Purpose:To evaluate the efficacy and toxicities of gemcitabine plus cisplatin for patients with relapsed ovarian cancer. Methods:Twenty-eight patients with recurrent ovarian carcinoma received gemcitabine (1000 mg/m~(2)) plus cisplatin (35 mg/m~(2)) on days 1 and 8 of each 21-day cycle. Of 28 patients, sixteen who relapsed within six months of previously platinum-based regimen were platinum-resistant and the other twelve were platinum-sensitive. Results:Of 28 patients, there were 5 (17.9%) complete and 12 (42.9%) partial responses, for an overall response rate of 60.7% (95%CI: 41.7%–79.6%). The median time to progression for objective responders was 5.5 months with a range of 2.5 to 20 months. Median overall survival for all 28 patients was 12.5 months. Among 16 platinum-resistant patients, a 56.3% response rate occurred. The median survival time was 10.5 months. Among 12 platinum-sensitive patients, a 66.7% response rate occurred. The median survival time was 14.5 months. There were leukopenia grade Ⅲ in 35.7%, grade Ⅳ in 17.9%; thrombocytopenia grade Ⅲ in 28.6 %, grade Ⅳ in 14.3% of patients. Conclusions:Cisplatin plus gemcitabine is active in patients with relapsed ovarian cancer. The adverse effects are tolerable. Hematologic toxicities are manageable with dose modifications.

Objective To investigate the feasibility of contrast-enhanced ultrasonography (CEUS) combined with Bosniak classification in diagnosis of cystic renal cell carcinoma (CRCC). Methods Routine and contrast-enhanced ultrasonic manifestations of 24 patients (24 lesions) of CRCC confirmed with operation and pathology were retrospectively analyzed. The number of septa, thickness of wall and septa, with or without solid nodules and blood supply were evaluated. Each tumor was categorized on CEUS images using the Bosniak classification system, and the diagnostic coincidence rate was calculated. Results On routine ultrasonographic images, there were 2 lesions without septa, 8 with a few septa and 14 with multiple septa, 5 lesions with septa and (or) wall thickness ≤1 mm and 19 lesions thickness ＞1 mm; solid nodules were shown in 7 lesions and the color flow was shown in 11 lesions. On CEUS images, there were 8 lesions with a few septa and 16 with multiple septa, 1 lesion with septa and (or) wall thickness ≤1 mm and 23 lesions thickness ＞1 mm; solid nodules were shown in 9 lesions, and the enhancement could be demonstrated in all the lesions. According to Bosniak classification system, CEUS demonstrated 15 grade Ⅲ and 9 grade Ⅳ lesions. The diagnostic coincidence rate of CEUS combined with Bosniak classification was 100%. Conclusion The blood supply and sophisticated internal structures of CRCC can be shown better with CEUS than routine ultrasonography. CEUS combined with Bosniak classification can be used for the diagnosis of CRCC.

Objective To study the relation between expressions of transforming growth factor ?1 (TGF-?1), transforming growth factor receptor type Ⅰ (T?RⅠ) and cell proliferation, cell cycle in gallbladder carcinomas, to disclose the mechanism of TGF-?1 and T?RⅠin the gallbladder carcinogenesis,and to evaluate their values in the prognosis of gallbladder carcinomas. Methods Thirty five gallbladder carcinomas age (57.94? 4.61) years, 14 male cases and 21 female cases comprised 32 adenocarcinomas, 2 adenosquamous carcinoma and 1 squamous cell carcinomas. Formalin fixed, paraffin embedded sections from gallbladder carcinomas were immunostained with TGF-?1, T?RⅠ, PCNA, cyclin E antibodies by immunochemical assays. Gallbladder adenoma and chronic cholecystitis were collected as non-malignant controls. Patients of gallbladder carcinomas were followed up. Results Positive immunostaining rate of TGF-?1 was 57.14% in gallbladder carcinomas, which was significantly higher than that in gallbladder adenomas and chronic cholecystitis (P

Objective To compare contrast-enhanced ultrasonography (CEUS) features of clear cell renal cell carcinoma (CCRCC) and angiomyolipoma (AML), and to explore the value of CEUS for differential diagnosis. Methods CEUS appearance of 106 CCRCCs and 25 AMLs confirmed pathologically were analyzed retrospectively. For each lesion, the enhancement degree, the homogeneity of enhancement, the presence of perilesional enhancement, the washing-in and washing-out pattern and the process of enhancement (i.e. diffuse, centrifugal or centripetal enhancement) were evaluated. The results were compared with the pathologic findings. Results There was no statistically significance in the degree of enhancement and the washing-in and washing-out pattern between CCRCC and AML (P>0.05). However, significantly different was found in the homogeneity of enhancement, the presence of perilesional enhancement and the process of enhancement between CCRCC and AML (P<0.01). Heterogeneous enhancement, perilesional enhancement and diffuse enhancement were mainly seen in CCRCC, and the positive predictive value for CCRCC was 97.26%, 100% and 94.74%, respectively. When all the three CEUS findings combined were used as criterion for differentiating CCRCC from AML, the positive and negative predictive values was 100% and 95.00%, respectively. Conclusion CEUS characteristics of CCRCC is different from that of AML. CEUS is useful for the differential diagnosis of CCRCC and AML.

Objective To investigate the clinicopathologic features,the complications of splenectomy and the survival of epithelial ovarian cancer patients with splenic metastasis.Methods A retrospective study was performed of 32 pailents with epithelial ovarian cancer who underwent splenectomy for tumor cytoreduction at Zhejiang Cancer Hospital between Jan 1998 and Jun 2006.Results Of 32 patients,23 patients(72%)were serous adenocarcinoma and 9 were non-serous adenocarcinoma.According to pathological grade,none was of G1,11 were of G2,21 were of G3.Postoperatively,20 patients were left with no residual tumor.7 were with≤2 cm and 5 were with＞2 cm residual tumor.Postoperative complications developed in 8 patients(25%),including subphrenic abscess,wound infection,gastric perforation,gastrorrhagia,phlebothrombosis,and bowel obstruction.The median follow up was 38 months,estimated 2-year and 5-year overall survival were 70%and 36%.Univariate analysis revealed that histological grade,residual tumor and courses of chemotherapy were influencing factors of the survival(P＜0.05),but multivariate analysis indicated that only residual tumor and courses of chemotherapy independently influenced survival(P＜0.05).Conclusions In epithelial ovarian cancer patients with splenic metastasis,low grade serous adenocarcinoma is most common.Splenectomy as part of cytoreductive surgery is associated with modest morbidity and mortality.Residual tumor and courses of chemotherapy are independent factors associated with the prognosis of the patients.

Objective:To explore the value of lactic acid (Lac), procalcitonin (PCT), sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in assessing the severity and predicting the prognosis in sepsis shock.Methods:A retrospectively study was conducted. Patients with septic shock hospitalized in the department of critical care medicine of the Affiliated Hospital of Jining Medical University from April 2015 to June 2019 were enrrolled. The patient's gender, age, body mass index (BMI), infection site, organ dysfunction status; Lac, PCT, C-reactive protein (CRP), heart rate and body temperature immediately after admission to the intensive care unit (ICU); APACHEⅡ and SOFA scores within 24 hours, and 28-day prognosis were collected. According to the 28-day prognosis, the patients with septic shock were divided into the survival group and the death group, and the differences in the indicators between the groups were compared. Multivariate Logistic regression analysis was used to screen the risk factors of 28-day death in patients with septic shock; receiver operating characteristic curve (ROC curve) was used to analyze the value of Lac, PCT, SOFA, APACHEⅡ, and age in predicting the 28-day prognosis of patients with septic shock.Results:A total of 303 septic shock patients were enrolled, of which 124 cases survived and 179 died on the 28th day, and the 28-day mortality was 59.08%. ① Compared with the survival group, patients in the death group were older (years old: 66.58±15.22 vs. 61.15±15.68), APACHEⅡ, SOFA, proportion of lung infections, Lac increased [APACHEⅡ score: 22.79±7.62 vs. 17.98±6.88, SOFA score: 9.42±3.51 vs. 5.65±1.59, proportion of lung infections: 53.63% (96/179) vs. 39.52% (49/124), Lac (mmol/L): 5.10±3.72 vs. 3.71±2.56], oxygenation index (PaO 2/FiO 2) and ICU body temperature decreased [PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): 198.94±80.15 vs. 220.68±72.06, ICU body temperature (℃): 37.47±1.08 vs. 37.80±1.14], and the differences were statistically significant (all P < 0.05).②Multivariate Logistic regression analysis results: after adjusted for potential confounding factors, APACHEⅡ, PCT, Lac, age and SOFA were independent risk factors for death in patients with septic shock [APACHEⅡ: odds ratio ( OR) =1.05, 95% confidence interval (95% CI) was 1.01-1.10, P = 0.039; PCT: OR = 0.99, 95% CI was 0.98-1.00, P =0.012; Lac: OR = 1.23, 95% CI was 1.08-1.40, P = 0.002; age: OR = 1.03, 95% CI was 1.01-1.05, P =0.009; SOFA score: OR =1.88, 95% CI was 1.59-2.22, P < 0.001]. ③ROC curve analysis showed that APACHEⅡ, Lac, age and SOFA could predict the prognosis of patients with septic shock [APACHEⅡ: the area under the ROC curve (AUC) = 0.682 4, 95% CI was 0.621 7-0.743 1, P = 0.000; when the best cut-off value was 18.500, its sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 72.63%, 54.84%, 69.89%, 58.12%, 1.608 1 and 0.499 2, respectively. Lac: AUC = 0.604 5, 95% CI was 0.540 8-0.668 2, P = 0.002; when the best cut-off value was 3.550 mmol/L, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 50.84%, 73.39%, 73.39%, 50.94%, 1.910 3 and 0.669 9, respectively. Age: AUC = 0.599 1, 95% CI was 0.535 4-0.662 7, P = 0.003; when the best cut-off value was 72.500 years old, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 42.46%, 75.00%, 71.03%, 47.45%, 1.698 3 and 0.767 2, respectively. SOFA: AUC =0.822 3, 95% CI was 0.776 7-0.867 9, P = 0.000; when the best cut-off value was 7.500, its sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 68.72%, 87.90%, 89.13%, 66.06%, 5.680 4, 0.355 9 respectively]. The combined prediction had a good sensitivity (72.63%) and specificity (84.86%), and AUC (0.876 5) was higher than that of a single variable, suggested that the multivariate combination was more accurate in predicting the short-term outcome of septic shock. Conclusion:Lac, PCT, SOFA score, APACHEⅡ score and age were independent risk factors for death in patients with septic shock, and the accuracy of Lac, SOFA score, APACHEⅡ score and age in predicting short-term prognosis of septic shock was better than that of single variable, and the diagnostic value was higher.

Objective To investigate the role of loss of heterozygosity (LOH) of SMAD2 and its relationship with clinicopathological parameters of primary gastric carcinoma. Methods Fifty cases of primary gastric carcinoma were monitored by polymerase chain reaction -single strand conformation polymorphism (PCR- SSCP) and silver staining to detect SMAD2 LOH. Results The incidence of LOH was 40.0%(22/45) at D18S450 and 33.3%(16/48)at D18S460 . LOH occurred in SMAD2 was 55.1%(27/49).The rate of SMAD2 LOH was 72.0% (18/25) in primary gastric carcinoma with lymph node metastasis , which was significantly higher than that in without lymph node metastasis (P

Objective To analyze the enhancement degree of prostate cancer on contrast-enhanced transrectal ultrasonography (CETRUS) in relation to tumor location.Methods 150 patients suspected of prostate cancer were evaluated with CETRUS.The degree of enhancement of the lesions was objectively measured using peak intensity (PI) with time-intensity curve analysis software.The peak intensity of the lesions located in the medial peripheral zone,the lateral peripheral zone and the transition zone was compared and analyzed.Results Prostate cancer was detected in 96 of 150 patients.The mean PI value of the prostate cancer was significantly higher than that of the benign prostate hyperplasia lesions [(9.88 ± 3.76)dB vs (8.74±4.52)dB,P ＜0.01].The PI value of the cancer foci located in the medial peripheral zone,the lateral peripheral zone and the transition zone increased gradually [(6.55 ± 2.90)dB vs (10.57±2.52)dB vs (13.64±2.38)dB,P ＜0.001].The Spearman correlation coefficient between the tumor location and the PI value was 0.718 (P ＜0.001).The partial correlation coefficient was 0.720 when the Gleason score was used as a covariate (P ＜0.001).Conclusions There was significant difference in enhancement degree between prostate cancer lesions with different location.Being aware of this might be valuable for improving the sensitivity and specificity of CEUS in diagnosis of the prostate cancer.

Objective To determine whether cadence contrast pulse sequencing (CPS) harmonic ultrasonography can be used to predict aggressiveness of peripheral zone prostate cancer.Methods CPS harmonic ultrasonography was performed in 62 biopsy-proved prostate cancer patients.Time intensity curves were reconstructed for biopsy-proved or radical prostatectomy histopathology proved prostate cancer lesions.The characteristics of the curves were described using hemodynamic parameters including arrival time (AT),time-to peak (TTP) and peak intensity (PI).The differences of hemodynamic parameters between different Gleason score and pathologic stage were analyzed.Results Prostate biopsy revealed 156 peripheral zone prostate cancer lesions among 62 patients,including 40 low grade lesions and 116 high grade lesions.In comparison with low-grade lesions,the contrast agents arrived and distributed earlier in highgrade lesions (P =0.005,0.023).In addition to lower AT and TTP,high-grade tumors had higher PI than low-grade tumors (P =0.008).Among 21 patients underwent radical prostatectomy,histopathology documented 14 low grade tumors and 17 high grade tumors,significant differences of hemodynamic parameters were found between these two groups (P ＜0.05).Furthermore,prostate cancer lesions with extra capsular extension also had high PI than those confined in the gland (P =0.000).Conclusions Contrast-enhanced ultrasound and hemodynamic parameters might be helpful in predicting aggressiveness of prostate cancer.

Objective To assess transrectal contrast enhanced ultrasound (CEUS ) targeted biopsy (TB) for detection prostate cancer (PCa) by comparing with systematic biopsy (SB) .Methods 151 consecutive patients scheduled for prostate biopsy were enrolled in this prospective study with a mean age of 68 8.± 8 0. (47-86) and prostate specific antigen (11 5.± 6 9.)μg/L (0 3.-39 8.μg/L) .CEUS was performed by a single experienced radiologist who was blinded to all clinical data with the Sequoia 512 ultrasonography system equipped with EV8C4 endfire probe .Hypoperfusion lesions ,hyperperfusion lesions and lesions with rapid wash‐in or wash‐out were suspicious for malignant ,and these lesions were sampled with 2-4 cores in addition with 10‐core SB .Results The overall PCa detection rate was 40 4.% (61/151) .Of 61 PCa patients , 11 (18 0.% ) had positive cores in TB ,18 (23 0.% ) had positive cores in SB and 36 (59 0.% ) had positive cores in both biopsy protocols .The PCa detection rate of TB and SB was 33 1.% and 31 1.% respectively (P=0 7.12) .A total of 1 755 cores were sampled including 1 510 SB cores and 245 TB cores .The positive rate for TB was significantly higher than SB (52 2.% vs 11 5.% ,P =0.000) .Of 61 PCa patients ,18 had low‐grade cancer (Gleason score<7) and 43 had high‐grade cancer (Gleason score≥7) .The sensitivity for high‐grade PCa was 86 0.% with TB ,which was significantly higher than low‐grade cancer (55 6.% ,P =0.018) . Conclusions The PCa detection rate of CEUS‐TB was equal with SB ,whereas the positive rate by core of CEUS‐TB was significant higher than SB .Furthermore ,CEUS‐TB was more sensitive in detection of high grade prostate cancer .