Objective To evaluate the diagnostic value of four common pleural fluid tumor markers.Methods A total of 126 patients (52 with definite malignant effusions, and 74 with benign effusions) were enrolled. Tumor markers [carcinoembryonic antigen (CEA), cancer antigen 125(CA125), carbohydrate antigen 15-3 (CA 15-3) and cytokeratin 19 fragments (CYFRA21-1)] in pleural fluid were determined by electrochemiluminescence immunoassay. The sensitivities, specificities, accuracies and youden index(YI) of single and combination of those markers were calculated. Results Malignant pleural effusions had higher levels of pleural fluid markers than effusions due to benign conditions. CA125 had the highest sensitivity (90.4 %), and CYFRA21-1 had the highest specificity (79.7 %), CEA and CYFRA21-1 had the highest accuracy (71.4 %), CEA had the highest YI (0.41). The combination of several serum tumor markers had higher sensitivities than the single marker for diagnosis of malignant pleural effusion. When the three tumor markers were combined with CEA, the combination of CEA, CYFRA21-1 and CA15-3 yielded the best results,with a sensitivity of 92.3 %, a specificity of 78.4 %, and an accuracy of 84.1%, YI of 0.71, while the combination of four tumor markers had a sensitivity of 94.2 %, a specificity of 75.7 %, and an accuracy of 83.3 %, YI of 0.70, and there was no statistical significance between the two combinations (P ＞0.05).Conclusion Single tumor marker had limited diagnostic value for malignant pleural effusions, while CEA,CYFRA21-1 and CA15-3 yielded the best and the most economic method, that guiding the selection of patients who might benefit from further invasive procedures.

AIM:ToinvestigatetheregulationofmiR-21onFasLexpressionanditseffectonthegrowthand apoptosis in glioma cells , and to evaluate the molecular mechanism .METHODS:Differential expression levels of miR-21 in human glioma U251 cells were achieved by transfecting with miR-21 mimics, miR-21 inhibitor or scramble .The viability and apoptosis of U251 cells were detected by CCK-8 assay and flow cytometry with Annexin V-FITC/PI double staining. The recombination vector pmirGLO-FasL was constructed .Dual-luciferase reporter experiment was performed to validate the target genes of miR-21.The expression vector pcDNA3.1-FasL was also constructed , and the biological activity and regula-tory role of miR-21 in U251 cell apoptosis were analyzed by a restore experiment .RESULTS:Exogenous overexpression of miR-21 increased the viability and decreased the apoptosis of U 251 cells ( P<0.05 ) , while miR-21 inhibitors generated the opposite results (P<0.05).Dual-luciferase reporter assay and restore experiment revealed that miR-21 negatively reg-ulated the expression of FasL gene which was regarded as the target gene , thus decreasing the apoptosis of U 251 cells. CONCLUSION:miR-21 increases the viability of glioma U251 cells, in which FasL may be one of the target genes .

EML4-ALKfusiongeneisoneofthenoveltargetsinthetherapyoflungcancer,whichcan be detected in several kinds of tumors.A specific ALK inhibitor has been shown to exert anti-tumor effects in non-small cell lung cancer with the EML4-ALK fusion gene.Correlative study between EML4-ALK gene fusion and EGFR-Kras mutations might cast new insight on the tumor target therapy.

ObjectiveTo investigate the effects of selective splenectomy on modulation of portal vein flow and prevention of small-for-size syndrome (SFSS) in living donor liver transplantation.MethodsTwenty six recipients who received LDLT from September 2007 to March 2008 were reviewed.The data of the portal vein flow of these recipients were collected during the operation.Simultaneous splenectomy was performed in patients with portal blood flow ＞250 ml/(min · 100g).No splenectomy was performed when the portal blood flow was less than 250 ml/(min · 100g).The effect of selective splenectomy on modulation of portal vein flow and whether splenectomy prevented the occurrence of SFSS were analyzed.ResultsThe portal vein flow decreased significantly after splenectomy in 8 patients who received splenectomy (P＜0.01),No SFSS occurred in the patients with or without splenectomy.Actual graft-to-recipient weight ratio (GRWR) of patients with splenectomy was significantly smaller than those with no splenectomy (P=0.044).The portal vein flow of patients with splenectomy was much higher than those with no splenectomy (P＜0.01).ConclusionAccording to the portal blood flow,selective splenectomy in LDLT decreased the portal vein flow and prevented the incidence of SFSS.

Objective To investigate the feasibility and clinical effect of one-stage total knee arthroplasty for old femoral condyle fractures combined with knee osteoarthritis.Methods From January 2003 to December 2010,11 patients with old femoral condyle fracture combined with knee osteoarthritis,including 4males and 7 females,aged from 38 to 77 years (average,58.3 years),underwent one-stage total knee arthroplasty.There were 8 cases of supracondylar fracture,and 3 cases of intercondylar fracture.Moreover,there were 2 cases of knee fibrous ankylosis with mild amyotrophy,3 cases of collateral ligaments injury of the knee,2 cases of fibrous union,and 2 cases of infective nonunion.Results All patients were followed up for 6 to 72 months (average,41.3 months).The HSS score improved from preoperative 6.65±7.01 (range,0-13)to 88.5±6.18 (range,81-95) at final follow-up.The range of motion of the knee improved from preoperative 32.7°±17.6° (range,0°-50°) to 101.3°±9.8° (range,85°- 115°) at final follow-up.One case underwent knee disarticulation 6 years after operation owing to infection.For other patients,there were no complications such as infection,deep vein thrombosis,knee instability,component loosening and inequality of lower limb.Conclusion One-stage total knee arthroplasty is a technically difficult but effective method for patients with old femoral condyle fracture and knee osteoarthritis.

In order to study the effects of dominant negative human telomerase reverse transcriptase (DN-hTERT) on cell growth and telomerase activity in osteosarcoma cell line MG63, MG63 cells were transfected with DN-hTERT-IRES2-EGFP9 (DN) or IRES2-EGF (I, blank vector) with lipofectamine 2000. The stably transfected cells were selected with G-418. Cell growth properties were examined under a fluorescence microscope. The hTERT mRNA expression was detected by reverse transcription-polymerase chain reaction (RT-PCR). Telomerase activities were measured by TRAP-ELISE. The tumorigenicity was studied with tumor xenografts by subcutaneous injection of cancer cells into nude mice. The results showed that cell growth was suppressed in MG63 cells transfected with DN-hTERT. The hTERT mRNA was increased in N-hTERT transfected-MG63 cells (MG63/DN). The telomerase activity was 2.45-0.11 in MG63/DN cells, while 3.40+/-0.12 in the cells transfected with blank vector (MG63/I), (P<0.05); DN-hTERT-expressing clones did not form tumors in 2 weeks, but the ratio of tumorigenesis was 30 % in nude mice bearing MG63/I (P<0.01). It was concluded that DN-hTERT could specifically inhibit the cell growth and telomerase activity in MG63 cells.

ObjectiveTo investigate the effect of operation treating spinal multi-level tuberculosis.Methods45 patients with multi-level spine tuberculosis were treated with debridement completely and anterior or lateral-anterior intervertebrae autograft. Of them, 5 patients added to anterior instrumentation.Results45 patients had been followed up for 12 to 40 months.The back pain of 40 cases were relieved within 5 weeks after operation, erythrocyte sedimentation rate decreased 3 weeks after operation. 38 patients who involved in kyphosis decreased their kyphosis mostly and only one patient lost 3 degrees in follow-up.15 patients who involved in neurological deficits improved one or two grades (Frankel). Grafts fused in 44 patients and there were no recurrent in follow-up.Conclusions Operative treatment is efficacious to multi-level body spine tuberculosis.

Objective To analyze the prognostic indicators in gastric cancer patients underwent radical resection.Methods Clinical data of 257 patients with gastric cancer underwent radical resection from Jan. 2003 to Oct. 2008 in our hospital were analyzed retrospectively. Univariate analysis using Kaplan-Meier analysis and log-rank analysis,multivariate analysis using COX proportion risk model were performed. Results Univariate analysis indicated that tumor site (P <0. 05) .Borrmann type (P <0. 01) .histological type (P <0. 01),depth of infiltration (P < 0. 01 ) , lymph node metastasis rate ( P < 0. 01 ) , tumor size ( P < 0. 01 ) ,complication ( P < 0. 01 ) and accessorial chemotherapy (P<0. 01) influenced the patients' prognosis. Cox regression analysis indicated that lymph node metastasis rate, depth of infiltration, Borrmann type and tumor size were the independent risk factors of prognosis(P<0. 05). The relative risk will increase 3.374 times,2. 337 times,1.657 times and 1.580 times with each additional level of lymph node metastasis, depth of infiltration, Borrmann type and tumor size. Conclusions There are various factors influencing the prognosis of gastric cancer,of which lymph node metastasis rate is the most important prognosis indicator.

Objective To investigatc thc short-term clinical and radiographic outcomes of tantalum trabecular metal (TM) components associated with TM augments for Paprosky type Ⅱ and type Ⅲ acetabular defects in revision hip arthroplasty.Methods From June 2014 to April 2016,seventeen patients with aseptic loosening underwent revision total hip arthroplasty for Paprosky type Ⅱ or type Ⅲ acetabular defects with TM revision acetabular cups and TM augments.The subjects consisted of 5 males and 12 females with mean age of 56.6 years (range 30-75).Acetabular bony defects were Paprosky type Ⅱ A in 4 hips,Ⅱ B in 3 hips,Ⅲ A in 8 and Ⅲ B in 2 hips.The whole hip revision was performed in 13 hips and acetabular reconstruction in 4 hips.Preand post-operative functional outcomes were accessed by the Harris Hip Score.The vertical and horizontal position of the rotation center from the intertear drop line were measured and analyzed.Complications were recorded during the follow-up.Radiographic examination was performed after operation immediately by X-ray.The recent X-ray was conducted to assess bone ingrowths at the cup-bone or augments-bone interface,radiolucent lines and implant migration.Results All of the patients were followed-up for an average of 23 months (range 11-33 months).There was no infection,dislocation or periprosthetic fracture complications at the last followed-up.The Harris Hip Score was improved from 45.8±3.4 pre-operatively to 79.2±7.5 post-operatively (t=-16.8,P=0.00).The mean vertical distance of the center of rotation was 32.1±4.3 mm preoperatively and 14.5±2.3 mm postoperatively (t=14.8,P=0.00).The mean horizontal distance of the center of rotation was 33.6±6.1 mm preoperatively and 27.8±3.2 mm postoperatively (t=3.5,P=0.00).More than 3 radiographic signs of osseointegration were observed in 11 hips.No progressive radiolucent lines or component migration was observed.All the TM components were well-fixed at last follow-up.Conclusion Using tantalum TM cups with TM augments in revision hip arthroplasty could be regarded as an effective management for Paprosky type Ⅱ and type Ⅲ acetabular defects.This technology can avoid using over-large cup,provide reliable primary stability,restore the center of rotation with almost normal hip biomechanics and improve the functional outcome.

Based on high throughput sequencing and PCR detection technology,this study has found out that intestinal microbial diversity was impaired and the quantities of two main bacteria flora (Bacteroidetes and Clostridium) were significantly reduced in patients with diarrhea-predominant irritable bowel syndrome (D-IBS).Meanwhile mucosal expression of toll-like receptor (TLR) 2 and TLR4 were significantly enhanced,which was inversely correlated with the reduction of Bacteroidetes and Clostridium.Thus,it suggests that D-IBS may be associated with TLR signal transduction triggered by the intestinal dysbacteriosis.