCC,collecting duct RCC and unclassified RCC.Metastatic lesions in lungs and lymph nodes might be more sensitive to Sunitinib.

Background and purpose: Platelet to lymphocyte ratio (PLR) is an important factor reflected systematic inflammation. The clinical value of PLR has not been confirmed. The present study was to explore the value of preoperative PLR in predicting clinical stage and prognosis in upper tract urothelial carcinoma. Methods:Patients who underwent surgical therapy with postoperative pathology upper tract urothelial carcinoma without metastasis from Jan. 2007 to Mar. 2012, were collected. Following up was done by telephone and clinic work, 150 vs 1 was taken as the threshold value of PLR, and the association of PLR with tumor stage, whether suffered bladder cancer as comorbidity, recurrent or metastasis, overall survival, tumor lesion, preoperative hematuria, gender and age was analyzed. We further analyzed the association difference of disease free survival (DFS) time and overall survival (OS) time between different PLR groups. Results:Fifty-one cases of UTUC were collected, and the postoperative mean following up time is 21 (9–51) months. Twenty cases recurred or metastasis and 9 cases died. The mean DFS time was 15 (2–51) months,and the mean OS time was 21 (9–51) months. One-factor analysis of variance showed that preoperative PLR was associated with tumor stage, overall survival rate, hematuria and gender, and the P value were 0.028, 0.008, 0.045, 0.036 respectively. High PLR group was intended to be non-organ confined disease, the sensitivity was 57%and the specificity was 74%. Survival analysis by Kaplan-Meier method showed there is no statistical difference in DFS between high and low PLR groups (P=0.155). But OS time in high PLR group was significantly less than that in low PLR group (P=0.006). Cox regression confirmed that only tumor stage is an independent prognostic factor of OS (P=0.029). Conclusion:PLR has potential clinical value in predicting advanced stage disease and Cox regression confirmed that only tumor stage is an independent prognostic factor of OS.