The TNM staging is the most common tumor staging system of lung cancer.The new revisioned 7th lung cancer TNM staging is published by the international association for the study of lung cancer (IASLC) in the 13th world conference on lung cancer.Accurate clinical staging depends on the multi-analysis from medical histroy,clinical examination,imaging examination and invasive test,which has important significance for guiding the treatment of lung cancer.The 7th lung cancer TNM classification has been revised respectively from the primary focus,lymph node metastasis and remote viscera metastasis,so as to make it more accurately corresponding to the prognosis of patients.

Objective To evaluate the effects of peer education program on HIV/AIDS prevention among senior high school students. Methods Three senior high schools were randomly selected from Hongkou District of Shanghai as sample schools. One hundred and forty-three students from one class of each school were randomly selected as intervention group,and 152 students from another class of each school were served as control group. Six class hours of peer education program on HIV/AIDS prevention were conducted among intervention group. The same questionnaires which contained knowledge of reproductive health,HIV/AIDS and sexually transmitted diseases were administered before the program,one week and one year after the program. Results The knowledge scores before the program,one week and one year after the program in intervention group were 21.66?8.71,31.72?7.78 and 30.97?8.46,respectively,and those in control group were 22.32?9.24,22.61?8.66 and 22.51?9.16,respectively. There was no significant difference in the knowledge scores before the program between intervention group and control group,while there were significant differences in the knowledge scores one week and one year after the program between intervention group and control group (P

Objective To summarize the clinical and pathological characteristics of gastrointestinal stromal tumors with hepatic metastasis, and to analyze its survival and explore its principles of diagnosis and treatment. Methods Among 99 patients diagnosed as gastrointestinal stromal tumors who had a completely case history in our hospital, we retrospectively analyzed the clinical data of 26 patients with hepatic metastatic and the factors influencing survival. Results The average age at diagnosis of primary and hepatic metastatic gastrointestinal stromal tumors was 50.8 and 51.8 years old respectively. Five cases were confirmed by pathological examination, 12 cases were diagnosed by the exploration during the operation and 14 patients had an imaging diagnosis only. Synchronous and metachronous hepatic metastasis happened in 8 and 18 patients respectively. The median interval between the primary tumor and the metachronous hepatic metastasis was 12 months. The primary sites of 12 cases were in stomach, 5 in colorectum, 6 in small intestine and 3 in extra-gastrointestinal tract.Four cases of the hepatic metastatic tumors were treated with surgical resections, 2 with injections of anhydrous alcohol, 3 with interven-tional therapies, 7 with systemic chemotherapies, 8 with imatinib and 2 without treatment. The median survival was 21 months after hepatic metastasis. The administration of imatinib was an important factor prolonging the survival after hepatic metastasis. Conclusions The most frequent primary site of hepatic metastatic stromal tumor is the stomach while small intestinal stromal tumors are most inclined to metastasize to the liver. Treatment with imatinib for more than 3 months can prolong the survival.

History, 20th Century ; History, 21st Century ; Periodontics ; history

Objective To discuss and prevent hepatic artery thrombosis (HAT ) or stenosis (HAS) after orthotopic liver transplantation (OLT). Methods In harvesting the donor's liver, the hepatic artery should be obtained together with its origin from the celiac artery as a whole. Damage to the hepatic artery should be avoided during dissection, the endothelium should not be injured, especially that of its branches. When the portal veins of the donor and the recipient were opened, the matching arteries were anastomosed end to end. If the diameter of the anastomosing artery was less than 5 mm, a branching section of the artery was selected, the bifurcation septum was divided so that the arterial end was enlarged to ensure a good anastomosis. The endothelium of the artery should be kept intact during the procedure. Results In 36 patients with OLT, no patients suffered from HAT or HAS. Conclusion The important procedures to prevent HAT or HAS in OLT are harvest of a complete donor's arteries, suitable selection of hepatic artery for anastomosis, precise technique of vascular anastomosis, and appropriate use of anticoagulant.

Objective To evaluate the effect of biochemotherapy (?-interferon or recombinant interleukin 2 plus 5-fluorouracil) in the treatment of renal cell carcinoma (RCC) after nephrectomy. Methods Thirty-six patients with RCC admitted during 1993 and 1996 were randomly divided into two groups; the treatment group (combined nephrectomy and biochemotherapy) and control group with nephrectomy alone. Results Biochemotherapy did not show significant effect on five-year survival rate in those patients with the lower grading (Ⅰ, Ⅱ stages) RCC or with negative expression of matrix metalloproteinases 2 and 9 (MMP 2,MMP 9). On the other hand, this treatment regimen showed good clinical results in the higher grading (Ⅲ, Ⅳ stages) cancer patients, and the five-year survival rate was higher in the patients with positive expression of MMP 2 and MMP 9 of RCC than those without biochemotherapy. Conclusion Biochemotherapy is a safe and effective adjunctive treatment for patients with RCC after nephrectomy. Some side-effects should be taken care of. Its doses and administration route should be further studied to enhance the treatment efficacy and reduce side-effects.

Objective To investigate the causes of death of renal transplantation recipients during perioperative period. Methods One thousand one hundred and twenty-three cases of renal transplantation patients admitted to 309 Hospital of PLA from Nov. 1988 to Apr. 2003 were analyzed retrospectively. Results Twenty-four patients died (2.1%), among them, 10 died from infection, 8 from cadio-cerebral vascular disease, 3 from stress ulcer, 2 from fulminant hepatic failure, and 1 from hyperosmolar nonketosis diabetic coma. Conclusions It is essential to confirm the diagnosis early and give effective treatment immediately in renal transplantation patients during perioperative period. Preventive measures aiming at decreasing the risk factors should be emphasized.

Objective To evaluate the technique of modified simultaneous renal-pancreatico-duodenal transplantation (SKPT) with enteric drinage (ED). Methods Simultaneous pancreaticoduodenal and kidney transplantation of cadaver donors has been performed for one uremic patient with insulin-dependent diabetes mellitus (IDDM). The allograft exocrine secretions were drained into the proximal jejunum via a side-to-side duodenojejunostomy (non Roux-en-Y). The patient received an immunosuppression therapy including zenapax (CD25 antibody), FK506, mycophenolate mofitil (MMF), and predinisone. Results Exogenous insulin was withdrawn on the 7 th day after operation and the renal function became normal on the 3 rd day. No serious surgical complication occurred. 35 days after operation, the patient was discharged with normal pancreatic and renal function. Conclusions (1) The modified ED-SKPT without Roux-en-Y anastomosis is a safe and effective procedure for the treatment uremia accompanied by of IDDM. (2) The modified ED-SKPT (non Roux-en-Y) is simpler than traditional method (with Roux-en-Y) in surgical technique, and it has no operation related complications as seen after BD-SKPT (simultaneous kidney-pancreatico-duodenal transplantation with bladder drainage). (3) Current immunosuppressive agents and good HLA-typing may decrease complications.

Objective To evaluate the condition of living renal donors with 3-dimensional volume rendering computed tomography (3D-CT) in preoperation. Methods 10 consecutive cases received hand-assisted transperitoneal laparoscopic living donor nephrectomy (HLDN) from December 2001 to July. Total patients underwent 3-dimensional volume rendering computed tomography before operation for assessing the condition of the anatomical location, number, anomalies and spatial interrelationships of the renal arteries and veins. These 3D-CT were directly compare with intraoperative surgical findings at laparoscopy and the harvested kidney ex vivo to value the sensitivity and accuracy of 3D-CT. Results The CT digital data of 10 cases were reconstructed to 3D-CT with volume rendering technique, and HLDN were performed successfully in all the cases. The 3D-CT accurately identifies renal vascular anatomy. Conclusions Not only the 3D-CT accurately identifies renal vascular anatomy but also tridimensional images reconstructed by the enhanced CT digital data of arterial phase, venous phase and renal parenchymal phase are viewed by surgeon in any position. It is a manner that may facilitate renal hilar dissection during laparoscopic donor nephrectomy. The 3D-CT should be a routine examination for living donor in preoperation

Objective To study the chimerism formation in kidney transplantation recipient receiving peripheral blood stem cells (PBSCs) of the donor after the patient received preoperative total lymphoid irradiation (TLI). Methods 5 patients of living donor kidney transplantation were involved in present study. The mean age of donors was 40 and that of recipients was 27. There was one patients with 4 HLA antigen mismatches out of 6 HLA-A, B, DR antigens, two patients with 3 HLA-mismatches, and two patients with 1 HLA-mismatch. The patients received TLI in doses 90cGy/d from day -5 to day -1. The immunosuppression protocol for these patients during operation and afteroperation was similar to that for other cases, but the dosage was slightly reduced. Donor PBSCs were harvested twice via leukapheresis after the administration of human recombinant granulocyte colony stimulating factor (G-CSF). PBSCs were infused intravenously to the recipients on postoperative day 4 and 7. Chimerism of peripheral blood cell in recipients was detected by PCR-SSP assays. The grafted kidney function, acute rejection frequency and GVHD episodes were also observed. Results After 5 days of G-CSF based mobilizing regimen, the average number of PBSCs harvested from donors was 34?10~6. At 1 month post-transplantation, donor type HLA-DR gene was detected in all the recipients. At 2 and 3 months post-transplantation, chimerism was not detectable in the recipient with 4 HLA antigens (including 2 HLA-DR) mismatched donor kidney and in the recipient with 3 HLA (including 2 HLA-DR and 1 HLA-B) mismatched donor, respectively. In the other 3 recipients, chimerism was still positive 3 months post-transplantation. There were no symptoms of GVHD or infections after infusion of PBSCs. Transplanted kidneys functioned normally and no rejection episodes were observed till the end of the study. The immunosuppressant dosage was lower for these 5 cases than those after conventional cadavar renal transplantation. Conclusions Non-myeloablative TLI conditioning regimen is a safe and effective method which can promote the engraftment of donor PBSCs and induce hemopoietic chimerism. Chimerism can alleviate rejection of the transplanted kidney and reduce the immunosuppressant dosage. Collection and infusion of PBSCs are simple, convenient, effective, and inexpensive, and it is an optimal source of hemopoietic stem cells.