Renal cell carcinoma is one of the most common malignant tumors of urinary system. The annual incidence rate is approximately 17.9/100 000 populations, and there is a continually rising trend in number of new diagnosis. Metastatic and high-risk renal cell cancer is associated with a poor prognosis and is resistant to traditional chemotherapy and/or radiotherapy. Although cytokine-based therapies (interferon and interleukin-2) have been widely used, their effectiveness remained unsatisfactory due to their low response rates and short survival. Drugs targeting anti-angiogenesis pathways have shown benefits in relapse-free survival. In this review, we introduce the recent advances in the treatment of renal cancer, especially the application of vasculogenic mimicry and mosaic vessels. Although targeted therapies with anti-angiogenic properties have proposed new treatment criteria for advanced renal cell carcinoma, new drugs or new combinations are needed to improve the clinical efficacy and minimize adverse effects.
Carcinoma, Renal Cell ; blood supply ; therapy ; Humans ; Kidney Neoplasms ; blood supply ; therapy

Differentiated somatic cells can be directly reprogrammed into induced pluripotent stem (iPS) cells in vitro. Similarly to embryonic stem (ES) cells, iPS cells have pluripotency to differentiate into all cell types and capability to self-renew themselves indefinitely. Without immune rejection and ethical issues, patient-specific iPS cells promise to be an ideal tool for regenerative medicine, drug screening, and toxicity testing.
Humans ; Induced Pluripotent Stem Cells

OBJECTIVETo compare the efficacy of ondansetron and granisetron in the prevention of postoperative nausea and vomiting (PONV) in high-risk patients.

METHODSTotally 200 patients with three key risk factors for PONV (female, non-smoking and postoperative opioid use) were equally randomized into ondansetron group and granisetron group. Ondansetron (4 mg) or granisetron (3 mg) was intravenously administered upon the completion of surgery. The episodes of nausea and vomiting were observed for 24 hours after surgery.

RESULTSA significantly greater proportion of patients in granisetron group achieved a complete response (i.e., no PONV or rescue medication) during the first 24 hours postoperatively versus those in ondansetron group (62.6% vs. 46.9%, respectively; P=0.048). There were no significant differences in terms of postoperative nausea incidences (42.9% vs. 34.3%, respectively), postoperative vomiting incidences (25.5% vs. 20.2%, respectively) and postoperative rescue anti-emetics incidences (19.4% vs. 15.2%, respectively) (P>0.05).

CONCLUSIONGranisetron is more effective than ondansetron in preventing PONV in high-risk patients during the first 24 hours postoperatively.

Adolescent ; Adult ; Aged ; Antiemetics ; therapeutic use ; Double-Blind Method ; Female ; Granisetron ; therapeutic use ; Humans ; Male ; Middle Aged ; Ondansetron ; therapeutic use ; Postoperative Nausea and Vomiting ; prevention & control ; Treatment Outcome ; Young Adult

OBJECTIVETo observe the safety and feasibility of tracheal intubation by target-controlled infusion of propofol and remifentanil without muscle relaxant in children.

METHODSTotally 100 4-10-year-old pediatric patients (ASA1) who had been scheduled for plastic surgery were equally divided into remifentanil group and control group through computer-generated randomized grouping. In all patients, five minutes after intravenous administration of atropine 0.01 mg/kg and midazolam 0.1 mg/kg, propofol was infused at the targeted effect-site concentration (Ce of 6 μg/ml. When the intended target Ce of propofol was reached, the remifentanil group began to be infused with remifentanil at a Ce of 5 ng/ml, and normal saline (0.1 ml/kg) was injected simultaneously. In the control group remifentanil was replaced by normal saline and rocuronium (0.8 mg/kg) was injected together with the normal saline. After the equilibration of plasma and the Ce of remifentanil were reached, tracheal intubation was attempted. The complications during the induction and tracheal intubation were recorded. The intubating conditions were assessed using a five-point scoring system based on ease of laryngoscopy, vocal cords position, coughing, jaw relaxation and limb movement.

RESULTSThe success rate of tracheal intubation was in 90% in remifentanil group and 98% in the control group (P=0.122).CONCLUSION Target-controlled infusion of propofol and remifentanil at Ce of 6 μg/ml and 5 ng/ml is feasible for the induction and tracheal intubation without muscle relaxant in children.

Child ; Child, Preschool ; Female ; Humans ; Infusions, Intravenous ; Intubation, Intratracheal ; Male ; Piperidines ; administration & dosage ; Propofol ; administration & dosage

OBJECTIVETo investigate the feasibility and effectiveness of laparoscopic radical trachelectomy and lymphadenectomy in the treatment of early-stage cervical cancer.

METHODSThe clinical data of 6 patients (stage 1a2 to 1b1), who underwent laparoscopic fertility-preserving radical operation for cervical cancer in our department from February 2009 to October 2010, were retrospectively analyzed in terms of operation duration, intra-operative blood loss, postoperative pathology, complications, and pregnancy.

RESULTSBoth radical resection of cervical and pelvic lymph node dissection were completed under laparoscopy, and only the cervical and vaginal cuffs were closed from vagina. The operation duration ranged 155-210 min (mean: 185 min) and the intra-operative blood loss was approximately 60-120 ml(mean: 105 ml). The average length of hospital stay was 18 days without complications, postoperative infection, and bleeding. Postoperative pathology showed no lymph node metastasis, and no ligament, blood vessels, vaginal cutting margin, or upper part of cervix was invaded by tumor cells. During the 8-20-month follow-up, 1 patient had become pregnant for 4 months and no case experienced tumor recurrence.

CONCLUSIONLaparoscopic fertility-preserving lymphadenectomy and radical trachelectomy is feasible for patients with early-stage cervical cancer who have strong wish to have a child.

Adult ; Female ; Fertility Preservation ; Follow-Up Studies ; Humans ; Hysterectomy ; methods ; Laparoscopy ; Retrospective Studies ; Treatment Outcome ; Uterine Cervical Neoplasms ; surgery ; Young Adult

OBJECTIVETo investigate the clinical and pathologic characteristics of anti-glomerular basement membrane(GBM) disease with normal renal function.

METHODSThe clinical and pathologic data of 6 patients with anti-GBM disease and normal renal function in Peking Union Medical College Hospital were reviewed retrospectively. Furthermore, 29 patients with anti-GBM disease and impaired renal function in the same period in the same hospital were enrolled as the control group. Factors that may influence the prognosis were analyzed.

RESULTSSix (17.1%) of all 35 patients maintained normal renal function for 12-133 months during follow-up. Five patients had microhematuria and proteinuria, one had pulmonary hemorrhage only, and three manifested as Goodpasture syndrome. Renal biopsies from 4 patients revealed linear deposition of IgG 2+-3+ along the glomerular capillary walls by immunofluorescence. As shown by normal light microscopy, mild mesangial proliferation and crescentic glomerulonephritis with a large amount of fibrinoid necrosis of glomerular capillary walls were observed in different patients; however, most pathological changes were mild. Five of these six patients were treated with immunosuppressive drugs and/or plasma exchange. Compared with the control group, the 6 patients with normal renal function had significantly higher hemoglobin[(77.97±20.62 vs.(99.67±19.80 g/L P=0.024], lower titers of anti-GBM antibody[(224.34 ± 145.79 vs.(80.23 ± 85.73 EU/ml P=0.027], and lower ratio of glomeruli with crescents[(0.58±0.29 vs.(0.17±0.27 ,P=0.005]. These 6 patients with normal renal function were followed up for 12-133 months, among whom 4 patients achieved complete remission and 2 had mild proteinuria and microhematuria.

CONCLUSIONAnti-GBM disease with normal renal function is not uncommon. Most patients have mild pathologic changes and good prognosis.

Adult ; Anti-Glomerular Basement Membrane Disease ; pathology ; physiopathology ; Female ; Follow-Up Studies ; Humans ; Kidney ; physiopathology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies

OBJECTIVETo explore the values of tissue factor (TF) and vascular endothelial growth factor (VEGF) expressions on peripheral CD14+ monocytes in disease assessment, prognosis, and short-term efficacy evaluation of non-Hodgkin lymphoma (NHL) patients.

METHODSTF and VEGF expressions on CD14+monocytes in 47 NHL patients (disease group) before chemotherapy and after 4 chemotherapy cycles and in 30 healthy subjects (control group) were detected by flow cytometry, and the potential relationship among TF, VEGF, International Prognostic Index (IPI), and short-term efficacy were analyzed.

RESULTSTF and VEGF expressions on CD14 + monocytes in disease group were significantly higher than those in control group ( all P <0. 01) and positive correlation was showed between them (r = 0. 708, P = 0.00). TF and VEGF expressions in Ann Arbor stage III and IV (n = 22 and 19) , symptomatic (n = 22) , lactate dehydrogenase (LDH) increased (n = 21) , Eastern Cooperative Oncology Group (ECOG) score 2-4 (n = 12) and extranodal lesions >1 (n = 16) groups were significantly higher than those in Ann Arbor stage II (an = 6) , asymptomatic (an =25) , LDH normal (n = 26) , ECOG score 0-1 ( n = 35) and extranodal lesions ~1 ( na = 31) groups, respectively (all P <0.05). The expressions of TF and VEGF on CD14 + monocytes in high-risk (n = 7) or high-middle-risk (n = 11) groups were significantly increased compared with low-risk (n = 15) or low-middle-risk(n = 14) groups, respectively (all P <0. 01). TF and VEGF expressions in non-remission group before chemotherapy (n = 11) were both obviously higher than those in remission group (an = 36, all P <0. 01) , and after chemotherapy their expressions in remission group were significantly lower than those before chemotherapy (all P <0. 01) , while such significant changes were not observed in the non-remission group ( all P > 0. 05).

CONCLUSIONThe high expressions of TF and VEGF on peripheral CD14 + monocytes can be useful markers in dis-ease assessment, prognosis evaluation and short-term efficacy observation of NHL patients.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Child ; Female ; Humans ; Lipopolysaccharide Receptors ; Lymphoma, Non-Hodgkin ; blood ; Male ; Middle Aged ; Monocytes ; metabolism ; Prognosis ; Thromboplastin ; metabolism ; Vascular Endothelial Growth Factor A ; blood ; Young Adult

OBJECTIVETo study the changes of body composition in females patients with human immunodeficiency virus (HIV)-related lipodystrophy (LD) syndrome (HIV-LD).

METHODSTotally 25 female patients who were treated in our hospital from January 2002 to December 2009 were divided into LD group and non-LD group based on the existence of LD. All these patients were receiving highly active antiretroviral therapy (HAART). In addition, 12 healthy women were set as the controls. Total and regional body composition were measured by dual X-ray absorptiometry in all three groups.

RESULTSThe fat mass (FM) was correlated negatively with the duration of HAART (r=-0.431, P=0.029). Multiple linear regression analysis showed that FM had positive correlation with weight and negative correlation with lean mass (LM) (r = - 0. 973, P =0. 000). Total, trunk and leg FM were significantly lower in LD patients than that in controls (P <0.05).Meanwhile, total, trunk and leg bone mineral contents were statistically lower in LD patients than that in controls (P <0. 05). Lumbar bone mineral density of LD patients was lower than that of non-LD patients and controls, and there was significant difference between LD patients and controls (P = 0. 001). LM of LD patients was higher than that of non-LD patients but without statistical difference (P > 0. 05).

CONCLUSIONSThe peripheral and central FM and bone mineral contents remarkably decrease in female patients with HIV-LD. How-ever, HIV-LD patients tend to have higher LM than non-LD patients. .

Adipose Tissue ; metabolism ; Adult ; Body Composition ; physiology ; Bone Density ; physiology ; Female ; HIV-Associated Lipodystrophy Syndrome ; metabolism ; Humans ; Middle Aged ; Young Adult

OBJECTIVETo compare and assess the effectiveness of leukocyte-filtered platelet and standard platelet concentrates transfusion in preventing platelet transfusion refractoriness (PTR) and human leukocyte antigen (HLA)-alloimmunization.

METHODSRandomized controlled trials (RCTs) or quasi-RCTs comparing leukocyte-filtered platelet with standard platelet concentrates transfusion (up to December 31, 2009) were searched and identified from Medline, EMBASE, The Cochrane Library, and CBM. A meta-analysis was conducted with Cochrane Collaboration's RevMan 5. 0.

RESULTSThe search identified 558 citations in total, in which 7 articles in English were finally included in the meta-analysis. The analysis showed that compared with standard platelet concentrates transfusion, leukocyte-filtered platelet transfusion significantly decreased PTR [ RR = 0. 59, 95% CI (0. 42, 0. 82) , P = 0. 002 ] and HLA-alloimmunization [ RR = 0. 49,95% CI (0. 33, 0. 74) , P =0. 0006]. Subgroup analysis showed that HLA-alloimmunization was significantly reduced by leukocyte-filtered platelet transfusion among the patients with acute myelocytic leukemia [ RR =0.42, 95% CI (0.32, 0.56), P <0. 00001], while no significant difference was detected in patients with acute lymphoblastic leukemia because of the limited sample size [ RR = 0. 50, 95% CI (0. 10, 2.41) , P =0. 39].

CONCLUSIONSThe current evidence shows that leukocyte-filtered platelet transfusion can prevent PTR and HLA-alloimmunization more effectively than standard platelet transfusion. Well-designed large-scale RCTs are still needed to further confirm this finding.

Filtration ; HLA Antigens ; immunology ; Humans ; Leukocytes ; immunology ; Platelet Transfusion ; methods ; Randomized Controlled Trials as Topic

OBJECTIVETo establish an appropriate animal model of uterine leiomyoma and to understand the pathogenesis of this disease.

METHODSMature female rats were intramuscularly injected with estradiol benzoate at 200 μg or 300 μg twice a week. After injection for 8 or 10 weeks, the rats were sacrificed. We measured the serum levels of estrogen (E(2)) and progesterone (P), evaluated ER and PR expression, and calculated the leiomyoma forming rate and mortality of the rats. Histological changes were compared between rat uterine leiomyoma and human uterine leiomyoma with HE staining. The optimal dose and duration of E(2) for induction of uterine leiomyoma in rat were determined.

RESULTSIn the rats treated with estradiol benzoate 200 μg for 8 weeks ìn the serum E(2) level increased significantly (P<0.01). Uterine nodules were visible in some of the tested rats. Based on the pathohistological Results , the uterine leiomyoma developed in the treated rats demonstrated similar features as in human uterine leiomyoma. The expressions of ER and PR were increased in the leiomyoma tissues.

CONCLUSIONThe rat model of uterine leiomyoma can be established by intramuscular injection of estradiol benzoate at 200 μg twice per week for 8 weeks, with similar features as those of human uterine leiomyoma. The high concentrations of ER and PR in uterine tissue might be related with the development of uterine leiomyoma in animal.

Animals ; Disease Models, Animal ; Estrogens ; administration & dosage ; adverse effects ; Female ; Leiomyoma ; chemically induced ; Rats ; Uterine Neoplasms ; chemically induced