Positive regulative factors of PI3K/Akt signaling pathways is often activated in ovarian cancer, whereas the function of negative regulator PTEN is often defective. These two kinds of regulators cooperatively regulate tumor cell proliferation and apoptosis in closely association with tumor angiogenesis and invasion and metastasis. It has been suggested that PI3K-Akt pathway is not only related to prognosis of tumor patients but can also be used as novel targets for tumor therapy.

OBJECTIVE: To evaluate the use and tendency of anti-rejection drugs in six cities in the Yangtze valley.METHODS: The consumption data for anti-rejection drugs in the Yangtze areas during the period 2004～2006 were analyzed statistically by the method of order of consumption sum.RESULTS: The anti-rejection drugs used in the Yangtze valley increased year by year,up 28.4% in 2005 and 23.9% in 2006 over the previous year.On the list of consumption sum for the six cities in Yangtze valley,the proportions for Shanghai over the 3 years were 67.1%,62.5% and 65.4%;those for Hangzhou were 12.6%,16.7% and 14.7%;5.3%,4.6%,4.6% for Nanjing;7.6%,9.0% and 7.4% for Wuhan;4.9%,4.5%,5.0%for Chendu,and 2.5%,2.7% and 2.9% for Chongqing.CONCLUSION: The consumption of anti-rejection drugs was unbalanced among the 6 cities in the Yangtze areas,but its clinical application was basically in line with the marketing of new drug both at home and abroad.The import drugs occupied the biggest market share,while the market share of the domestic drugs increased slowly but steadily.The prices for anti-rejection drugs were still very high,which should be lowered to reduce patients' economic burden.

Objective:To explore the clinical significance of classification and grading of ovarian serous tumors (OST) and the correlation of classification and grading with expressions of p53 and Ki-67 proteins, so as to provide a basis for accurate diagnosis and reasonable treatment of OST.Methods:A total of 100 paraffin-embedded ovarian tissues were collected from Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from January 2012 to November 2017. The classification and grading of OST was based on the World Health Organization (WHO) ovarian tumor tissue classification, the work conference on borderline ovarian tumors which was held in August 2013 in Maryland, United States, and the two-level tissue classification system of the United States MD Anderson Cancer Center. The 100 cases of ovarian tissues included 10 cases of normal ovarian tissues (NOT), 12 cases of ovarian serous cystadenoma (OSA), 18 cases of ovarian serous borderline tumor (OSBT), 22 cases of low-grade serous carcinoma (LGSC), and 38 cases of high-grade serous carcinoma (HGSC). The expressions of p53 and Ki-67 proteins in paraffin-embedded tissues were detected by immunohistochemistry. The clinical characteristics of patients with different types of OST and their relationships with the expression of p53 protein and Ki-67 positive index were analyzed.Results:Among OSBT, LGSC and HGSC groups, the proportion of patients with onset age > 50 years old [38.9% (7/18), 45.5% (10/22), 73.7% (28/38)], poor differentiation [0 (0/18), 0 (0/22), 100.0% (38/38)], stage Ⅲ-Ⅳ [5.6% (1/18), 27.3% (6/22), 39.5% (15/38)] increased sequentially, and the differences were statistically significant (all P < 0.05). Among NOT, OSA, OSBT, LGSC and HGSC groups, there were significant differences in the positive rate of p53 protein [20.0% (2/10), 25.0% (3/12), 27.8% (5/18), 31.8% (7/22), 57.9% (22/38)] and Ki-67 positive index [(10.40±0.00)%, (31.49±6.53)%, (42.81±6.84)%, (74.29±6.54)%, (77.04±8.88)%] (all P < 0.05). In the patients with ovarian serous carcinoma (LGSC + HGSC), there was no significant difference in the positive rate of p53 protein and Ki-67 positive index between the onset age ≤ 50 years old and > 50 years old groups (both P > 0.05), but there were significant differences between the patients with different tissue differentiation grade, clinical stage and metastasis (all P < 0.05). There was significant difference in Ki-67 positive index among NOT, OSA, OSBT, LGSC and HGSC patients with positive expression of p53 protein ( P < 0.01). Conclusions:The classification and grading of OST is related to onset age, tissue differentiation and clinical stage, which can be used to guide treatment and judge prognosis. The positive rate of p53 protein and Ki-67 positive index increase with advancing grade of breast lesions, which may be related to the occurrence and development of OST.

Objective To analyze the prevention and treatment of postoperative hemorrhage after pancreaticoduodenectomy. Methods The clinical data of 142 patients undergoing pancreaticoduedenectomy from Jan 1995 to Dec 2008 were retrospectively analyzed. Results The incidence of postoperative hemorrhage was 14.1% (20/142), the mortality caused by this complication was 35% (7/20). Among these patients, intra-abdominal hemorrhage occurred in seven cases, and gastrointestinal hemorrhage occurred in 14 cases, with one case suffering both. There were three and four cases of early and delayed intra-abdominal hemorrhage respectively. Early and delayed gastrointestinal hemorrhage occurred in three and eleven cases respectively. Univariate analysis showed that operative blood loss, blood transfusion, infection and pancreatic fistula were significantly associated with postoperative hemorrhage. Multivariate analysis using Logistic regression identified two variables as independent factors associated with postoperative hemorrhage, namely, infection(OR=6.918) and pancreatic fistula(OR=3.948). Conclusions The incidence and mortality of hemorrhage after pancreaticoduodenectomy is still high. Skillful operation and prevention of pancreatic fistula, infection and stress ulcer are the key paints for reducing postoperative hemorrhage. Proper treatments should be used according to the site, onset and severity of hemorrhage.

Objective To estalish an accurate method for determining the content of astragaloside Ⅳ in Shouqing Granula. Method TLC scanner was selected to detect astragaloside Ⅳ with silica gela thin layer. The sample was separated by using chloroform-methanol-water (13 : 6 : 2) below 10 ℃ overnight with the under layer solution, ?_s=530 nm, ?_R=700 nm. Results The linear ranges of astragaloside Ⅳ was 0.22～ 0.73 ?g, the average recovery was 97.72%, RSD=0.69%. Conclusion The method was simple and accurate, and can be used for the quality control of Shouqing Granula.

Objective To evaluate right ventricular (RV)systolic function in type-2 diabetes mellitus (T2DM)patients.Methods Fifty T2DM patients and fifty normal controls were included in the study and underwent echocardiographic examinations.The following parameters were measured:1 ) Right heart dimensions,pulmonary artery (PA)diameter,pulmonary acceleration time (AT)and PA systolic pressure (PASP);2)RV systolic function:RV fractional area change (RVFAC),tissue Doppler-derived tricuspid lateral annular systolic velocity (S'),tricuspid annular plane systolic excursion (TAPSE),longitudinal strain of six RV segments by 2-dimensional speckle tracking imaging (2D-STI);3 )RV diastolic function:E,A ratio of the tricuspid inflow spectrum (E/A),E,E'(peak early diastolic velocity of the tricuspid annulus) ratio (E/E');4)RV Tei index.Results Statistic analysis showed that T2DM patients had thicker RV walls,wider PAs and shorter AT than the control group (P =0.000,0.001 and 0.000),while their right heart chamber sizes and PASP remained unchanged.Among systolic parameters,absolute values of RV longitudinal strain at the lateral wall-mid (lat-m),septum-mid (sep-m)and septum-basal (sep-b)segments were significantly lower in the diabetic group than the control group (P =0.001 ,0.000 and 0.005),whereas strain of the other three RV segments and RVFAC,TAPSE.S'were not significantly different.Moreover, E/A,E/E'and Tei index were all significantly different between the two groups (P = 0.000,0.000 and 0.006),indicating declined diastolic and general function of RV in the T2DM group.Conclusions RV myocardial strain by 2D-STI is more sensitive in detecting RV systolic dysfunction than TAPSE,S' and RVFAC.Among the six segments of RV walls,lat-m,sep-m and sep-b are better locations for 2D-STI than the other three.

Objective To evaluate the role of real-time three-dimensional transesophageal echocardiography(RT-3D TEE)in left atrial appendage (LAA)occlusion.Methods Consecutive 10 atrial fibrillation (AF)patients (CHADS2 ≥ 2 )with high risk bleeding underwent LAA occlusion under the guidance of TEE.The LAA orifice shape and characteristics of lobes were assessed,the size of LAA with RT-3D TEE wee measured before closer implanation,and the position of the LAA occlusion device were evaluated by RT-3D TEE.The correlational analysis between LAA diameter and occluder size was conducted.Results Among 10 patients,the test results revealed 8 cases with complete LAA occlusion and 1 case with incomplete occlusion,and 1 case with failed occlusion.Five cases showed approximate round LAA ostium,and the other 5 showed approximate oval ostium.The average number of LAA lobes were 2.2±0.7. LAA ostium long diameter were larger by 3D TEE compared with 2D TEE[(21 .8±5.1)mm vs (20.8±4.1) mm],and ostium short diameter were smaller by 3D TEE compared with 2D TEE [(16.1 ± 3.0 )mm vs (1 7.0±2.6)mm],however there were no significant differences between 2D and 3D TEE measurements,and the mean ostium diameter and LAA depth were comparable between two methods.LAA ostium long diameter,short diameter,average diameter and LAA depth assessed by 3D TEE and 2D TEE showed good correlation with occluder diameter (3D TEE:r =0.719,0.690,0.791 ,0.71 1 ,and P =0.029,0.040,0.01 1 , 0.032,respectively;2D TEE:r = 0.887,0.894,0.932,0.896,and P = 0.001 ,0.001 ,0.000,0.000, respectively).LAA occlusion device position assessed by RT-3D:6 cases with appropriate position, acceptable position with 2 cases,and 1 case with malposition.Conclusions RT-3D TEE can play important role in evaluating the morphology of LAA,accurately judging LAA ostium shape and size and position of the occlusion device.

Objective To explore the imaging features of papillary thyroid microcarcinoma(PTMC) with real time contrast-enhanced ultrasound.Methods One hundredand forty-three cases with 149 thyroid nodules(no diffuse lession) were divided into two groups according to the diameter size(group 1,＜0.5 cm;group 2,0.5-1.0 cm) and examined by contrast-enhanced ultrasound during preoperation.Pathology was followed up as golden diagnosis criteria.Results Seventy-five benign tumors and 74 PTMC were confirmed by pathology.There were significant differences in echoes homogeneity between benign and malignant tumors in group 2(W =1 029.5,Z =-5.524,P =0.000) but no in group 1(W =933.0,Z =-1.738,P =0.082).And nonhomogeneous enhancement were showed in most PTMC in group 2.But most PTMC showed homogeneous enhancement in group 1.Conclusions Contrast-enhanced ultrasound is valuable in diagnosis of PTMC with the diameter size of 0.5-1.0 cm.

Objective To assess the value of transesophageal echocardiography (TEE) in left atrial appendage (LAA) closer with Amplatzer Cardiac Plug (ACP).Methods Consecutive 32 atrial fibrillation patients (CHADS2≥1) with high risk bleeding underwent LAA occlusion with ACP LAA occlusion device under the guidance of TEE.Measurements of LAA anchoring area diameter (AAD) and LAA anatomical orifice diameter (AOD) including maximum,minimum values,and LAA depth on 2 dimentional TEE (2D TEE) were conducted before closer device implantation.The outcomes of LAA occlusion were analyzed.Results Among 32 patients,27 cases achieved successful LAA occlusion,including 2 cases with peripheral leakage ≤5 mm,and 5 cases failed occlusion.Among 5 failed closed patients,3 cases with LAA AAD≥ 30 mm,1 case with LAA of short depth,and 1 case with anatomical variation of LAA of low position that access sheath could not be positioned in the LAA.LAA AAD maximum,minimum and LAA depth were (25.9±4.9)mm,(20.0±3.8)mm,(31.0±5.6)mm,respectively,and LAA AOD maximum,minimum diameters were (26.2±6.2)mm,(19.4±4.3)mm,respectively.Among 10 cases with LAA AAD≥30 mm,7 cases achieved successful LAA occlusion,but 3 cases failed.The implanted device diameter was (26.4±3.8)mm,and device compression rate was (7.6±5.5)%.The coefficient of correlation between device diameter and large LAA AAD and AOD is 0.770 and 0.717,respectively.There was no complication but 1 case with pericardial effusion.Conclusions Two dimentional TEE measurements of LAA have clinical guiding significance in the selection of proper size of ACP LAA occluder.The AAD of 2D TEE has the good correlation with ACP occluder′s size,the AADs are important factors which affect the success of LAA occlusion.

Objective To discuss the feasibility and accuracy of left atrial appendage (LAA)ejection fraction by real-time 3 dimensional imaging (3D-EF),and tissue velocity of the LAA wall by tissue Doppler imaging (TDI)via transesophageal echocardiography (TEE)in assessing LAA functions.Methods A total number of 76 patients with atrial fibrillation (AF)were included in the study consecutively and underwent TEE for LAA investigations.3D-EF,fractional area change by 2 dimensional imaging (2D-FAC),peak emptying velocity (PEV),LAA tissue velocity by TDI at the mid-portion of lateral wall (TDI-L),mid-portion of septal wall (TDI-S)and the apical tip (TDI-A)were calculated.Results Statistic analysis showed the following results:1 )2D-FAC,3D-EF,PEV,TDI-L,TDI-S and TDI-A were all significantly higher in patients with sinus rhythm than those with AF during the TEE examinations (all P <0.05),and significantly higher in patients without spontaneous echo contrast (SEC)than those who had SEC (all P <0.05);2)The results of 3D-EF showed a good correlation with 2D-FAC (r=0.727,P =0.000),and their correlations with PEV were similar (2D-FAC and PEV:r =0.685;3D-EF and PEV:r =0.632,both P =0.000);3)TDI-A [(14.95±4.63)cm/s]were significantly higher than TDI-L [(12.62±3.96)cm/s]and TDI-S [(12.68±3.59)cm/s](both P =0.000).The correlations of TDI-A with PEV,2D-FAC and 3D-EF were all marked higher than those of TDI-L and TDI-S (with PEV:r=0.840 vs r=0.564,r=0.524;with 2D-FAC:r=0.701 vs r=0.486,r=0.504;with 3D-EF:r=0.753 vs r=0.493,r=0.522,all P <0.05). Conclusions 3D TEE is feasible and reliable in assessing LAA emptying function.The best location for LAA tissue velocity evaluation is the apical tip.