Objective To investigate the relationship between insulin like growth factor (IGF Ⅰ)、IGF Ⅱ and IGFBP 3 and Child Pugh classification in patients with liver cirrhosis and to determine the potential clinical markers of functional hepatic reserves. Methods Forty four patients with posthepatitic cirrhosis were divided into 3 groups according to disease severity (Child Pugh Score) and 38 healthy subjects severed as controls. Serum levels of IGF Ⅰ, IGF Ⅱ and IGFBP 3 were measured in these groups by immunoradiometric assay. Results Baseline IGF Ⅰ, IGF Ⅱ and IGFBP 3 levels were significantly lower in patients with cirrhosis than in controls, and the serum concentrations of IGF Ⅰ, IGF Ⅱ and IGFBP 3 were associated with the marked changes of liver function due to Child Pugh score. They all showed a significant correlation with the degree of hepatic dysfunction and dropped markedly during the progression of liver failure. The sensitivity of IGF Ⅱ is much higher than that of IGF Ⅰ and IGFBP 3. It was found that IGF Ⅰ

Objective To investigate the effect of specialized human tel omerase antisense oligodeoxyribonucleotides (AS-ODN) on the growth inhibition o f well, moderate and poor differentiated gastric cancer cell lines, and to explore its inhibitory mechanism and the correlation between the inhibition ratio of gastric cancer cells and differentiation of the tumor cells. Methods Under the given circumstances, three distinct differentiated gastric cancer cell lines were treated with AS-ODN. The telomerase a ctivities were measured by modified telomeric repeat amplification protocal assa y. The cell viability was detected by Trypan blue test, and the cell apoptosis was determined by cell morphological observation under light and electromicroscope, flow cytometry an d TUNEL assay. Results The telomerase activity and cell growth were apparently suppressed in MK N45 and SGC7901 cells, under defined concentrations of AS-ODN. Whilst, in MKN28 cells, only telomerase activity was suppressed at same concentration . There were no obvious changes in non-antisense oligomers treated group. The apoptotic features of MKN45 and SGC7901 were noticed by microscopic observa tion, TUNEL assay, after three distinct gastric cancer cell lines being continuo usly exposed to 10 ?mol/L AS-ODN for 96 h. Furthermore, the flow cytometric analy sis verified that the average apoptotic rate of MKN45 and SGC7901 was 44.75% and 33.56% respectively, but there were no obvious changes in non-antisense oli gomers treated group (P

Objective:To investigate the clinical characteristics of adrenal incidentaloma and explore the management strategies for this disease. Methods:The clinical data of adrenal neoplasm patients admitted in The First Affiliated Hospital and Cancer Center of Sun Yat-sen University from January 2001 to January 2013 were analyzed retrospectively. Results:The data of 667 patients with adre-nal incidentaloma were analyzed. Adenoma was the most common tumor in 511 cases with pathological results (240/511, 47%). Fur-thermore, the pathologic results indicated that 18%(90/511) of these cases were pheochromocytoma and 8%(41/511) were adreno-cortical carcinoma. Of the 511 cases, 266 had≤4 cm tumors, and 245 had>6 cm tumors. In cases with≤4 cm tumors, 260 (98%) had benign tumors, and 183 of these cases underwent laparoscopic adrenalectomy. In cases with>6 cm tumor, 91 cases (37%) had malig-nant tumors, and 162 of these cases underwent open adrenalectomy. Conclusion:The suggested cut-off size for adrenal incidentalo-ma diagnosis is 4 cm. Laparoscopic adrenalectomy is the recommended management strategy for small (≤4 cm) and nonfunctional ad-renal incidentaloma.

Objective To investigate the techniques of laparoscopic retroperitoneal lymph node dissection(LRPLND)through extraperitoneal approach. Methods Seven non-seminomatous germ cell testicular tumor(NSGCT)patients of clinical stage Ⅰ underwent LRPLND through extraperitoneal approach.The average age was 31(27-39 years old),the average weight was 62 kg(weight 58-72 kg).Pathological examination revealed 2 testis mixed carcinoma(major of embryonal carclnoma and seminoma),2 yolk sac tumor,1 ehoriocarcinoma,2 teratoma with seminoma.Two of them were in right side,and 5 in left.All the chest X-ray,abdominal CT and bone scanning of them were normal before operation.All patients were general anesthetized.Three or 4 trocars were placed,from 2 of them two gasbags were used to expand the retroperitoneal space at volume of 800-900 ml.The retroperitoneal fat was cleared off from the surface of Gerota's fascia to iliac fossa and the plane spance betwwwn anterior rena fascia and posterior peritoneum was separated In the same way the Plane between dorsal renal and the surface of psoas major and quadratus lumborum unto iliae lossa was exposed.Abdominal aorta or vena cava was exposed,then divided and dissected free from surfaee of psoas maior.The conflux of renal vein and testicular vein at the deep face of renal artere(left)was exposed,then testicular vein was ligated and divided it at its end.Fat and lymph tissue between ureter and vessels was dissected to the crotch of abdominal aorta or inferior vena cava.The primary inguinal incision of testectomy was then excided.Normal antegrade ejaculation recovered in 1 month postoperatively. Results The initial 2 operations were converted to open way as the peritoneum were penetrated largely.The other 5 operations were successful.The average operating time was 285 min(245-350 min),intraoperative blood loss was 100-250 ml.Four patients'pathologic results accorded with clinical staging,and 2 positive lymph nodes were found in the other one.The average number of lymph node resected was 25.6 counts(22-31).Follow-up for 3-20 months,chest X-ray and abdominal CT revealed no evidence of recurrence or distant metastasis,and serum tumor markers were in normal range.Normal antegrade ejaculation recovered in 1 month postoperatively. Conclusions The technique through extraperitoneal approach could be applied for LRPLND.It might be an approach for diagnosis and treatment of stage Ⅰ NSGCT.

Background and purpose: The clinical and pathological characteristics and treatment strategy for the patients with testicular diffuse large B cell lymphoma still need to be further studied. This study was done to evaluate the diagnosis and strategy for the disease by retrospective analysis of 21 patients with testicular diffuse large B cell lymphoma. Methods: 21 patients with pathologically proved as diffuse large B cell lymphoma after surgery in the Sun Yat-sen University Cancer Center and The Guangzhou General Hospital of PLA from September 2002 to April 2009 were accrued. There were 3 in stage Ⅰ_E , 4 in stage Ⅱ_E , 5 in stage Ⅲ_E and 9 in stage Ⅳ according to Ann Arbor stage standard. All patients received adjuvant chemotherapy with CHOP regimen initially after operation. Radiotherapy or other salvage chemotherapy regimen was given after failure of the initial treatment. The follow-up information was collected for to all of the patients. Results: Follow-up time ranged from 10 to 83 months. After completion of first-line chemotherapy(CHOP), overall response rate was 72.2%(13/18)with complete remission (CR) rate of 33.3%(6/18)and partial response rate(PR) of 38.9%(7/18). 3 patients in stage Ⅰ_E survived free from disease until now. Tumor relapsed and refractory eases were observed in 10 patients, and they all showed little response to chemotherapy with a response rate of 30.0%(3/10). Among the 21 patients, 11(52.3%) cases died of the disease with a median survival time of 28 months. Of these 21 patients, 7 patients were CD10(+), 5 patients overexpressed bel-6, 12 patients were bcl-2(+), and 15 patients overexpressed MUM1.Overexpressed bcl-2 and MUM1 indicated bad prognosis. Conclusion: Most of the testieular diffuse large B cell lymphoma patients were non-GCB. And they were sensitive to CHOP chemotherapy. The results suggested that all patients should receive chemotherapy after surgery. It was curable in the early stage. However,the options of treatment method for the patients with relapsed and refractory cases are limited and need to be further explored.

Objective To analyze the outcome of intra-artery chemotherapy for T1G3 bladder cancer , and its effectiveness and safety. Methods From June 2003 to May 2014, 39 patients with T1G3 bladder cancer chose intra-artery chemotherapy (Gemcitabine plus cis-platin), and close follow-up was required after 2 cycles of chemotherapy. During the follow-up, transurethral resection of bladder tumor was performed for non-muscle invasive bladder cancer, and cystectomy was performed for muscle invasive tumor. Results Of all patients, 32 were male and 7 were female. The median age was 56 years old (range: 32-82 years), and median follow-up time was 56 months (range: 12-136 months). Nineteen patients were primary bladder cancer, and 20 were recurrent tumor. During the follow-up, 17 patients developed recurrent tumors, including 8 progressed tumors and 3 died from tumor. Two-year and 5-year progressed-free survival were 88% and 74%, and 2-year and 5-year cancer-specific survival were 97% and 89%, respectively. During 5 years′ follow-up, 81% survivor preserved intact bladder, and only 1 patient cancelled chemotherapy for adverse effect. Conclusions Intra-artery chemotherapy (GC regimen) is a choice for T1G3bladder cancer, preventing from disease progression with good tolerance.

Objective To analyze the changes of benign and malignant thyroid nodules during followup and to increase the diagnostic accuracy.Methods The ultrasonographic changes of 161 thyroid nodules confirmed by pathology were retrospectively analyzed,including size,internal components,echogenicity,margin,microcalcification,anteroposterior to transverse dimension ratio(A/T) and the relationships with thyroid capsule,and the change of cervical lymph nodes.Results Ninety-three benign thyroid nodules and 68 malignant thyroid nodules were enrolled in this study,the changes in size,internal components,microcalcification,the relationships with glandular capsule,and cervical lymph nodes were significantly different (P ＜ 0.05),while the echogenicity,margin,and A/T were not significantly different,benign nodules changed more easily in size and internal components,while malignant nodules changed more easily in microcalcification.Both the nodules broken the thyroid capsule or cervical lymph nodes exhibited malignant signs suggest probable malignancy.Conclusions Analyzing the ultrasonographic changes during follow-up contributes to identify benign and malignant thyroid nodules.

Objective To evaluate the efficacy of patients with stage T2 bladder cancer who underwent combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy.Methods The survival data of bladder cancer paients from January 2000 to December 2014 with stage T2N0M0 were retrospectively analyzed.Thirty-five patients of cT2N0M0 receive combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy(group A),and 80 patients of pT2N0M0 underwent radical cystectomy (RC) (group B).The pathological diagnosis of all patients was urothelial carcinoma.In group A,there were 33(94.2％) males and 2 (5.8％) females;20 (57.1％) tumor size less than 3 cm and 15 (42.9％) larger than 3 cm;24 (68.6％) with single tumor and 11 (31.4％) with multiple tumors;11 (31.4％) patients with primary tumors and 24 (68.6％) recurrent tumors.In group B,there were 71 (88.7％) males and 9 (11.3％) females;35 (43.8％) tumor size less than 3 cm and 45(56.2％) larger than 3 cm;44 (55.0％) with single tumors and 36 (45.0％) with multiple tumors;22(27.5％) patients with primary tumors and 58 (72.5％) recurrent tumors.Results Groups A and B consisted of 35 and 80 patients and median follow-up time was 68 (13-157)and 67 (4-198)months,respectively.There was no significantly statistical difference in disease-specific survival (DSS) between the two groups(P =0.888),76.5％ for group A and 60.6％ for group B respectively.In group A,26 (74.3％) patients achieved complete response (CR) to intra-arterial chemotherapy.Additionally,amounts of 21 (60.0％) patients preserve their functional bladder successfully and their median follow-up time was 69 (13-134)months.8 patients receive delayed radical cystectomy when suffered tumor recurrence and none of them had lymph node metastases.Of those pathological stage was presented as stage T2 5 cases,T3 2 cases and T4 1 case.Importantly,the 8 patients who receive delayed RC did not confer worse DSS when compared with those underwent immediate RC in group B (P =0.809).Cox proportional hazards model showed that tumor number and CR to intra-arterial chemotherapy was independent prognostic factor for disease-free survival (HR =0.238,P =0.007) and DSS(HR =0.085,P =0.004) respectively.During the period of intra-arterial chemotherapy,we did not observe hematological toxicity of grade Ⅳ and the hematological toxicity of grade Ⅰ-Ⅲ was 9 (25.7％),6 (17.1％) and 4 (11.4％).Conclusions For patients with T2N0M0,combined treatment of bladder-preserving surgery and adjuvant intra-arterial chemotherapy could be a therapy with long-term survival outcome and safety.The therapy could be offered as alternative treatment option for patients who were unsuitable for receiving RC.

OBJECTIVETo explore the diagnosis, treatment and prognosis of testicular benign tumors in children.

METHODSThe clinical data of 37 boys (aged between 3 months to 12 years) with testicular tumors treated in our center between August 2000 and August 2013 were retrospectively analyzed. The median age was 14 months and 21 boys were less than 2 years old. The tumors were on the left side in 18 cases, on the right side in 15 cases, and on both sides in 4 cases (adrenal residue testis tumor). Thirty-five patients presented with painless scrotal mass; in the other two cases, testicular residue tumor was found in routine medical examination in one case and testicular mature teratoma was found due to perineal pain in the other; both of the boys underwent ultrasound or CT examination. Thirty-three boys had tumor marker detection. Of the 37 boys with benign testicular tumors, 25 underwent radical inguinal orchiectomy and 12 had testis-sparing surgery.

RESULTSThe boys were followed up for 3-107 months (median 46 months). No patients were found to have tumor recurrence, metastasis or such complications as testicular atrophy; 3 boys had natural fertility later in adutthood.

CONCLUSIONSA high proportion of testicular tumors in children are benign. Preoperative ultrasound or CT combined with detection of tumor markers such as serum AFP can be important in the diagnosis of pediatric testicular tumors, for which testis-sparing surgery should be considered.

Biomarkers, Tumor ; Child ; Child, Preschool ; Humans ; Infant ; Male ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Orchiectomy ; Retrospective Studies ; Teratoma ; diagnosis ; pathology ; therapy ; Testicular Neoplasms ; diagnosis ; pathology ; therapy

OBJECTIVETo define the clinicopathological risk factors of intravesical recurrence of primary transitional cell carcinoma of the ureter after surgical intervention.

METHODSPatients with primary carcinoma of the ureter treated between January 2000 and December 2010 were retrospectively analyzed. The intravesical recurrence-free survival rate was calculated using Kaplan-Meier method. Multivariate analysis was conducted with Cox's regression.

RESULTSA total of 104 patients were enrolled, who were followed up for a median of 46 months (13-89 months). Thirty-nine of the patients showed postoperative intravesical recurrence. Urine exfoliative cytology (P=0.000), number of tumors (P=0.006), tumor grade (P=0.039) and co-existence of bladder tumor (P=0.014) were found to independently influence the postoperative intravesical recurrence. Patients with more risk factors had poorer intravesical recurrence-free survival.

CONCLUSIONUrine exfoliative cytology, number of tumors, tumor grade and co-existence of bladder tumor are independent risk factors for postoperative intravesical recurrence of primary transitional cell carcinoma of the ureter. Close follow-up and rigorous treatment are essential for patients with high risk factors.

Adult ; Aged ; Carcinoma, Transitional Cell ; pathology ; surgery ; Causality ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Regression Analysis ; Retrospective Studies ; Risk Factors ; Ureteral Neoplasms ; pathology ; surgery ; Urinary Bladder Neoplasms ; pathology