Objective To analyse the clinicopathologic factors affecting prognosis and fertility of patients with malignant ovarian germ cell tumor (MOGCT).Methods The medical records and follow up data of 106 patients with MOGCT treated at Affiliated Tumor Hospital of Guangxi Medical University between January 1986 and December 2010.Kaplan-Meier method was used to analyse survival curves.The different prognoses between different clinicopathologic factor was evaluated by univariate analysis and log-rank test.The multivariate analysis was performed by the Cox proportional hazard regression method.Logistic regression analysis was used to evaluate the influence of different factors on the prognoses and fertility.Results The median age at primary treatment was 22 years old (range:9-61 years old),59 patients received fertility-preserving surgery,45 patients received radical surgery,only 2 cases performed biopsy; 94 patients received postoperative adjuvant chemotherapy.Median follow-up time was 56.5 months (range:2-309 months),there were 11 cases recurrences,23 cases died from cancer.Of 47 patients live without tumor,45 patients had normal menstrual.Of the 39 patients desiring pregnancy,31 cases got 33 successful pregnancies,resulting in 33 live births.There is no statistically significant difference (P ＞0.05) in progression free survival (PFS ; 67.6％ versus 63.3 ％) and overall survival (OS ; 70.0％ versus 64.1％) and mortality [15％ (9/59) versus 31％ (14/45)] between fertility-preserving surgery patients and radical surgery patients.The univariate analysis showed that the pathological types,postoperative residual tumor size,lymph nodes and omental resection were associated with OS (P ＜ 0.1),and postoperative residual tumor size,chemotherapy cycles,lymph nodes and omental resection were associated with PFS (P ＜0.1).The multivariate analysis showed only the postoperative residual tumor size was independent prognostic factor of OS (P =0.039),and postoperative residual tumor size,chemotherapy cycles,lymph nodes resection were independent prognostic factors of PFS (P ＜ 0.05).There is no statistically significant difference in OS,PFS and fertility between fertility-preserving surgery patients treated with or without a comprehensive staging surgery (P ＞ 0.05).Conclusions MOGCT can achieve a good prognosis after surgery combined chemotherapy.Postoperative residual tumor size is independent prognostic factor of PFS and OS.Comprehensive staging surgery could not improve prognosis.Fertility-preserving surgery plus adjuvant chemotherapy appeared to have little or no effect on prognosis and fertility.

Objective: To investigate the effects of Krüppel-like factor 4 (KLF 4) knockdown on epithelialmesenchymal transition (EMT), cell migration and invasion of prostate cancer cells. Methods: The prostate cancer cells with stable knockdown of KLF 4 named as LNCaP-shKLF4 cells and the LNCaP-con cells as the control were constructed. The expressions of KLF4 mRNA and protein in LNCaP-con and LNCaP-shKLF4 cells, and the expressions of EMTassociated gene mRNA and protein in the prostate cancer PC3-shKLF4 cells with stable knockdown of KLF 4 and the PC3-con cells (as the control) as well as the LNCaP-shKLF4 and LNCaP-con cells were detected by real-time fluorescence quantitative-PCR and Western blotting, respectively. The abilities of migration and invasion of PC3-shKLF4 and PC3-con cells as well as LNCaP-shKLF4 and LNCaP-con cells were detected by Transwell chamber assay. Results: LNCaP-shKLF4 and LNCaP-con cells were successfully constructed. The expression levels of KLF4 mRNA and proteins in LNCaP-shKLF4 cells were lower than those in LNCaPcon cells (P<0.01, P<0.05). The expression levels of E-cadherin (E-cad) mRNA in PC3- shKLF4 and LNCaP-shKLF4 cells were higher than those in PC3-con and LNCaP-con cells, respectively (both P<0.01). The expression levels of N-cadherin (N-cad), Zinc finger E-box-binding homeobox 1 (Zeb1), Snail1, vimentin (Vim) and matrix metallopeptidase 1 (MMP1) mRNAs in PC3-shKLF4 and LNCaP-shKLF4 cells were lower than those in PC3-con and LNCaP-con cells, respectively (all P<0.05). The expression levels of E-cad protein in PC3-shKLF4 and LNCaP-shKLF4 cells were higher than those in PC3-con and LNCaP-con cells, respectively (both P<0.05). The expression levels of N-cad, Zeb1, Snail1, Vim and MMP1 mRNAs in PC3-shKLF4 and LNCaP-shKLF4 cells were lower than those in PC3-con and LNCaP-con cells, respectively (all P<0.05). The abilities of migration and invasion of PC3-shKLF4 and LNCaP-shKLF4 cells were weaker than those of PC3-con and LNCaP-con cells, respectively (P<0.01, P<0.05). Conclusion: KLF 4 knockdown in prostate cancer cells can activate the expression of epithelium-associated genes and inhibit the expressions of mesenchymal-associated genes, resulting in the inhibition of cell migration and invasion of prostate cancer cells in vitro.

Objective To evaluate the diagnosis value of urodynamics in patients with benign prostate hypertrophy(BPH).Methods With urodynamic device,the full set of urodynamic exam was administrated in 427 patients with BPH,and the externalsphincter urethral myogram was monitored simultaneously in pressure-flow studies(PFS).The umdynamic finding such as Qmax 、Pdet-Qmax、Popen、DS(descending slope) and post-voiding residual(PVR)were recorded,as well as the situation of bladder detrusor constraction and bladder compliance and urethral sphincter coordination. The bladder outflow obstruction was diagnosed by A-G nomogram，P-Q plot and DS.The IPSS score and prostate volume were also acquired. Results The diagnostic rate of BOO is 81.5％,among them concomitantly detrusor muscle impair in 117 cases(27.4％), decreased bladder compliance in 162 case (37.9％)，urethral sphincter dyssynergia in 148 cases(34.7％)，and unstable bladder in l64 cases (38.4％). The increase degree of BOO show an increasing tendency with urodynamic findings such as Qmax ,Pdet-Qmax,Popen,DS and IPSS score and prostatic volume respectively，however a decreasing tendency with Qmax and bladder compliance. Conclusions The urodynamic exam plays an important role in diagnosis of BOO.There is a positive relation among degree of BOO with urodynamic finding such as Pdet-Qmax,Popen,DS and IPSS score and prostatic volume,however，negative relation with Qmax and bladder compliance respectively.

Background: Colonoscopy is an important approach for the screening of colorectal cancer, however, the quality of colonoscopy is affected by a series of factors such as withdrawal time and bowel cleanliness. It is recommended that colonoscopy withdrawal time should not be less than 6 minutes. Aims: To study the relationship between withdrawal time of colonoscopy and the detection rate of colorectal polyps, which is considered as an important quality indicator for colonoscopy. Methods: A total of 2 924 cases of patients who underwent colonoscopy at the Southern Division of Shanghai Renji Hospital from September 2018 to September 2019 were enrolled in this retrospective study. Colonoscopies were performed by two experienced senior endoscopists. Patients were divided into two groups according to the presence of colorectal polyps. The gender, age, cecal insertion time, depth of insertion and withdrawal time were recorded and compared between the two groups. The influential factors for detection of colorectal polyps were analyzed by logistic regression model. Results: Of the 2 924 cases, 1 105 (37.8%) found polyps under colonoscopy. There were significant differences in gender and cecal insertion time between the two groups (P<0.05). Logistic regression analysis revealed that male (OR=3.175, 95% CI: 1.596-6.317, P=0.001) and withdrawal time ≥ 5 min (OR=4.945, 95% CI: 2.037-12.005, P<0.001) were associated with detection of colorectal polyps. Conclusions: For experienced senior endoscopists, the risk-benefit balance might be achieved by controlling the colonoscopy withdrawal time within 5-6 minutes.

Objective: To explore the value of cervical transformation zone (TZ) type in assessing whether a random biopsy should be used to diagnose high-grade squamous intraepithelial lesion (HSIL) among patients without visible lesions under colposcopy. Methods: A total of 517 patients who underwent colposcopy (without visible lesions) due to high risk subtype infection of human papillomavirus (HPV) or thinprep cytologic test (TCT) abnormality were enrolled. TZ types were identified, random biopsies were performed, and the value of TZ type, Ⅱand III in the diagnosis of HSIL was evaluated. Results: There were 517 cases without visible lesions under colposcopy. Three hundred and ninety-six of them were TZ type III, and the detection rate of HSIL was 3.8% (15/396) by random biopsy, while one hundred and twenty one of them were TZ type and Ⅱ, and the detection rate of HSIL was 8.3% (10/121). Compared with the TZ type III, the detection rate of HSIL in the TZ type and Ⅱ was significantly increased (P=0.000). Logistic regression showed that TCT abnormality, TZ type and Ⅱ were the risk factors for HSIL detection in patients without visible lesions under colposcopy. Conclusion: Random multipoint biopsy can significantly increase detection rate of cervical HSIL when no visible lesion is visualized under colposcopy, particularly in women with abnormal TCT results or TZ type and Ⅱ.

Objective • To investigate the effects of levosimendan on kidney injury in the rat model of cardiopulmonary resuscitation. Methods • Twentyfive healthy adult male SD rats were randomly divided into three groups, which were sham group (S group, n=5), levosimendan group (L group, n=10) and control group (C group, n=10). Cardiac arrest and cardiopulmonary resuscitation procedure were created in L group and C group by inducing ventricular fibrillation. L group was treated with levosimendan during and after resuscitation, while C group and S group were given equivalent volume of saline solution. S group was not induced into cardiac arrest and resuscitation. Serum interleukin-6 (IL-6), IL-10, tumor necrosis factor-α (TNF-α), creatinine (SCr), blood urea nitrogen (BUN) and cystatin-C (CysC) levels were compared between L group and C group at 1, 4 and 6 h after resuscitation.Three groups of rats were sacrificed, and the pathological changes of kidney tissues were observed at 6 h after resuscitation. Results • All rats were resuscitated successfully. No differences were found between the three groups about baseline data. After resuscitation, compared with S group, the levels of serum inflammatory cytokines and kidney function indicators increased dramatically (all P<0.05) in the other two groups. In resuscitation after 1, 4 and 6 h, the levels of IL-6 and TNF-α in L group were lower than those in C group, but IL-10 levels were higher in L group (P=0.000, P=0.002, P=0.036) than those in C group, and there were significant differences between the two groups (all P=0.000). In resuscitation after 1, 4 and 6 h, the levels of SCr (P=0.001, P=0.007, P=0.472), BUN (P=0.001, P=0.004, P=0.122) and CysC (P=0.493, P=0.001, P=0.175) were lower in L group than those in C group. Only 1 and 4 hours after resuscitation, the differences in the levels of SCr and BUN were significant, and only 4 hours after resuscitation, the difference in the level of CysC was significant between L group and C group. Both L and C group showed pathological characteristics of severe acute kidney injury, and the pathological injury scores of L group were alleviated compared with those of C group (all P=0.000). Conclusion • Levosimendan can improve kidney injury of cardiac arrest and cardiopulmonary resuscitation model rats.

Objective • To evaluate population anterior horn biopsy in the diagnosis of prostate cancer. Methods • The clinical and pathological data of 1 679 patients who underwent ultrasound-guided initial 12-core prostate biopsies at Renji Hospital, Shanghai Jiao Tong University School of Medicine, were retrospectively analyzed. The performances of 12-core (including anterior horn) biopsy and the 10-core (except anterior horn) biopsy were compared in total population and different subgroups for the detection rates of prostate cancer. Results • Of the 1 679 patients, 678 (40.4%) were diagnosed with prostate cancer, and 59 (8.7%) were only positive at anterior horns. After excluding the anterior horn biopsy, the detection rate was 36.9% (619/1 679), which was lower than the overall detection rate including the anterior horn biopsy (40.4% vs 36.9%, P=0.046). In prostate specific antigen (PSA) and prostate volume subgroups, for the patients with PSA>10 ng/mL and prostate volume ≥ 30 mL, the biopsy detection rate was improved by adding the anterior horn biopsy (P<0.05). The patients with only positive anterior horn biopsy had higher prostate volumes and lower Gleason scores, compared with the patients with positive biopasy excluding anterior horn (P=0.006, P=0.000). Conclusion • Adding the anterior horn biopsy could improve the prostate cancer detection rate, recommended to be routinely used in the initial prostate biopsies.

Objective • To evaluate the strain parameters measured by two-dimensional speckle tracking echocardiography (2D-STE) in predicting myocardial segment functional recovery and left ventricular (LV) remodeling. Methods • Eighty-one patients with first acute ST-elevation myocardial infarction were enrolled. All patients underwent cardiac magnetic resonance (CMR) within 8 days after reperfusion therapy to detect the percentage of necrotic myocardium and the presence of microvascular obstruction or intra myocardial hemorrhage. Echocardiography examination for the first time was performed on the same day as CMR. Segmental and global circumferential strain (CS), radial strain, and longitudinal strain were measured by 2D-STE. Echocardiography was performed again after an average follow-up of 14 months. Results • The segments with functional recovery were associated with higher absolute values of strain parameters at baseline compared to those without functional recovery. The receiver operating characteristic (ROC) curve analysis showed that the sensitivity and specificity of CS≤-7.77% to predict the functional recovery of myocardial segment were 77.17% and 61.40%, respectively (AUC=0.74, P=0.000). Multiple Logistic regression showed that the percentage of necrotic myocardium and global CS (GCS) were the powerful predictors of LV remodeling (P<0.05). According to ROC curve analysis, GCS≥-17.48% had sensitivity of 88.33% and specificity of 69.23%(AUC=0.80, P=0.000) in predicting LV remodeling. Conclusion • Among the strain parameters of 2D-STE, CS may be an ideal predictor of segment functional recovery and LV remodeling after myocardial infarction.

Objective: To study the application of occipitocervical fusion and fixation in malformation of craniocervical junction surgery. Methods: Thirty-six consecutive patients with craniocervical junction malformation were decompressed under evoked-potential monitoring. Sixteen patients were treated with posterior occipitocervical fusion and fixation using Vertex screw-hook system, and 11 using Vertex screw-rod system, other patients using Mountaineer OCT spinal system. All patients were followed up for 2 to 12 years (mean 7 years). The recovery rate was analysed based on the scoring system of the Japanese Orthopaedic Association (JOA). Results: All the patients were followed up. A stable bony fusion according to radiological criteria was achieved in all cases. There was no implant broken and dislocation. The improvement rate according to JOA scoring system were evaluated. Twenty-four cases (66.7%) got cured; 4 cases (11.1%) had remarkable effects; 8 cases (22.2%) were effective; none was ineffective. Conclusion: Occipitocervical stabilizations hope to be restored through occipitocervical fusion and fixation. Good results can be obtained in most patients with complete radiological data, proper surgery indication, suitable surgical modality and internal fixation materials.

Objective:　Retrospective analyse the main factors influencing the recurrence of gastric cancer after operation, man attempt to improve the standard of diagnosis and treatment.　Methods: Retrospective analysis was male in 25 cases operated for recurrence of gastric cancer during the period from January 1995 to December 1999.　Results: The recurrences were mainly located in the peritoneal cavity, the lymph nodes and the anatomotic region. Serosal involvement of the lesion, non-radical or irrational extent of lymphatic curage(D≤N) and inadequacy of gastric resection were the main causes of recurrence.　Conclusions: Post-opertive recurrence is closely related to the staging of gastric cancer, the rational extent of operation and the adoption of other therapeutic measures. Early detection and treatment of gastric cancer are most important in reducing recurrence and in improving the prognosis.