Heptocelluar carcinoma is a common tumor,and transcatheter arterial chemoembolization has become the first choice for treatment. However,combined with TCM ,Clinical effect was more signifi cant. This article generalized research results about the basic syndrome type in recent years,including liver depression and spleen defi ciency,qi stagnation and blood stasis,spleen deficiency with dampness retention,dampness-heat of liver and gallbladder,and liver-kidney yin deficiency. In addition,the article summed up the dialectical therapy of Heptocelluar carcinoma. Soothing liver and invigorating spleen is mainly used,combined with resolving dampness,activating blood and removing toxin,tonifying liver and kidney. In order to broaden the treatment of the disease.

With the wide application of contrast media in modem medicine,contrast-induced nephropathy (CIN) has attracted more clinical attention.Renal ischemia and renal tubular toxicity have been considered to be the pathogenesis of CIN.The most promising biomarkers,except for serum creatinine,include neutrophil gelatinase associated lipocalin (NGAL),cystatin C (Cys C),kidney injury molecule-1 (KIM-1),urine N-acetyl beta-D amino glucosidase (NAG) and micro molecular RNA (microRNA).Before use of contrast media for angiography,both the patient's own risk factors and the contrast-associated risk factors should be carefully evaluated.The patient's own risk factors include basic renal function,diabetes,anemia,homocysteine,etc.The contrast-associated risk factors include the osmotic pressure,viscosity,dosage,application frequency of the used contrast agent,etc.At present,hydration therapy is still the main method for CIN,and other therapeutic methods include medication,such as statins,vasodilators,antioxidants,traditional Chinese medicine,etc.,and blood purification therapy.This paper aims to make a brief summary about the research progress in CIN,focusing on its diagnosis,pathogenesis,risk factors and preventive measures.

Objective To construct a nomogram for estimating disease free survival of node-positive penile cancer treated with surgery.MethodsThe clinicopathological data of 32 node-positive penile squamous cell carcinoma patients were retrospectively reviewed.All patients had undergone primary tumor excision and regional lymphadenectomy.The pathological records showed that 10 were N1,13 were N2 and 9 were N3.Median level of preoperative squamous cell carcinoma antigen (SCCAg) was O.9 μg/L.With a median follow-up of 16.5 months,13 patients developed recurrence.Based on the stage,histological grade and preoperative serum squamous cell carcinoma antigen level,a nomogram was drawn on the basis of the Cox regression model.Results Stage and preoperative serum SCCAg levels were independent prognostic factors for disease free survival in node-positive penile cancer treated with surgery.The hazard ratio of SCCAg level and N stage was 2.76 (95％ CI:1.40-5.44,P=0.0034) and 28.51 (95％ CI:2.55 -319.11,P =0.0066).The nomogram demonstarted good discrimination and calibration with a concordance index of 0.855.Conclusions Based on the N stage and preoperative serum SCCAg level,a nomogram to predict disease free survival in node-positive penile cancer treated with surgery was set up.The prediction model could be helpful in predicting the risk of recurrence.

Objective To evaluate the prognostic value of bilateral inguinal lymph node metastases in node-positive penile cancer. Methods Sixty patients with surgically resected node-positive penile cancer were analyzed. All the patients underwent regional lymph node dissection. Recurrence free survival curves were plotted by Kaplan-Meier method and compared by the Log-rank test. Multivariate survival analysis was performed using Cox regression model. Results Of all the patients, 18 cases had bilateral inguinal lymph node metastases. The 3-year recurrence free survival rate in patients with bilateral invovlement was significantly lower than those with unilateral disease (26.7 % vs 65.3 %, χ2 =10.6, P=0.001). In order to evaluate wether the prognostic significance of bilateral lymph node metastases was dependent of increased number of positive nodes, the two predictors were included in multivariate survival analysis.Both the number of metastatic nodes and bilateral nodal disease were independent prognostic factors (P ＜0.05).Comparisons of survival curves showed those patients with bilateral nodal disease and more than 2 metastatic nodes had worst outcome. Conclusion Bilateral inguinal lymph node metastases is an important prognostic factor in penile cancer irrespective of the number of positive lymph node.

Objective To construct and evaluate a nomogram for predicting the risk of regional lymph node metastases according to pathological features of the primary penile squamous cell carcinoma. Methods The clinical and pathological data of 73 patients who had undergone partial/radical penectomy and ilio/inguinal lymphadenectomy for squamous cell carcinoma of the penis from 1990 to 2005 were retrospectively collected. The expressions of molecular markers (p53, Ki-67, E-cadherin and MMP-9) were determined by immunohistochemistry. A logistic regression model was used to construct the nomogram. Results Tumor grade, the expression level of p53 and lymphovascular invasion were independent prognostic factors of regional lymph node involvement (P<0. 05). The nomogram predicting the risk of metastatic lymph node involvement showed a good concordance index (0. 92) and good calibration. Conclusions Based on the pathological findings of primary tumor, a nomogram to predict the probability of regional lymph node involvement in penile squamous cell carcinoma patients is constructed. This statistical tool is not only helpful in judging individualizing tumor risk, but also in facilitating patients communication in treatment options.

To explore the relationships between traditional Chinese medicine (TCM) constitutional types and overweight or obesity so as to provide evidence for adjusting constitutional bias and preventing and treating obesity.

Objective To investigate the changes of red blood cells (RBC) and blood lipid in Han high altitude immigration dur‐ing the process of altitude acclimatization and their correlation .Methods Forty male Han nationality teachers entering Xizang Ali area and working for 1 year were selected .The blood samples were collected before entering plateau and within 3 d after returning to plain .The blood routine and the blood lipid level were detected .Results In the early return to plain ,the RBC ,TG ,CHO and LDL‐C levels in the research subjects were increased ,in which RBC and TG were significantly increased (P< 0 .01) ,HDL‐C was significantly decreased .After returning to plain ,RBC was positively correlated with TG and CHO (r=0 .46 ,P<0 .01 and r=0 .36 , P<0 .05) .Conclusion High altitude hypoxia environment is the primary cause leading to the change of RBC and blood lipid inde‐xes in the plain population after entering the plateau environment .

Objective To investigate the toxicities of sorafenib in the treatment of advanced re-nal cell carcinoma, and discuss the management. Methods Fifty-eight patients with advanced renal cell carcinoma were treated with sorafenib from March 2006 to February 2008. Of them, 44 were males and 14 were females with the average age of 50 years. Single agent of sorafenib 400 mg twice daily was administrated to 49 patients, and the other 9 patients were given sorafenib and Interferon-a as a combination therapy. The main toxicities such as hand-foot syndrome, alopecia, rash, mucositis, fatigue, diarrhea, weight loss, hypertension, hemoptysis, liver dysfunction, hypophosphatemia and anemia were analyzed for their occurrence time, duration, and grade. Results The toxicities of sor-afenib included hand-foot skin reaction (75.9%), alopecia (67.2%), rash (39.7%), mucositis (24.1%), fatigue (74.1%), hypertension (24.1%), and liver dysfunction (13.8%). Twelve cases (20.7%) experienced grade 3 toxicities and had dose reduced; and two cases encountered grade 4 tox-icities and had permanent withdraw. Conclusions There is peculiarity in treating Chinese advanced renal cell carcinoma patients with sorafenib. The incidences of major toxicities of sorafenib are higher in Chinese patients than what have been observed in studies conducted in US and Europe. Toxicities such as hemorrhage and angina could also appear and need carefully monitored. Generally, most of the toxicities of sorafenib are grade 1 and 2, and easy to be managed in clinic.

Background and purpose:Chemotherapy with docetaxel has become the first line treatment for hormone refractory prostate cancer.To preliminarily investigate the efficacy of docetaxel plus prednisone and mitoxantrone plus prednisone for treating metastatic hormone-refractory prostate cancer and to further evaluate its adverse events in Chinese patients. Methods:83 patients with metastatic hormone-refractory prostate cancer were candidates for the trial and given a combination of docetaxel 75 mg/m2 intravenously on d 1 or mitoxantrone 12 mg/m2 on day 1 plus prednisone 5 mg twice daily on d 1~21, 21 days a cycle. Serum PSA level, relief of bone pain, myelosuppression, and vomiting were recorded and calculated.Results:Docetaxel plus prednisone were administered to 44 patients, 13.6% (6/44) of them got a complete response; 29.5% (13/44) achieved a partial response; 29.5% (13/44) had stable disease; and 27.3% (12/44) progressed. The average time to PSA progression was 37.8 weeks (12~101 weeks) in the responsive and stable disease patients. The 12 patients with progressive disease were given MP as a salvage therapy, and 16.7% (2/12) achieved a partial response, 25.0% (3/12) had stable disease. Only 2 patients died of disease aggravation. Mitoxantrone plus prednisone were given to 39 patients, and 7.7% (3/39) of them got a complete response; 25.6% (10/39) achieved a partial response; 25.6% (10/39) had a stable disease; and 41.0% (16/39) of patients progressed. The mean time to PSA progression was 25.3 weeks (8~61 weeks) in the responsive and stable disease patients. The 14 patients with progressive disease were administered DP as a salvage therapy, and 7.1% (1/14) achieved a complete response, 35.7% (5/14) got a partial response, 21.4% (3/14) had stable disease and from the new baseline. Four patients died at the last follow-up.Conclusions:In Chinese patients, docetaxel plus prednisone is better than mitoxantrone plus prednisone in PSA response rate and PSA control, but there occurs a bit more toxicity. When the tumor is resistant to one regimen, the other might be still effective in controlling the disease from progression.

Objective To study the sensitivity and specifity for detection of bladder tumor by Narrow-band imaging flexible cystoscopy compared with WLI flexible systoscopy. Methods Between February 2009 and July 2009, NBI flexible cystoscopy and conventional WLI flexible cystoscopy with the same instrument (Olympus Exera Ⅱ endoscopy system) were both performed on 31 patients highly suspect of bladder neoplasm with same observed time and in a randomized sequenced paradigm. Every suspect mucosa lesion was biopsied in both NBI and WLI image to compare the diagnostic accuracy between them. Results Twenty-eight patients(90%) were pathologically bladder urothelial cell carcinoma (UCC). Of 28 patients 3 were Tis, 15 were Ta, 7 were T1, and 3 were T2. Twenty were low grade carcinom, 8 were high grade carcinoma and 16 had multiple tumors, 12 had a single tumor.Of 73 biopsied lesions, 61 were diagnosed UCC under WLI image with 84% sensitivity, while 80 of 91 diagnosed under NBI image with 88% sensitivity. WLI detected 23 patients with bladder UCC while NBI detected all 28 patients. NBI detected 19 additional UCC lesions in 15 of 28 patients, as compared with WLI(P＜0. 05). Conclusion NBI flexible cystoscopy can detect more bladder urothelial cell carcinoma than WLI flexible cystoscopy.