OBJECTIVE To investigate the expression and clinical significance of epidermal growth factor receptor (EGFR), the mutations of gene EGFR, KRAS and BRAF in sinonasal intestinal-type adenocarcinomas. METHODS We investigated the EGFR protein expression by immunohistochemistry method with antibodies targeting the extracellular domain, the intracellular domain, and the phosphorylated isoform in a series of 11sinonasal intestinal-type adenocarcinomas tissues. EGFR, KRAS, and BRAF mutational status were detected by DNA direct sequencing and Melt curve method.RESULTS The findings were analyzed with respect to clinical data, histological typing, and outcome of the patients. EGFR was expressed in 72.7% tumors with a focal distribution with both extracellular domain and intracellular domain, which showed a significantly correlation. p-EGFR was expressed in 9.1% tumors. 9.1% tumors had the mutation of EGFR gene in exon 19, 9.1% tumors had the mutation in exon 2 and exon 15 of gene KRAS and BRAF respectively. There was no association between these molecular features and the survival period of the patients. CONCLUSION The current study revealed various EGFR expression patterns in sinonasal intestinal-type adenocarcinomas, that indicated the tumor heterogeneity. Sinonasal intestinal-type adenocarcinomas share common alterations of the EGFR pathway as the mutation of EGFR, KRAS and BRAF genes, but with a lower frequency.

The incidence of liver cancer has been increasing year by year.In China,the incidence of liver cancer is 25.7/10 million.However,when the important organs have been involved or when the malignant liver tumors are located adjacent to the hepatic portal vital organs,the lesions are usually difficult to be surgically removed,and the curative results of chemotherapy and radiotherapy for such lesions are often poor.In recent years,along with the gradual rise of ablation techniques,the irreversible electroporation (IRE),regarded as a new ablation method that uses non-thermal energy,has been widely employed in clinical practice.Through generating instantaneous high voltage electrical pulses,IRE produces irreversible nanoscale damage to the cell membrane.Both domestic and foreign researches have indicated that for the treatment of inoperable primary or metastatic liver tumors IRE can effectively inactivate the tumor tissue while the lumen architecture of the vessels can be preserved and large vessel or bile duct will not be damaged.This paper aims to make a comprehensive review about IRE device structure,mechanism of therapeutic action,preclinical studies,clinical application methods and clinical efficacy in order to provide reference for the application of this technology in clinical practice.(J Intervent Radiol,2017,26:285-289)

Objective To investigate the expression of angiotensinⅡ (Ang Ⅱ ) and its type 1 receptor (AT1) in circulation, placenta and kidney of the rots preeclampsia. Methods Preedampsia rat model was developed by inhibitor of nitric oxide synthase (L-NAME). The systolic blood pressure (SBP), 24 h urine protein, hepatic and renal function were compared among the precelampsia group, the normal pregnant group and nonpregnant control group. The kidney tissue was observed by light microscopy. ELISA and radioimmunoassay were used to detect Ang Ⅱ in rat plasma and kidney homogenate respectively. Placental AT1 was measured by Westem blot. The level of kidney AT1 was evaluated by immunohistochemistry and Western blot. Results In preeclampsia rats, SBP and 24 h urine protein were significantly higher compared with control groups. Compared to normal pregnant group, plasma Ang Ⅱ of preeclampsia rats was much higher [(0.706±0.086) ng/L vs (0.540±0.085) ng/L, P＜0.05]; placental AT1 was increased by 46%(P＜ 0.05); kidney Ang Ⅱ was decreased signigicantly [(65.543±40.634) ng/g vs (165.543±33.078) ng/g, P＜0.05]. The expression of ATI in kidney of preeclampsia rats was reduced evidently,which was only 33% of normal pregnancy group and 59% of nonpregnant control greup,respeetively (P＜0.05). Conclusions In preeclampsia rat model, the circulating Ang Ⅱ is increased, the placental RAS isactivated, while the kidney BAS is suppressed. The underlying mechanism of proteinuria and kidney damage associated with this phenomenon in preeclampsia needs further research.

ObjectiveTo elucidate the association between aquaporins (AQPs) expression in kidney tissue and edema of nephrotic syndrome(NS) patients.MethodsNS patients were divided into edema group (14 cases) and non-edema group (8 cases).Ten patients without NS were used as control group.Expressions of AQP1,AQP2,and AQP4 in renal tissues of 3 groups were detectedbyimmunohistochemistrywithstandardtechniquesandsemi-quantitativeanalysis.Association between AQPs expression and edema was examined.ResultsThe positive index of AQP1 expression in proximal tubules in edema group was 0.0373±0.0110,which was significantly lower as compared to non-edema group (0.0510±0.0120) and control group 0.0574±0.0100),while the difference between non-edema and control groups was not significant.The positive index of AQP1 expression in glomerulus was 0.0106±0.0037 in edema group,which was significantly higher than that in non-edema group(0.0021±0.0013) and control group(0.0020±0.0012),while no significant difference was found between the last two groups.AQP2 mainly localized in the collecting duct system.The positive indexes of AQP2 expression were 0.0498±0.0081,0.0370± 0.0072 and 0.0255±0.0103 in edema group,non-edema group and control group,respectively.The differences were significant among 3 groups.AQP4 expression was not found in the renal cortex and collecting duct system.ConclusionsAQPs expression is different in renal tissues of NS patients.AQP2 may play an important role in the edema of NS patients,and AQP1 may involve in the occurrence of edema.

Objective To investigate the association of the expressions of glomerular nephrin, vascular endothelial growth factor (VEGF) and its receptor (VEGFR) with proteinuria in preeclampsia rats. Methods A rat model of preeclampsia was developed by inhibitor of nitric oxide synthase (L-NAME). The systolic blood pressure (SBP) and 24 h urine protein were compared among the normal female group (n=6), the normal pregnant group (n=8), nonpregnant control group (n=6) and preeclampsia group(n=8). The kidney biopsies of each group were observed by light and electron microscopy. The glomerular nephrin was detected by Western blotting and real-time PCR. Immunofluorescence was used to detect the expression of WT1. The level of glomerular VEGF and VEGFR (Flt-1 and Flk-1) were evaluated by Western blotting. Results The level of glomerular nephrin protein in the rats with preeclampsia (0.0726±0.0074) was significantly lower compared with normal female group (0.3795±0.0509), normal pregnant group (0.2361±0.0437) and nonpregnant control group (0.7265±0.0503) (P＜0.01, respectively), while the levels of nephrin mRNA were not significantly different among 4 groups. The expression of WT1 was not significantly different among 4 groups as well. The level of glomerular VEGF in preeclampsia group (1.5429±0.0898) was significantly higher compared with normal female group (1.1870±0.1160), normal pregnant group (1.3741 ±0.1165) and nonpregnant control group (1.0155±0.0742)(P＜0.01,respectively). VEGFR (Flt-1 and Flk-1) was also significantly higher in preeclampsia rats compared with other control groups (P＜0.05, respectively). Conclusions In preeclampsia rats, nephrin is decreased significantly and the glomerular VEGF-VEGFR is increased significantly compared with the other control groups. The abnormal expression of nephrin and VEGF-VEGFR may be involved in the preeclampsia proteinuria. The underlying mechanism of this phenomenon needs further research.

Objective To discuss the clinical value of magnetic resonance diffusion-weighted imaging (MR-DWI) in distinguishing tumor remnants from tumor necrosis of pancreatic carcinoma after cryoablation treatment.Methods Conventional MRI T1WI,T2WI scan,DWI sequence and dynamic enhanced MRI scan were performed in 26 patients with pancreatic carcinoma who were received cryoablation treatment.The changes in MRI signals after cryoablation treatment were recorded.The apparent diffusion coefficient (ADC) values of the normal pancreas,preoperative tumor tissue,postoperative remnants and necrosis tissue were calculated,and the results were compared.The correlation between the ADC values and the size of the tumor was evaluated,and the differences in ADC values among the tumors that had different diameter,location and staging were statistically analyzed.Results Of the 26 patients,complete necrosis of tumor was obtained in 16.The necrotic tumor tissue displayed low-signal on T1WI,high-signal on T2WI and low-signal on DWI,with no enhancement on dynamic enhanced imaging.Active residual tumor tissue was detected in 9 patients,among them the residual tumor diameter ＞5 cm was seen in 7 patients;the residual rate was 34.6％.ADC values of the following tissue,from low to high in order,were preoperative pancreatic tumor tissue (1.022± 0.126)x10-3 mm2/s,postoperative residual tumor tissue (1.130±0.155)x10-3 mm2/s,normal pancreatic tissue (1.924±-0.124)×10-3 mm2/s and postoperative necrosis tissue (2.312-±0.214)×10-3 mm2/s.No statistically significant difference in ADC values existed between preoperative pancreatic tumor tissue and postoperative residual tumor tissue (P=0.452),while statistically significant difference in ADC values existed between normal pancreatic tissue and postoperative necrosis tissue (P＜0.001).The ADC values of pancreatic tumor tissue bore a negative correlation with the tumor size (R=-0.43,P=0.027 2),while the ADC values lacked the relationship to the tumor location as well as to the tumor staging (P=0.738 8 and P=0.089 5 respectively).Conclusion MR-DWI can effectively distinguish the residual tumor tissue from the necrotic tumor tissue of pancreatic carcinoma after cryoablation treatment,which provides reliable basis for further clinical diagnosis and treatment.

Objective To explore the impacts of preeclampsia and the different extent of proteinuria on maternal and perinatal outcomes.Methods The retrospective analysis was conducted according to the perinatal clinical data of preelacmpsia,pregnancy-induced hypertension in pregnant women and normal pregnant women from the Fifth People's Hospital of Shanghai,excluding twins,diabetic mellitus and patients with chronic kidney disease previously.Patients were divided into three groups on the basis of their conditions:① preeclampsia patients (A group,220 cases); ② patients with gestational hypertension (B group,189 cases); ③ normal pregnant (C group,220 cases).Patients with pre-eclampsia according to the degree of proteinuria were further divided into three subgroups:A1:patients with mild proteinuria (n =109); A2:patients with moderate proteinuria (n =72); A3:patients with severe proteinuria (n =39).Results Compared with the other two groups,the patients in A group had higher blood pressure,serum creatinine,uric acid,cesarean section rate,perinatal prematurity,stillbirth,fetal distress and neonatal asphyxia in preeclampsia group.However,the serum albumin level,eGFR,neonatal birth weight,length and Apgar scores were lower in A group compared with B and C group (P ＜ 0.05).In three subgroups,serum creatinine level,uric acid level,cesarean section rate,perinatal prematurity and fetal distress were significantly increased in A3 group compared with A1 group,while the serum albumin level,eGFR,gestational age and neonatal birth weight were obviously lower in A3 group than in A1 group (P ＜ 0.05).In patients with preeclampsia,24 h urinary protein was negatively related with the levels of serum albumin and eGFR (P ＜ 0.05),and positivly related with the blood pressure,serum creatinine and caesarean production rate (P ＜ 0.05).Large amounts of proteinuria was a risk factor of adverse outcome for pregnant patients with preeclampsia (OR =2.899,P ＜ 0.05).Conclusions Preeclampsia patients with large amount of proteinuria have poor maternal and perinatal outcomes.Massive proteinuria is a risk factor of adverse outcome for patients with pre-eclampsia.

Objective To compare the prevalence and correlation factors of chronic kidney disease (CKD) in urban and rural areas in Minhang district of Shanghai through the social economic and clinical data of the elderly population.Methods Jiangchuan Street and Pujiang town were randomly selected to represent the urban and rural population in Minhang district of Shanghai,respectively.Based on the over-60-year old people health examination program,6151 objectives with complete clinical-epidemiological data and bio-chemical index were investigated.The prevalence of CKD in urban and rural areas was compared,and the correlation factors for the urban and rural CKD were evaluated by multiple logistic regression analysis.Results (1) The survey objectives with an average age of (69.57+7.04) years,including 4345 cases of the city residents and 1806 cases of rural residents,were enrolled.The age structures of urban and rural showed differences,population over 80 years old account for 13.1％ of the rural total,significantly higher than 7.4％ in the urban population (P ＜ 0.001).(2) The prevalence rates of diabetes,hyperuricemia,hyperlipidemia and hyperlipidemia in urban residents were higher than those in rural residents,which were 26.4％ vs 13.7％,9.9％ vs 2.3％,53.7％ vs 37.4％,51.4％ vs 15.6％ (all P＜ 0.01).The awareness rates of kidney disease and hyperlipidemia showed significant differences in urban and rural areas,which were 32.9％ vs 44.2％,84.6％ vs 62.8％ (all P ＜ 0.01).Compared with those in rural areas,the treatment rates of hypertension and high blood lipids in urban residents were increased (all P ＜ 0.01).(3) The prevalence of CKD was 23.4％.Female CKD prevalence was higher than male,respectively 26.3％ and 18.5％ (P ＜ 0.01).In urban CKD prevalence was 22.2％,lower than 25.2％ in rural.The prevalence rate of hematuria in urban areas was lower than in rural areas,but the prevalence rate of decline in renal function was higher (all P ＜ 0.05).With the increase of age,the prevalence rate of CKD was increased (P ＜ 0.01).(4) Age (OR=1.072),smoking history (OR=1.543),previous history of kidney disease (OR=1.351),diabetes (OR=1.373),hyperuricemia (OR=2.498),obesity (OR=1.364),history of interventional therapy (OR=1.896) had positive correlation with CKD in city elderly population,while the higher education (OR=0.676,OR=0.604) and drinking (OR=0.585) had negative correlation (all P ＜ 0.05).Age (OR=1.032),female (OR=1.860) had positive correlation with CKD in rural elderly population (all P ＜ 0.05).Conclusions CKD has been a common chronic progressive disease of the aged in Minhang district.The prevalence of CKD is higher in urban areas than in rural.Age is a common factor for CKD in urban and rural.Previous smoking,history of kidney disease,diabetes,hyperuricemia,obesity,history of interventional therapy,education and drinking have correlation with urban CKD patients.Female has correlation with rural CKD population.

Objective To describe the circadian profiles of interdialytic blood pressure in maintenance hemodialysis patients and to investigate its related factors. Methods Ambulatory blood pressure monitoring (ABPM)was conducted in forty-four patients on regular hemodialysis during interdialytic days.Three groups were identified with their ambulatory blood pressure:non-hypertension group,controlled hypertension group and uncontrolled hypeaension group.Hemoglobin,creatinine,Kt/V,serum total calcium,serum phosphate,immunoreactive parathyroid hormone(iPTH),interdialytic weight gain and Morisky self-report scale etc.were assessed. Results (1)No significant difference was found in ABPM index ranged from decline in nocturnal systolic and diastolic blood pressure,AASI to dipper percentage in three groups.Nevertheless,24-h average pulse pressure in uncontrolled hypertension group was higher than the other groups[(80.06+13.41)vs(53.00±7.73),(57.85±21.97)mm Hg,all P＜0.01].(2)All the three groups showed the blood pressure profile of double-peak and trough.In the uncontrolled hypertension group,however,the nocturnal blood pressure decrease was not notable.(3)Nocturnal systolic blood pressure decline Was negatively correlated to iPTH(r=-0.039,P＜0.05).(4)In ten dippers out of all 44 patients,AASI was negatively correlated with nocturnal diastolic blood pressure decline (r=-0.748,P＜0.05). Conclusion Nocturnal blood pressure decline is correlated to iPTH and arterial selerosis.

Objective:To investigate the relationship of the acute radiation reactions of totalbody irradiation before hematopoietic stem cell transplantation with the different total and fractionated doses of irradiation.Methods:The clinical data of 48 patients who underwent 6 MV X-ray total body irradiation pretreatment from May 2015 to December 2019 in Shijiazhuang Ping'an Hospital before undergoing hematopoietic stem cell transplantation were retrospectively analyzed. The patients were divided into 8 Gy group (12 cases), 10 Gy group (31 cases) and 12 Gy group (5 cases) according to the total radiation dose, and divided into 4 Gy/f group (17 cases) and 5 Gy/f group (31 cases) according to the fractionated radiation dose. Acute radiation reactions in the oral mucosa, pharynx, salivary glands, upper gastrointestinal tract, lower gastrointestinal tract and lung of patients in each group after radiotherapy were summarized and compared.Results:Acute pharyngeal reaction in the total radiation dose of 8 Gy group showed that 11 cases (91.7%) were grade 0 and 1 case (8.3%) was grade 1; in the total radiation dose of 10 Gy group, 10 cases (32.3%) were grade 0, 13 cases (41.9%) were grade 1, 4 cases (12.9%) were grade 2, 3 cases (9.7%) were grade 3, and 1 case (3.2%) was grade 4; in the total radiation dose of 12 Gy group, 2 cases (40.0%) were grade 0, 1 case (20.0%) was grade 1, 1 case (20.0%) was grade 2, and 1 case (20.0%) was grade 3. The severity of acute pharyngeal radiation reaction in the total radiation dose of 8 Gy group was better than that in the 10 Gy and 12 Gy groups, and the difference was statistically significant ( χ2 = 11.338, P = 0.003); there was no significant difference in the incidence of acute radiation reactions in other parts (all P > 0.05). Acute pharyngeal radiation reaction in the fractionated radiation dose of 4 Gy/f group showed that 13 cases (76.5%) were grade 0, 2 case (11.8%) was grade 1, 1 case (5.9%) was grade 2, and 1 case (5.9%) was grade 3; in the 5 Gy/f group, 10 cases (32.3%) were grade 0, 13 cases (41.9%) were grade 1, 4 cases (12.9%) were grade 2, 3 cases (9.7%) were grade 3, and 1 case (3.2%) was grade 4. The severity of acute pharyngeal radiation reaction in the fractionated radiation dose 4 Gy/f group was better than that in the 5 Gy/f group, and the difference was statistically significant ( Z = -2.606, P = 0.009); there was no significant difference in the incidence of acute radiation reactions in other parts (all P > 0.05). Conclusion:The total dose of 8 Gy and fractionated dose of 4 Gy/f in the total body irradiation before hematopoietic stem cell transplantation can alleviate the acute pharyngeal radiation reaction.