Objective To assess the clinical value of transcatheter arterial chemoembolization (TACE) together with radiofrequency ablation (RFA) and sorafenib in treating recurrent hepatocellular carcinoma (HCC) after surgery.Methods A total of 40 patients with recurrent HCC after surgery, who were encountered at authors' hospital during the period from December 2009 to May 2014, were collected. The patients were divided into the study group (n=20) receiving TACE combined with RFA and sorafenib and the control group (n=20) receiving TACE plus RFA. Within 7-10 days after TACE, RFA was carried out. In the study group, oral sorafenib therapy (400 mg, two times everyday) started at 4 days after TACE. Withdrawal of sorafenib would be ordered if drug resistance occurred. Each patient underwent TACE combined with RFA not less than two times. Results The median survival time of the study group and the control group was 31.0 months and 24.8 months respectively, and statistically significant difference existed between the two groups (P<0.05). The one-year, 2-year and 3-year survival rates of the study group were 85%, 70% and 50%respectively, while the one-year, 2-year and 3-year survival rates of the control group were 80%, 55% and 30% respectively; the differences between the two groups were not statistically significant (P>0.05). The progression free survival (PFS) time of the study group and the control group was 6.8 months and 5.7 months respectively, the difference between the two groups was statistically significant (P<0.05). Conclusion TACE combined with RFA and sorafenib can prolong the overall survival time and the progression free survival time of patients with recurrent HCC after surgery.

Objective To discuss the effectiveness of anterolateral thigh propeller flaps for treatment of inguinal skin and soft tissue defects.Methods From June,2009 to October,2014,12 patients with inguinal skin and soft tissue defects were treated with anterolateral thigh propeller flaps pedicled with perforator of descending branch of lateral circumflex femoral artery.Of them there were 8 males and 4 females,aged from 22 to 51 years.The left side was involved in 3 cases and right side 9 cases.Defects were caused by traffic accident injury in 5 cases,crash injury of heavy object in 7 cases.There were mere skin and soft tissue in 2 cases,combined with bone fractures,nerves,vessels and muscles injury in 10 cases.The area of defects ranged from 9.0 cm×5.0 cm to 22.0 cm×9.0 cm.During operation,anterolateral thigh propeller flaps ranging from 11.0 cm×7.0 cm to 24.0 cm×1 1.0 cm were used to repair the wounds.Results All flaps and skingrafts survived after operation and the wounds obtained primary healing.After 8-24 months follow-up,all flaps were characterized by soft texture,good color,and satisfactory appearance.According to the Britain's Medical Research Council at 8 months after operation,the sensation of the flaps were recovered to S2 ～ S3+,No obvious scar contracture and chromatosis were observed at donor site.Conclusion Anterolateral thigh propeller flaps pedicled with artery descending branch of lateral circumflex femoral perforator is an ideal choice for the reconstruction for inguinal skin and soft tissue defects.

Objective To discuss the clinicopathologic features, diagnosis and treatment of pri-mary prostatic signet ring cell carcinoma (PPSRCC). Methods Clinical data of 23 PPSRCC cases were retrospectively reviewed. The mean age was 74 years and majority of them had aggravated dysu-ria. The mean serum PSA was 45.3 ng/ml (7.4-126.8 ng/ml). To exclude the metastasis from stomach and colon SRCC, upper gastric tract endoscopy and barium enema were carried out. Seven pa-tients received radical prostatectomies and 2 patients who had positive margins received hormonal and radiation therapy. The rest of patients received maximal androgen blockade therapy. Photoselective vaporization of the prostate was performed on 11 patients who had lower urinary tract symptoms. All cases were investigated by routine pathological, immunohistochemical studies. Results Seventeen cases of PPSRCC were associated with concurrent high-grade prostatic carcinoma, only 6 cases were pure SRCC. Immunohistochemical stains were positive in all cases for PSA and PAP. Stains were ne-gative for AB/PAS (23/23) and CEA (21/23). The clinical TNM stages were 7 of Ⅱ , 10 of Ⅲ and 6 of Ⅳ. Follow-up was available on 20 cases with a mean 24 months and 3 cases were lost during follow up. Eight cases died of metastasis. Five cases had evidence of recurrence 12-21 months from presen-tation. Conclusions The diagnosis of PPSRCC depends on pathological and immunohistochemical studys after metastasis from stomach and colon SRCC is excluded. Early diagnosis and combination treatment for PPSRCC might improve its prognosis.

Objective: To investigate the clinical effect of reconstruction of bone defects of forearm using free vascularized fibular grafts(VFG). Methods: 22 patients with bone defects of forearm were treated with free VFG. 6 cases with upper limb bone and soft tissue defects were repaired with free vascularized osteoseptocutaneous fibula as a composite flap. The length of ulna defect ranged from 4 cm to 12 cm and radius defect from 5 cm to 14 cm. The length of harvested fibula ranged from 13 cm to 24 cm. The area of the skin flaps ranged from 12 cm×6 cm to 20 cm×11 cm. Results: All graft bone achieved bone union, with the healing time from 3 to 6 months (mean, 4.5 months). The operation incision healed primarily and all flaps survived with soft texture. All patients were followed up for 12-26 months (mean, 20.5 months). The function of forearm was recovered without refracture. The movement of ankle and the sensation in the leg were normal. According to the Anderson standard at last follow-up visit, the results were excellent in 9 cases, good in 11 cases and fair in 2 cases, with an excellent and good rate of 90.9%. Conclusions Vascularized fibular grafts VFG is an effective method to repair bone defects of forearm.

Exosomes are widely distributed in various body fluids. They are extracellular vesicles with a diameter of 30-100nm that contain a variety of biologically active substances. They play an important role in a variety of biological processes such as tumor invasion, migration and immune escape. With the progress of research, exosomes derived from bladder cancer have shown great potential in the early diagnosis and treatment of bladder cancer. This article reviews the main biological characteristics of exosomes and their new developments in the diagnosis and treatment of bladder cancer.

Bladder cancer(BC) ranks the first of genitourinary tumor in China and is one of the most common urological malignancies, in which 25%-30% of patients were diagnosed with muscle-invasive bladder cancer. Radical cystectomy combined with pelvic lymph node dissection is the standard procedure for treatment, which can effectively avoid tumor recurrence or distant metastasis as well as improve the prognosis of patients. However, some patients may not tolerate or refuse to undergo radical bladder surgery due to worry about high complication rate, high morbidity and poor postoperative quality of life. With the increasing understanding of bladder cancer heterogeneity and biological behavior, the treatment of bladder cancer has changed from a surgery-based treatment model to an individualized and comprehensive treatment model by multidisciplinary collaboration. The bladder-preserving treatment can achieve the same oncological prognosis as that of radical bladder surgery with a better quality of life of the patients, which has become a hot topic and focus of research in muscle-invasive bladder cancer treatment. This article reviewed the progress of research related to the comprehensive treatment of muscle-invasive bladder cancer with preservation of the bladder.

Despite the increasing number of patients was diagnosed with prostate cancer due to widespread cancer screening, PSA testing does not differentiate between lethal and slow-growing inert prostate cancers. This leads to a proportion of patients being over-diagnosed and consequently over-treated.The current study has found that PSA exists as a precursor to post-translational modification, and that [-2]proPSA originates only from the peripheral zone of the prostate. Furthermore, the study has shown that prostate health index (PHI) calculated from [-2]proPSA, fPSA, and PSA has a higher positive predictive value for prostate cancer, making it useful in the diagnosis of clinically significant prostate cancer. This article reviews the progress of research related to PHI in prostate cancer diagnosis and treatment.

Prostate cancer is one of the most frequent malignancies of the urological tract. Surgery, radiotherapy, and immunotherapy are the main treatment methods for prostate cancer, which often lead to unsatisfactory outcomes due to the obvious heterogeneity of the tumor. Recently, poorly differentiated, self-renewing cancer initiation sites and treatment-resistant cancer stem cells (CSC) have become a hot topic in prostate cancer research. Targeting prostate cancer stem cells is a novel and promising therapy. In this article, we review the mechanism of stemness maintenance of CSC, its impact on the tumor microenvironment, and the related research progress in prostate cancer treatment, providing a theoretical basis for the targeted therapy of prostate cancer stem cells.

Bladder cancer (BC) is one of the most common malignancies of the urinary tract. Surgery combined with chemoradiotherapy is the mainstay of treatment, but BC is markedly heterogeneous, leading to unsatisfactory outcomes. Antibody-drug conjugate (ADC), a new type of targeted drug, has achieved remarkable results in the treatment of tumors by coupling a chemical junction with a highly cytotoxic small molecule, which can exert anti-tumor effects while avoiding the impacts on normal cells. To date, several ADCs have been used in the treatment of BC at home and abroad, and play an increasingly important role in the field of BC therapy. This article briefly introduces the mechanism of ADC, the current application of ADC in BC treatment, and the problems and challenges faced, hoping to provide reference for clinical work.