This paper presents a case of hyperthyroidism with myasthenia gravis (MG),diagnosed by neostigmine-test.Thyrotoxicosis and clinical manifestations of MG were controlled by acetylcholinesterase-inhibitor and immuno-suppressive medicine.Being followed for more than 2 years,the patient had been free of clinical symptoms of MG and his thyroid function was normal.

Objective To investigate the effect of an intrauterine system for controlled release of levonorgestrel (LNC-IUS) in perimenopausal women.Methods A total of 105 perimenopausal patients (aged from 42 53 years with a mean age of 45.8±2.9 years) treated with LNGr-IUS in Beijing Hospital were enrolled in this study.Retrospective analysis concerning reasons for device placement,clinical effects and adverse reactions was conducted.Results Of the patients,25 (23.8％) had menorrhagia,38 (36.2％) had dysmenorrhea,16 (15.2％) had a combination of menorrhagia and dysmenorrhea,9 (8.6％) had undergone cystectomy for endometriosis followed by gonadotropinreleasing hormone-analogue (GnRH-a) therapy,13 (12.4 ％) had simple endometrial hyperplasia,and 4 (3.8％) had leiomyoma combined with systemic disorders.A statistical difference in the average hemoglobin level was found in menorrhagia patients with anemia before and after treatment [(99.4 ±19.1) g/L vs.(123.3±24.5) g/L,P＜0.01].Dysmenorrhea symptom scores decreased six months after treatment[(5.9± 1.0) vs.(3.0±0.7)],P＜0.05).No adnexal masses were found on Bultrasound 12 months after treatment in patients who had undergone cystectomy for endometriosis.For patients with simple endometrial hyperplasia,diagnostic dilation and curettage 12 months after treatment showed normal endometrial morphology,with a total effectiveness rate of 100％.No adverse reactions were found.Conclusions The intrauterine levonorgestre[-releasing system is effective in the treatment of menorrhagia,dysmenorrhea and simple endometrial hyperplasia,and can prevent the recurrence of endometriotic cyst in perimenopausal women.

Objective To investigate the features of renal lesions in von Hippel-Lindau (VHL) disease and the surgical intervention. Methods The clinical and pathological data from 6 patients with renal lesions in a large Chinese VHL disease kindred were reviewed individually.One patient had multifocal renal cysts,and 5 patients had bilateral renal cell carcinomas and multifocal renal cysts. Results Among 10 kidneys in the 5 cases of bilateral renal cell carcinomas, nephron-sparing surgery (NSS) was performed in 5,radical nephrectomy (RN) in 3 and observation in 2.After operation,the pathological findings indicated that all solid lesions were renal clear cell carcinoma, with one malignant cyst being detected.The Fuhrman's nuclear grade of the RCC was grade Ⅰ in 14 tumors,grade Ⅱ in 6 tumors.The TNM stage was T 1N 0M 0 in 4 cases and T 2N 0M 0 in 1 case.During a mean follow-up of 47 months (range,9 to 113 months),all patients were alive without evidence of RCC recurrence and metastasis.Five patients had normal renal function and 1 patient experienced an increase in serum creatinine but without dialysis. Conclusions The renal lesions in VHL disease include both cysts and carcinomas,which are often multifocal and bilateral.Almost all the tumors are of clear cell type with a low stage and grade.Nephron-sparing surgery may be justified and effective in the management of VHL patients.

Purpose:To investigate the roles of artesunate on the proliferation and apoptosis of gastric carcinoma cells,also to explore it s possible mechanism of anticancer effects. Methods:The inhibition on the proliferation of cultured stomach carcinoma cell line(MGC-803) was observed by using MTT analysis.and apo ptosis was assessed by flow cytometry together with transmission electron micros copy.Using reverse transcriptase polymerase chain reaction,the expression of sur vivin mRNA was evaluated before and after action of artesunate on malignant cell s. Results:The proliferation of MGC-803 was inhibited notably by artesunate with a dosage-dependant character(P

Objective To evaluate the values of contrast-enhanced ultrasound in diagnosis of cystic renal cell carcino-ma. Methods A total of 73 patients with renal cystic lesions were included in this study. The image features of ultrasound and contrast-enhanced ultrasound examination were analysed. All of patients underwent surgical treatment and had patholog-ical results. The diagnostic values of the ultrasound and contrast-enhanced ultrasound were analyzed by evaluating the im-age features of cystic renal cell carcinoma. Results There were 64 cases of cystic renal cell carcinoma, 9 cases of benign cyst. With ultrasound and color doppler ultrasound,irregular shape, thickness wall, solid ingredients, divisions and more blood flow signals were found in cystic renal cell carcinoma. Renal cyst showed regular shape, few solid component and thin separation and inconspicuous blood flow signals. In contrast-enhanced ultrasound, cystic renal cancer contrast agent appear-ing time was (15.13±4.21)s, and reached the peak time (23.42±5.68)s, fade time was (28.42±4.27)s. The enhanced mode for fast in and fast out was found in 22 cases (34.3%), fast in and slow out in 30 cases (46.8%), slow in and fast out in 2 cases (3.2%), slow in and slow out in 4 cases (6.4%), and synchronously in and out in 6 cases (9.3%). The hyper-enhancement was found in 42 cases (65.6%), the iso-enhancement and hypo-enhancement in 22 cases (34.4%). In renal cyst, There were three cases out of contrast filling. In other 6 cases, the contrast agent appearing time was (16.67±2.73)s, the peak time was (25.83±3.06)s and fade time was (34.17±4.26)s. The enhanced mode for fast in and fast out was found in 1 case (16.7%), fast in and slow out in 1 case (16.7%) and synchronously in and out in 4 cases (66.6%). The hyper-enhancement was found in 2 cases (33.3%), the iso-enhancement and hypo-enhancement in 4 cases (66.7%). The sensitivity, specificity, positive predic-tive value, negative predictive value and accuracy of ultrasound were 85.9%, 66.7%, 94.8%, 40.0%and 83.6%. The sensitiv-ity, specificity, positive predictive value, negative predictive value and accuracy of contrast-enhanced ultrasound were 92.2%, 77.8%, 96.7%, 58.3%and 90.4%. Conclusion Contrast-enhanced ultrasound can be used in benign and malignan-cy identification of renal cystic lesion.

Objective To investigate the influence of fixation of both lower limbs with negative pressure vacuum cushion and fixation of both ankles with self-made foam mat on setup errors in radiotherapy for rectal cancer.Methods A total of 12 patients with rectal cancer were enrolled in 2014 and randomly divided into group A (using negative pressure vacuum cushion) and group B (using self-made foam mat).An offline registration analysis was performed for the images of 108 times (A,B group of 54 times) of kilovoltage cone-beam CT (CBCT) before and after treatment.Grey scale translation error registration was used,and the results of registration were analyzed.The setup errors in x-axis (left-right direction),y-axis (cranial-caudal direction),and z-axis (anterior-posterior direction) were compared between the two groups.Results There was no significant difference in the absolute setup error in the y-axis between the two groups (2.13±0.64 mm vs.2.61±1.17 mm,P=0.399),while group A showed significantly lower absolute setup errors in the x-axis and z-axis than group B (x-axis:1.51±0.28 mm vs.2.70±1.05 mm,P=0.039;with an error rate of 7.41％ vs.42.59％;z-axis:1.10±0.29 mm vs.2.37±0.71 mm,P=0.002;with an error rate of 1.85％ vs.35.19％).Conclusions In the radiotherapy positioning for rectal cancer,fixation of both lower limbs with negative pressure vacuum cushion effectively avoids the translation and rotation of both lower limbs,reduces absolute setup errors,and has higher accuracy than fixation of both ankles with self-made foam mat.

Renal cell carcinoma is one of the most common tumors in the urinary system. Most of these tumors are malignant. The incidence of renal tumors has increased in recent years. Contrast-enhanced ultrasound examination is increasingly applied in clinics and has become a common diagnostic method for renal lesions. Contrast-enhanced ultrasound can clearly show the organization of tu-mor blood vessels and capillaries and provide dynamic observation of the blood perfusion status of normal human tissues and tumor tis-sues. This review discusses the situation and value of contrast-enhanced ultrasound in renal tumor treatment.

This study aimed to investigate the synergistic effect of lidamycin (LDM) and rituximab on human B cell lymphoma Ramos cells. Cell proliferation was measured using MTS assay, cell apoptosis was analyzed by Annexin V-FITC/PI assay, the expression of apoptosis related proteins was analyzed by Western blotting, and the in vivo lymphoma inhibition was verified using BALB/c mice inoculated via tail vein using Ramos cells which stably expressed pEGFP-N1 plasmid. The results showed that, after the pretreatment with rituximab for 48 h, rituximab and LDM showed significantly synergistic effects on cell proliferation. Cells in combined treatment group had a higher apoptosis rate than that in LDM treatment group. Compared with the LDM treatment group, the expression of apoptosis-related proteins such as Cleaved caspase-3, Cleaved caspase-7, Cleaved caspase-9 and Cleaved PARP in combined treatment groups increased, and expression of cIAP-2 and Bcl-2 decreased. The result of in vivo experiment showed that, in the combined treatment group, the survival time of BALB/c mice was significantly longer than the mice in control group and LDM treatment group, and the degree of tumor accumulation and metastasis to lymph nodes and spleen was lower.

Objective To investigate the expression of Oct4 protein and analyze its correlation with the clinic pathological features and prognosis of non-muscle-invasive bladder cancer.Methods The oct4 protein expression was assessed by immunohistochemical analysis in 87 specimens of bladder transitional cell carcinoma and 15 specimens of adjacent normal tissues.A correlation between Oct4 and clinic pathological features was analyzed.Results The positive rate of Oct4 protein was significantly higher in bladder cancer than that in normal bladder tissue (P＜0.01).The positive rate of Oct4 protein was 40.7％ in G1 bladder cancer,69.4％ in G2 bladder cancer and 91.7％ in G3 bladder cancer,and the differences was significant (P＜0.01).All patients were followed up for 3-78 months,and 63 of them relapsed.The expression of Oct4 protein was significantly higher in patients of recurrence than in non-recurrence (77.8％ ∶ 37.5％,P ＜ 0.01 ).21 patients of recurrence were in progression,and the expression of Oct4 protein had no significant differences between patients of progression and non-progression (71.4％ ∶65.2％,P ＞0.05).The positive rate of Oct4 protein was not related with gender,age,tumor number and size (P ＞0.05).Conclusion The detection of Oct4 protein is in favor of early detection of bladder tunor,estimation the degree of differentiation and surveillance for recurrence of superficial bladder cancer.

Objective To explore the expression and significance of N-cadherin in urothelial bladder cancer and analyse its relation to clinicpathologic and prognosis of bladder cancer.Methods The expression of N-cadherin in 145 urothelial bladder cancer and 25 normal bladder tissues was detected by immunuhistochemisty,and correlations between N-cadherin and clinicopathologic features were analysed.Results The positive rate of N-cadherin protein was significantly higher in bladder cancer than in normal bladder tissue (P＜0.01).The positive rate of N-cadherin protein was 38.6％ in G1 bladder cancer,58.4％ in G2-G3 bladder cancer,and its difference was significant (P =0.028).The expression was significantly lower in non-muscle-invasive bladder cancer than in muscle invasive bladder cancer (45.7％ vs 64.7％,P=0.029).The muscle-invasive bladder cancer patients were followed up 4-103 months.Among those,the overall survival with positive expression of N-cadherin protein was 24.2％ (8/33),and the overall survival with negative expression of N-cadherin protein was 66.7 ％ (12/18).Kaplan-Meier analysis showed the positive expression of N-cadherin was significantly associated with overall survival of patients with muscle-invasive-bladder cancer (P=0.002 2).Multivariate Cox analysis showed that N-cadherin expression was an important prognostic factor.Conclusions The expression of N-cadherin protein was high in bladder cancer.The detection of the expression of N-cadherin protein is associated with the diagnosis and prognosis of bladder cancer.