Purpose:To investigate the prognostic factors for breast cancer patients with liver involvement.Methods:114 breast cancer patients with liver metastases,who were hospitalized in Fudan University Cancer Hospital between January,1996 and December,2003,were included in this study.Their survival data were analyzed.Results:The response rates with first-,second-,third-,fourth-line chemotherapy were 31.9%,27.8%,16.7% and 0%,respectively.Univariate analyses indicated that patients with impaired liver function and patients with a short interval between surgery and the first recurrence or metastasis had a poor prognosis.Multivariate analyses suggested that the presence of liver function impairment was an independent prognostic factor for overall survival.Conclusions:The response rates of chemotherapy drop with number of lines of chemotherapy.Breast cancer patients with liver involvement and impaired liver function have a poor prognosis.

In order to improve the sterilizer operators' skills and reduce sterilization failure caused by wrong operations, the standardized training and examinations were provided for the sterilizer operators in accordance with their years of working ex-perience and professional title. The results indicated that the standardized training could improve the quality of sterilization, prolong the life of sterilizer and avoid sterilization failure due to wrong operations.

Objective To assess the prognostic values of the immunohistochemical expression of vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor-2 (VEGFR-2) in a cohort of patients with operable advanced laryngeal cancer who have been treated with induction chemotherapy. Methods VEGF and VEGFR-2 expression in the Forty-nine patients was quantified by an enzyme immunosorbent assay in a retrospective series.Results The moderate to high VEGF expression in 34 patients were found and low expression in 15 patients. VEGFR-2 expression was moderate to high in 31 patients and was low expression in 18. The probability of a complete response to induction chemotherapy was significantly higher in patients with none to low VEGF expression.Conclusion VEGF expression seems to be a significant predictor of complete response to induction chemotherapy.

Objective To investigate the diagnosis and treatment of anorectal malignant melanoma,in order to regulate surgical methods and explore multi-modality treatment.Methods Clinical pathological features,diagnosis and treatment procedures of 38 patients with anorectal melanoma were reviewed,and their correlation with prognosis were analyzed.Results In 38 patients,10 of them were male and 28 were female,with the mean age of 58.7 years old (ranged 28-75 years old).28 patients underwent abdominoperineal resection,10 patients underwent wide local excision.The 1-,3-,and 5-year disease-free survival rates were 64.9 ％,18.5 ％ and 5.7 ％,respectively.The 1-,3-,and 5-year overall survival rates were 85.8 ％,24.1％ and 6.4 ％,respectively.Tumor thickness (≥ 1.51 rm) and tumor diameter (≥3 cm) were associated with lymph metastases (x2 =13.093,4.449,P =0.011,0.020),tumor thickness was also associated with distant metastases (x2 =11.965,P =0.018).According to the Kaplan-Meier method,comprehensive treatment after surgery had significant effects on disease-free survival (x2 =7.441,P =0.006).Tumor thickness,lymph metastases,and clinical staging had significant effects on overall survival (x2 =16.741,16.474,16.775,P =0.002,0.000,0.000).Cox proportional hazards model indicated that comprehensive treatment after surgery was the independent prognostic risk factors of disease-free survival (95 ％ CI 1.420-17.621,P =0.012).Tumor thickness and lymph metastases were the independent prognostic risk factors of overall survival (95 ％ CI 0.250-0.949,1.033-2.573,P =0.035,0.036).Conclusion Early detection,reasonable surgical procedure,generalized systemic focus on immunotherapy treatment are the key to improve quality of life and prolong the survival time of anorectal malignant melanoma patients.

Objective: To investigate the actualities of service in Outpatient Pharmacy and Emergency Pharmacy. Methods: With queuing theory of operational research and data statistics, the specialities and varities of service in both Pharmacies were investigated before and after the application of computer network. Results: (1)The distribution of the patients number arriving the Pharmacies was unequal.(2) The time of service was extended after using network.(3)The average individual time of service in Emergency Pharmacy was 74 s, and 48 s in Outpatient Pharmacy. The reasons for the average individual time of service in Emergency Pharmacy more than that in Outpatient Pharmacy was related to the formulation of drugs in 2 pharmacies and the number of drugs on prescriptions. (4)The number of windows for service should be increased in Emergency Pharmacy after using network. Conclusion: Operational research and data statistics will provide the data assisting the manager in making decisions. [

Objective To investigate the correlation between 24 h urinary protein quantitation and pregnancy outcome in patients with pre-eclampsia.Methods A total of 332 pre-eclampsia patients were selected in Tongji Hospital from January 2014 to December 2016.The patients were divided into microalbuminuria group(24 h urinary protein quantification ＜ 0.3 g,n =46),mild proteinuria group (0.3 g ≤ 24 h urinary protein quantification ＜ 2.0 g,n =98),moderate proteinuria group (2.0 g ≤ 24 h urinary protein quantification ＜ 5.0 g,n =71) and severe proteinuria group(24 h urinary protein quantification ≥ 5.0 g,n =117) according to the results of 24 h urinary protein quantification.The pregnancy outcomes were compared between the four groups.Results The 24 h urinary protein quantification and the serum creatinine,urea nitrogen,uric acid levels in the mild proteinuria group,moderate proteinuria group and severe proteinuria group were significantly higher than those in the microalbuminuria group (P ＜ 0.05);and gestational week was significantly shorter than that in the microalbuminuria group (P ＜ 0.05).The 24 h urinary protein quantification and serum urea nitrogen,uric acid levels in the moderate proteinuria group were significantly higher than those in the mild proteinuria group (P ＜ 0.05);and gestational week was significantly shorter than that in the mild proteinuria group (P ＜ 0.05);but there was no significant difference in serum creatinine level between the two groups (P ＞ 0.05).The 24 h urinary protein quantification,serum creatinine,urea nitrogen and uric acid levels in the severe proteinuria group were significantly higher than those in the mild proteinuria group (P ＜ 0.05);and the gestational week was significantly lower than that in the mild albuminuria group (P ＜ 0.05).The 24 h urinary protein quantification in the severe proteinuria group was significantly higher than that in the moderate proteinuria group (P ＜ 0.05),but there was no significant difference in the gestational week and serum creatinine,urea nitrogen,uric acid levels between the two groups (P ＞0.05).There was no significant difference in the rates of cesarean section and spontaneous labor between the four groups (P ＞0.05).The rate of induced labor in the moderate proteinuria group and the severe proteinuria group was significantly higher than that in the mild albuminuria group and the microalbuminuria group (P ＜ 0.05).There was no significant difference in the rate of induced labor between the mild proteinuria group and the microalbuminuria group (P ＞ 0.05).There was no significant difference in the rate of induced labor between the severe proteinuria group and the moderate proteinuria group (P ＞ 0.05).The incidence of complications in microalbuminuria group,mild proteinuria group,moderate proteinuria group and severe proteinuria group was 30.43％ (14/46),47.96％ (47/98),74.65％ (53/71) and 74.36％ (87/117) respectively;the incidence of complications in the moderate proteinuria group and the severe proteinuria group was significantly higher than that in the microalbuminuria group and the mild albuminuria group (P ＜ 0.05),but there was no significant difference in the incidence of complications between microalbuminuria group and mild albuminuria group (P ＞ 0.05),there was no significant difference in the incidence of complications between the moderate proteinuria group and the severe proteinuria group (P ＞0.05).The incidences of premature birth and neonatal asphyxia in the mild proteinuria group were significantly higher than that in the microalbuminuria group (P ＜ 0.05),and the body mass of the neonates was significantly lower than that in the microalbuminuria group (P ＜0.05),but there was no significant difference in the perinatal mortality rate and the incidences of fetal growth restriction(FGR) and poor neonatal resuscitation between the two groups (P ＞ 0.05).The incidences of FGR,premature birth,neonatal asphyxia,poor neonatal resuscitation and the perinatal mortality in the moderate proteinuria group and severe proteinuria group were significantly higher than those in the microalbuminuria group (P ＜ 0.05);and neonatal body mass was significantly lower than that in the mieroalbuminuria group (P ＜ 0.05).The incidences of FGR,premature birth and poor neonatal resuscitation and perinatal mortality in the moderate proteinuria group were significantly higher than those in the mild proteinuria group (P ＜ 0.05);and the neonatal body mass was significantly lower than that in the mild proteinuria group (P ＜ 0.05);but there was no significant difference in the neonatal asphyxia incidence between the two groups (P ＞ 0.05).The incidences of FGR,premature birth,neonatal asphyxia,poor neonatal resuscitation and perinatal mortality in the severe proteinuria group were significantly higher than those in the mild proteinuria group (P ＜ 0.05);and the body mass of the newborns was significantly lower than that in the mild albuminuria group (P ＜ 0.05).The incidence of neonatal asphyxia in the severe proteinuria group was significantly higher than that in the moderate proteinuria group (P ＜ 0.05),but there was no significant difference in the incidences of FGR,premature birth,poor neonatal resuscitation,perinatal mortality and neonatal body mass between the two groups (P ＞ 0.05).Conclusions The of 24 h urinary protein quantitation is closely related to the pregnancy outcome in patients with pre-eclampsia,the 24 h urinary protein quantification should be regularly detected in the patients with pre-eclampsia.When the urinary protein quantitation is more than 2.0 g,the incidences of maternal complications and poor prognosis of the perinatal infants is significantly higher,but the boundary value of the 24 h urinary protein quantitation for the diagnosis of severe pre-eclampsia still needs further large sample study.

Objective To investigate MRI features of metanephric adenoma(MA). Methods The retrospective analysis was performed on 6 adult patients that were scanned by regular, DWI and dynamic-enhancement MRI two weeks before surgery and diagnosed with MA pathologically after surgery. MRI features of lesions were observed. The signal intensities of lesions and contralateral normal renal cortex and medulla were respectively measured in plain scan, cortex, parenchyma and delayed phase. The enhancement magnitudes were calculated and the ADC values of lesions were measured. The differences of the signal intensity and enhancement magnitude were assessed by paired-sample t test among renal cotex, medulla and lesions. Results All lesions in MA were single and solid masses. Four cases occurred in the right kidney and two cases in the left kidney. The maximum diameters of the lesions ranged from 21 to 79 mm and the mean value was(41 ± 20)mm. Five cases were round or oval, while one case was irregular. The signal intensity in five cases was slightly lower in T2WI than the renal parenchyma, while one case was slightly higher than the renal parenchyma. The hyperintentsity of DWI and hypointensity of ADC were seen in all cases. The mean ADC value was(0.759 ± 0.211) × 10-3mm2/s. Hemorrhage were seen in two cases. Necrosis was present in one case and the capsules were seen in two cases. No scar, fat and swollen lymph nodes was seen in all cases . There was no statistical significance of the signal intensity between lesions measure in the plain scan and normal renal parenchyma(P>0.05). After adminstrating contrast materials, all lesions shown persistently mild to moderate enhancement . The siganl intensities of lesions measured in three phases after enhancement were signifcantly lower than those of the renal cortex(P<0.05). No significant differences of the signal intensity measured in cortex and medulla phase between lesions and normal renal medulla was present(P>0.05). But the signal intensities of leisons in delayed phases were significantly lower than thoseof renal medulla(P<0.05). Except from the difference of enhanced magnitude in cortex phase between lesions and normal medulla, significant differences were present between leisons and normal renal parenchyma(P<0.05). Conclusion MRI manifestations of MA show certain distinction, including, dominantly solid lesions, relatively lower signal intensity of lesions than that of renal cortex, slowly persistent enhancement, high signal on DWI and low signal on ADC.

Objective To discuss the diagnostic value of DSA for massive hemorrhage in lower gastrointestinal tract resulting from tumour. Methods 24 patients with massive lower gastrointestinal hemorrhage were performed DSA and then operated as tumour. Results Among 24 patients, 17 cases demonstrated direct signs of hemorrhage, 9 cases visible turnout vessels; 24 patients all showed clumping tumour-specifie dyeing. Conclusion DSA is of great value to determining the location and qualitation of the massive lower gastrointestinal hemorrhage resuhing from tumours.

Objective To explore the feasibility of robot-assisted laparoscopic inferior vena cava (IVC) thrombectomy in treating renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava thrombus.Methods From November 2014 to January 2017,5 cases of renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava tumor thrombus were treated with robot-assisted surgery.There were 4 males and 1 female with the median age of 59 years (range 54-71 years).Four cases had the renal tumor on the right side and one on the left side.The mean tumor size was 6.8 cm (range 5-9 cm) with 3 cases of T3b and 2 cases of T3c.There were 4 cases of level Ⅲ and 1 case of level Ⅳ inferior vena cava thrombus with the median length of 9 cm (range 7-11 cm).The surgical procedure for Mayo level Ⅲ inferior vena cava thrombus included mobilization of both left and right robes of liver,subsequently controlling the suprahepatic infradiaphramatic IVC and first porta hepatis simultaneously.The surgical procedure for Mayo level Ⅳ inferior vena cava thrombus included cardiopulmonary bypass by multi-disciplinary cooperation among urologists,hepatobiliary and cardiovascular surgeons.The procedures included live mobilization,control of the superior vena cava and first porta hepatis and remove thrombus in the atrium and IVC respectively.Results All operations were completed successfully.The median operative time was 440 min (320-630 min).The blood recovery device was used and the intraoperative estimated blood loss was 2 500 ml (500-6 000 ml) and all cases required intraoperative blood transfusion.The median time of intraoperative occlusion of IVC was 35 min (25-50 min).All patients were transferred to the intensive care unit for median of 4 days (2-8 days) after surgery.The median time to remove the postoperative drainage tube was 9 days (7-12 days).Postoperative pathological diagnosis revealed 5 cases of clear cell carcinoma.Postoperative renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients who improved after medical therapy.During median 19.6 months (12-48 months) of follow-up,1 patient died and 1 patient progressed.Conclusions Despite the high risk of surgery,robot-assisted laparoscopic IVC thrombectomy for renal tumor with Mayo level Ⅲ-Ⅳ thrombus is feasible for experienced surgeons in selected patients.However,the oncological outcomes need further investigation.

Objective To investigate the influence of epidural analgesia on labor duration under the new partogram recommendations using quantile regression.Methods In this study,we recruited 300 nulliparous women at full term who were hospitalized in Department of Obstetrics and Gynecology,Tongji Medical College,Huazhong University of Science and Technology from May to September,2018.The participants who were willing to receive epidural analgesia during labor were assigned to the epidural group (n=150),and those who were not to the control group (n=150).Labor duration and delivery outcomes were analyzed by Student's t test,Mann-Whitney U test,Chi-square test and Fisher's exact test.Quantile regression models were also used to investigate the effect of epidural analgesia on labor duration.Results The median durations of first-and second-stage labor in the epidural group were 600(400-840) and 66(45-98) min,respectively,which were significantly longer than those of the control group [420(320-610) and 52(33-87) min] (Z=-4.273,P＜0.001;Z=-3.210,P=0.001).Quantile regression analysis showed that,for the first stage of labor,epidural analgesia was associated with labor prolongation,and had significant effects on all the percentiles (all P＜0.05).The regression coefficients increased (95.630-285.000) correspondingly as the percentiles of the labor duration (from 10th to 90th percentiles) increased.For the second stage of labor,epidural analgesia showed a significant impact on prolongation only between the 25th and 75th percentiles (coefficients:10.000～18.143;all P＜0.05).Although the epidural group had a significant higher episiotomy rate [46.8％(65/139) vs 33.3％(48/144),x2=5.318,P=0.021],more times of urine catheterization during labor [1(0-1) vs 0(0-1),Z=-0.974,P=0.001]and higher rate of oxytocin administration during labor [48.7％(73/150) vs 30.0％(45/150),x2=10.952,P=0.001],when compared with the control group,there was no significant difference in cesarean section rate,assisted vaginal delivery rate and neonatal outcomes between the two groups (all P＞0.05).Conclusions Epidural analgesia may associated with the prolongation of the first and second stage of labor,especially with the first stage of labor,but has no adverse effects on maternal and neonatal outcomes.