Objective To assess the necessary excision of normal parenchyma tissue in nephron sparing surgery for renal cell carcinoma. Methods 102 specimens from radical nephrectomy for RCC were step sectioned at 3 mm intervals and examined.The tumor and field 20 mm beyond pseudocapsule were continuously sectioned and examined for completeness of pseudocapsule,the presence of micro multifocal carcinoma and for vascular and parenchyma invasion beyond pseudocapsule. Results 49 (48.0%) of the 102 specimens were void of intact pseudocapsule.The presence of extra pseudocapsule cancerous lesions was within 0～8 mm [(1.2?1.9) mm] beyone the capsule,with 30.4% of them within the field of 1～8 mm.with the statistic method of one side analysis of frequency,the percentile value of P97.5 and P100.0 was 7.4 and 8.0 mm respectively. Conclusions These data denote that when nephron sparing surgery is done for renal cell carcinoma,at least 10 mm of normal parenchyma tissue beyond the pseudocapsule should be excised with the tumor.The nucleation techniquc should not be encouraged.

0.4).ConclusionsThese data denote that biological behaviors and malignant features of multifocal tumors are very similar to those of primary ones.In addition,considering the significant relationship of multicentricity with vascular invasion and incompleteness of pseudocapsule of RCC,it is suggested that the secondary tumors might be more likely the result of intrarenal metastasis of the primary tumor rather than the results of multifocal genesis.

Objective To explore the safety and efficacy of small margin in nephron sparing surgery for early localized renal cell carcinoma (RCC). Methods A total of 325 cases of RCC with normal contralateral kidney and staged as Tla were retrospectivly studied.According to the margin size,125 cases were with surgical margin ≤ 5 mm (group ≤ 5 mm),102 cases with margin 6-9 mm (group 6-9 mm) and 98 cases with margin ＞ 10 mm (group ＞ 10 mm).The margin size and status was pathologically evaluated and clinical results including local recurrence,distant metastasis and overall survival rate were followed up and comparatively analyzed. Results None of the patients had positive surgical margins.The mean and median margin sizes were 2.2 and 2.0 mm for group ≤ 5 mm,6.7 and 6.0 mm for group 6-9 mm and 11.8 and 12.0 mm for group ＞ 10 mm.The difference was statistically significant (P=0.025).The mean and median follow-up time for all the patients were 79 and 83 months (range 15-132 months),with 69 and 73 months (range,15-130 months) for group ≤ 5 mm,83 and 86 (range,17-132 months) for group 6-9mm and 82 and 82 (range 60-103 months) for group ＞ 10 mm.Three patients in group ≤ 5 mm,5 in group 6-9 mm and 2 in group ＞ 10 mm died of no-cancer related disease during follow-up.One patient in group ≤ 5 mm (0.74％) experienced ectopic recurrence in the same kidney and one in group 6-9 mm was detected local recurrence in situ (0.98％).No distant metastasis was detected in all the patients.The overall 5-year survival rate for patients in groups ≤ 5mm,6-9 mm and ＞ 10 mm were 99.2％,99.0％ and 98.0％,respectively.(Kaplan-Meier survival analysis,Log Rank,x2 =1.511,P=0.470). Conclusions Small margin in nephron sparing surgery is safe and effective in treating RCC with stage T1a,which provides excellent renal function preservation,favorable long-term progression-free survival rate,and is not associated with an increased risk of local recurrence.

Objective To study the incidence of multi ce ntricity in renal cell carcinoma (RCC). Methods 102 kidn eys from radical nephrectomy for RCC were step sectioned at 3 mm intervals and a ny abnormal tissue were removed, stained and examined. The tissue 2.0 cm beyond pseudocapsule and tissue of renal hilum were continueously or interruptedly sect ioned and examined for any tumor invasion of the pseudocapsule, micro-multifoca l carcinoma and vascular invasion beyond pseudocapsule. The relationship between the pathological findings of the primary tumors and multicentricity was evaluat ed. Results The total incidence of multifocal carcinoma in this group was 15.7%.It was 4.9% in primary tumors 4 cm or less and 23.0% in tumors larger than 4 cm (P= 0.014). Vascular invasion and interrupted pseud ocapsule were two significant predictors of multicentricity of RCC (P=0.017 and 0.006). Conclusions In the RCC patients with normal contralateral kidneys, nephron-sparing surgery should be performed only in tumo rs 4 cm or less. In patients nephron-sparing surgery is imperative, even tumors 7 cm or less might be in consideration, but intensive followup is necessary due to the increased incidence of multicentricity.In most cases, a partial nephrect omy instead of tumor enucleation should be performed.

Objective To investigate the expression of E-cadherin and matrix metallopeptidase 7(MMP-7)and their significance in basal-like and Her-2 over-expressing breast carcinoma. Methods The protein expression of E-cadherin and MMP-7 were analyzed by immunohistochemical method in 20 cases of basal-like breast carcinoma and 21 cases of Her-2 over-expressing breast carcinoma.Statistical method was used to analyze the clinicopathological performance.Patients were followed up from 6 to 60 months.Results The ratio of basal-like breast carcinoma and invasive ductal carcinoma was 3.4%(20/501).the mean age was 49 years.The mean size of basal-like breast carcinoma(2.1 cm)was smaller than that of Her2 over-expressing breast carcinoma(3.0 cm)(P<0.05).The 5-year survival rate of patients with basal-like breast carcinoma was obviously(40.0%) lower than that of Her-2 over-expressing breast carcinoma (71.4%)(P<0.05),though,the 3-year survival rate was similar between the two groups.The protein expression of E-cadherin was down-regulated and even deficient in basal-like breast carcinoma(P<0.05).The protein expression of MMP-7 was higher in basal-1ike breast carcinoma than that in Her-2 overexpressing breast carcinoma(P<0.05).Conclusion Down-regulated expression of E-cadherin and upregulated expression of MMP-7 may be one of the mechanisms leading to high metastasis of basal-like breast carcinoma.

Objective To explore the effects of leukoaraiosis on cognitive function in elderly patients after acute cerebral infarction.Methods From May 2010 to August 2011,a total of 147 elderly patients with acute cerebral infarction were enrolled,including 96 patients with leukoaraiosis and 51 patients without leukoaraiosis.The Montreal Cognitive Assessment (MOCA) and the correlative factors of cognitive function were assessed in all patients.Results There was no statistical difference in general information between patients with and without leukoaraiosis.There were significant differences in the MoCA scores between patients with and without leukoaraiosis (x2 =19.15,P＜0.01),as well as between the vital and non-vital positions of cerebral infarction (x2=21.41,P＜0.01).The Logistic regression analysis showed that the vital position of infarction and leukoaraiosis were related to the cognitive impairment (OR=12.27,6.60,both P＜0.01),while the area of infarction and the type of cerebral infarction in Oxford County Community Stroke Project (OCSP) had no effects on cognitive impairment.Pearson correlation analysis showed that there was a positive relationship between the degree of white matter lesions and the decline in cognitive function (r=-0.87,P＜0.01).Conclusions The position of acute cerebral infarction and leukoaraiosis are independent risk factors for cognitive function after acute cerebral infarction,and the former plays a more important role than does the latter.

Objective To investigate the expression and significance of caveolin-1 in breast carcinoma.Methods Using immunohistochemical method the protein expression of caveolin-1 were analyzed in 105 cases of breast carcinoma and 50 cases of non-cancerous breast tissues.The relationship between caveolin-1 expression and CK5/6,EGFR,and E-cadherin expression was investigated.Clinical data of 105 cases of breast carcinoma were retrospectively analyzed.Results Among 105 cases of breast carcinoma,there were 20 cases of basal-like subtype,22 cases of luminal subtype A,23 cases of luminal subtype B,23 cases of HER2 over-expressing subtype,17 cases of normal breast-like subtype.Positive rate of caveolin-1 was significantly lower in breast carcinoma than in non-cancerous breast tissues (24.8％ vs.88.0％,P ＜ 0.05).Positive rate of caveolin-1 (75.0％) was higher in breast carcinoma than in luminal subtype A ( 4.8％ ),luminal subtype B ( 17.4％ ),HER2 over-expressing subtype ( 17.4％ ) or normal breast-like subtype( 11.8％ ),all P ＜0.05.Caveolin-1 expression was associated with expression of CK5/6 and EGFR(P ＜0.01 ).In univariate analysis,positive caveolin-1 was associated with higher lymph node metastasis rate (18/26,69.2％ )than negative (37/79,46.8％ ),P =0.047,and shorter 5-year-disease-free survival (38.46％ vs.74.68％,P =0.0004 ),but in multivariate analysis caveolin-1 was not an independent predictor of 5-year- disease-free survival (P ＞ 0.05).Conclusions Caveolin-1 can be seen as a screening mark of basal-like breast carcinoma,it may promote the invasiveness of breast cancer cells,but it is not an independent prognostic predictor of breast cancer patients.

Objective To comprehensively evaluate prevention and health care services of community health centers in Shandong province since the ongoing health reform and provide policy basis for development of community health services.Methods To study with rank sum ratio method and important quadrant models.Results Seventy-eight percent of community health centers were appraised as“average”.Overall satisfaction of residents for preventive and health services was 2.66 points.Preventive and health services of community health centers are expected to improve.Conclusion Overall prevention and health services of CHS centers were found less than satisfactory.Prevention and health services of CHS centers in regions a and B were poor,which deserves attention of the government health authorities.The government is expected to take actions to promote development of CHS centers for prevention and health care service.

BACKGROUND: Tumor-adopted immunity and gene transduction technique are used to introduce tumor necrosis factor-α vector into carrier cells, which are then re-infused into the body so that cancer cells can be killed by tumor necrosis factor-α more directly and effectively with fewer side effects on the other tissues due to high local expression.OBJECTIVE: To study the bioactivity of in vitro cultured tumor necrosis factor-α transduced tumor-infiltrating lymphocytes as well as the inhibitory effects on cancer cells of cancer-loaded rats infused in different ways.DESIGN: A randomized controlled study based on experimental animals.SEETING: Cancer Research Institute of China Medical University.MATERIALS: This study was carried out at the Cancer Research Institute and the Experimental Animal Department, China Medical University,between January 2000 and December 2001. TJ8510 cell line (human brain glioblastoma cell line) was provided by the Neurological Research Institute of Tianjin Medical University Affiliated Hospital. The experimental animals were 36 BALB/C nude mice congenitally having no thymius.METHODS: Based on the establishment of tumor necrosis factor-α retroviral transduction system and the preparation of cartier cells tumor-infil-trating lymphocytes, the monoclonal virus cell line PLC-2 and PLJC-5available were used to introduce marked gene NeoR and targeted gene tumor necrosis factor-α into tumor-infiltrating lymphocytes, respectively.Then cell proliferation, tumor necrosis factor expression and in vitro antitumor activity were examined. After cancer cell inoculation, the 36 nude mice were randomly divided into 6 groups: local infusion control group, local tumor-infiltrating lymphocytes infusion group, local tumor necrosis factor-tumor-infiltrating lymphocytes infusion group, venous infusion control group, venous tumor-infiltrating lymphocytes infusion group and venous tumor necrosis factor-tumor-infiltrating lymphocytes infusion group, and the therapeutic effects on the cancer-loaded mice were observed.proliferation and tumor necrosis factor-α expression in tumor-infiltrating oR-tumor-infiltrating lymphocytes and tumor necrosis factor-tumor-infiltrating lymphocytes was not significantly different from each other (P ＞ 0.05).NeoR-tumor-infiltrating lymphocytes, though not significantly different (P ＞0.05), significantly differ from that of tumor necrosis factor-tumor-infiltrating lymphocytes (P ＜ 0.01); moreover, tumor necrosis factor-tumor-infiltrating lymphocytes were found to express higher tumor necrosis factor-α conactivity did not significantly differ between tumor-infiltrating lymphocytes and NeoR-tumor-infiltrating lymphocytes (P ＞ 0.05), but obviously increased come of the animal experiment: 40 days after tumor necrosis factor-tumorinfiltrating lymphocytes infusion, cancer size in local tumor necrosis factortumor-infiltrating lymphocytes infusion group was found smaller than that in local infusion control group [(307±42) and (2 048±278) mm3, P ＜ 0.01],and it was also smaller in venous tumor necrosis factor-tumor-infiltrating lymphocytes infusion group than that in venous control group [(954±195)and (1 989±305) mm3 , P ＜ 0.05].CONCLUSION: Tumor necrosis factor-α gene transduced tumor-infiltrating lymphocytes could effectively express tumor necrosis factor, exerting higher and in vivo anti-tumor effects than tumor-infiltrating lymphocytes in cancer-loaded nude mice. No obvious inhibitory effects on the growth of subcutaneous solid carcinoma could be observed in nude mice after venous infusion of human brain glioblastoma tumor-infiltrating lymphocytes, but the inhibitory effects became obvious due to venous infusion of tumor necrosis factor-tumor-infiltrating lymphocytes and significant due to local tumor necrosis factor-tumor-infiltrating lymphocytes infusion, indicating that local infusion is the preferable way in the treatment of glioblastoma by immuno-gene therapy.

Objective To explore the effects of radiofrequency ablation ( RFA) combined with percutaneous vertebroplasty ( PVP) by the injection of artificial bone for metastatic spinal tumor. Methods Fifty-eight patients with metastatic spinal tumors were divided into bone cement group 1 (n=12),bone cement group 2 (n=16), artificial bone group 1 (n=16), artificial bone group 2 (n=14). The patients in bone cement group were arranged RFA combined with PVP by injection of bone cement,and the artificial bone group were treated with RFA combined with PVP by injection of artificial bone. The vertebral body modality,fractures, and visual analogue scale ( VAS) ,spinal ODI score were compared before operation,1 week,1,3,6,9,12 months of after operation. Results There were 12 patients (42. 9%) with vertebral body deformation in bone cement group,which was more than those in artificial group (6. 7%) (χ2 =8. 4768,P=0. 0036). The VAS or DOI score decreased after operation than those pre-operation in the 4 groups (P<0. 01),but increased in bone cement group after operation of 6, 9 and 12 months than those in artificial group (P<0. 05). Conclusion The combination of RFA and PVP by injection of bone cement or artificial bone is effective to metastatic spinal tumors. The effects of PVP injection with artificial bone maintains longer duration compared to bone cement.