Objective: To evaluate the incidence, clinical features, diagnosis and treatment of primary ex-tranodal non-Hodgkin' s lymphoma (PE-NHL). Methods: The data of 110 patients diagnosed as PE-NHL be-tween January 2001 and May 2008 were reviewed. Results: These PE-NHL patients counted 60.11% of the 183 malignant lymphoma patients at the same period. The primary sites affected were the gastrointestinal tract 21.82% (24/110), Waldeyer ring 10.91% (12/110), nasal cavity 9.10% (10/110), soft tissue 9.10% (10/110), mediastinum 7.27% (8/110) and other unusual sites 41.82% (46/110). Symptoms and signs of PE-NHL were not specific, and 77.27% of these cases had a swelling organ or lump of the primary organ affected. Ac-cording to the International Prognosis Index (IPI), the percentage of patients in low, intermediate, and high group was 41.11%, 44.44% and 14.44%, respectively. Immunophenotype was assayed in 93 cases. The per-centage of B-cell lymphoma was 69.90% while that of T-cell lymphoma was 30.10%. For those 95 cases treat-ed, the effective rate including complete remission (61.05%) and part remission (16.84%) was 77.89%, the median survival was 30 months, and the 5-year overall survival (OS) was 27%. While, for patients with prima-ry gastrointestinal non-Hodgkin' s lymphomas (PGIL), the complete remission rate, part remission rate and the effective rate was 65.21%, 17.39% and 82.80%, respectively. The median survival was 24 months, and the 5-year overall survival (OS) was 30%. Conclusion: PE-NHL is more common than nodal lymphoma. The symptoms and signs of PE-NHL of different sites are quite different. To improve the curative strategies of PE-NHL, it is important to make an allround understanding of PE-NHL and follow reasonable mode of diagno-sis and therapy.

Objective: To discuss the surgical treatment of carcinoma of the pancreas with superior mesenteric artery (SMA) invasion. Methods: Vascular resection and reconstruction of the portal vein and hepatic artery were performed in 2 cases. Results: The portal vein (PV), superior mesenteric vein (SMV) and superior mesenteric artery (SMA) were involved. During surgery, the invaded superior mesenteric vessels were localized. Case 1 underwent pancreaticoduodenectomy with vascular resection, SMA partial resection and reconstruction. Case 2 was submitted to total pancreatic resection with simultaneous vascular resection of spleen artery and SMA reconstruction. No perioperative mortality occurred. Conclusion: Regional pancreaticoduodenectomy with superior mesenteric artery resection is a safe and effective surgical treatment for pancreatic carcinoma.

Objective: To study the relationship between the whole blood zinc concentration and prostate carcinoma and to explore the diagnostic value of the whole blood zinc concentration combined with blood serum prostate specific antigen (PSA) for prostate cancer. Methods: A total of 95 patients with prostate carcinoma and 91 patients with benign prostate hyperplasia were selected between July 2005 and October 2008 in Zhongda Hospital of Southeast University and The Affiliated Drum Tower Hospital of Nanjing University Medical School. The whole blood zinc concentration was analyzed by atomic absorption spectometry. The serum PSA was analyzed by radioimmunoassay. Results: The volumes of the whole blood zinc concentration were 4.73±1.51 μg/mL in the prostate carcinoma group and 6.82±1.63 μg/mL in the benign prostate hyperplasia group, with a significant difference between the two groups (P＜0.001). The serum PSA general distribution was significantly different between the two groups (P＜0.01). There was no significant difference in the serum PSA of 4.0 to 10.0 ng/mL between the two groups (P=0.14). Compared with that in the benign prostate hyperplasia group, the area under ROC curve for the whole blood zinc concentration in the prostate carcinoma group was 0.82. The diagnostic accuracy was optimal with 5.24μg/mL set as the cut-off value of the whole blood zinc concentration and the Youden's index was 0.46 when it was combined with serum PSA 4.0 ng/mL (connection in series). The specificity was 75%, up to 2.34 times of serum PSA applied alone. Meanwhile, the Youden's index was 0.51, achieving 2.22 times. It was not helpful for the diagnosis of prostate carcinoma that the two diagnostic tools were in parallel by which the Youden's index was only 0.14. Conclusion: Detection of the whole blood zinc concentration is beneficial for differentiation of prostate carcinoma from benign prostate hyperplasia. Combined with serum PSA (connection in series), it can significantly impove diagnostic efficiency when PSA was 4.0～10.0ng/mL. Detection of the whole blood zinc concentration can provide valuable information for the diagnosis of prostate cancer and worths clincal application.

Objective:This work aimed to compare the three-year results, prognostic analysis, and adverse reactions of intensi-ty-modulated radiation therapy (IMRT) positioned by PET-CT and conventional radiotherapy in locally advanced non-small cell lung cancer (NSCLC) patients who underwent concurrent chemotherapy. Methods:A clinical trial was carried out in Qingdao Cancer Hospi-tal. The patients who joined our study were divided into IMRT and conventional radiotherapy (CRT) groups. A total of 48 patients were in the IMRT group and another 40 were in the CRT group. The total dose was 60 Gy throughout the 6-week treatment. The plati-num-based concurrent chemotherapy, combined with regimens such as docetaxel, navelbine, and pemetrexed, was conducted for two cy-cles followed by two to four cycles of consolidation chemotherapy. Results:Significant differences were observed between the curative ratio of the IMRT (77.1%) and CRT (52.5%) groups (P=0.015). No significant difference existed between the short-term survival rates of the two groups. The 1-, 2-and 3-year survival rates were 77.1%, 54.2%, and 22.9%in the IMRT group, as well as 65.0%, 47.5%, and 17.5%in the CRT group, respectively. Significant differences existed in some adverse reactions between the two groups, such as radia-tion gastrointestinal reactions, esophagitis, and pneumonia. More patients died of local recurrence and radiation pneumonia in the CRT group than in the IMRT group. The local recurrence rate was also lower in the IMRT group than in the CRT group. Conclusion:IMRT has obvious advantages in improving the short-term curative effect and reducing adverse reactions. Regarding the survival rate, a long-term follow-up of the two groups is required in the future.

Multidisplinary treatment is the mordent means of local-regional gastric cancer therapy, and individualized treatment decisions are dependent on the patient's characteristics. Stage II patients previously treated with standard D2 resection should receive oral administration of S-1 or combination chemotherapy of XELOX. However, patients at stage IIIb or at a more advanced stage should receive combination treatment as priority. Concurrent radiochemotherapy was recommended to treat patients that had been operated by D0 or D1 resection. Perioperative chemotherapy is more reasonable than pure neoadjuvant chemotherapy. No evidence has verified that perioperative or neoadjuvant chemotherapy leads to better survival compared with postoperative adjuvant chemotherapy. The value of chemotherapy before operation is rest with the effect of downstaging and conversion of the unresectable tumor to a resectable one. Con-current radiochemotherapy prior to an operation needs further investigation to affirm its high efficacy of downstaging and conversion.

Objective:Pathological nipple discharge (PND) is commonly associated with benign breast disorders. However, PND lesions can also be malignant and can be the initial or unique presenting symptom of breast cancer. This study aimed to investigate the relationship between the clinical factors and the character of PND lesions. Methods:The clinical data of 207 patients with PND as their primary complaint were retrospectively analyzed. Results:Univariate analysis showed that the risk factors for breast cancer usually increase in patients with PND accompanied by a breast lump or breast calcification or those aged over 50 (P<0.05). The characteristics and course of PND were not correlated with the diagnoses of benign and malignant degrees of PND (P>0.05). Multivariate analysis indicated that patients aged over 50 with PND accompanied by a breast lump or breast calcification have a higher risk of suffering from breast cancer. Conclusion:The ages of patients with PND accompanied by a breast lump or breast calcification may significantly affect the diagnosis of benign and malignant PND lesions.

Objective: This study aimed to compare and analyze the functional differences between peripheral blood mono-cyte-derived dendritic cells (DCs) of Helicobacter pylori-positive and H. pylori-negative patients with gastric cancer. Methods:H. py-lori infection was detected in 84 patients with gastric cancer in our hospital from January 2011 to October 2012 by the 14C-urea breath test. DCs were generated from monocytes isolated by an adherent method from the two groups of patients and cultured in the presence of rhIL-4, rhGM-CSF, and rhTNF-α. Furthermore, the expression of surface marker molecules was determined by fluorescence-activat-ed cell sorting analysis. The cytotoxicity of DCs pulsed T cells against gastric carcinoma cell was assessed by the lactate dehydroge-nase-releasing assay. The secretion of IL-12 and IFN-γin the supernatant was determined by enzyme-linked immunosorbent assay. Re-sults:No difference was observed in the morphological change of the maturation process. The mean expression of CD1a, CD80, CD83, CD86, and HLA-DR molecules in DCs of H. pylori-infected patients was higher than that in DCs of H. pylori-negative group, and the differences were statistically significant except for CD1a and HLA-DR. The cytotoxicity activities, IL-12 release, and IFN-γrelease in the H. pylori-positive group were significantly higher than those in the H. pylori-negative group (P<0.05). Conclusion:H. pylori infec-tion has no effect on the morphological change of the maturation process of monocyte-derived DCs. These data clearly demonstrate that monocyte-derived DCs of H. pylori-infected patients with gastric cancer can induce stronger maturation and activation than those of H. pylori-negative patients.

Objective:This study was aimed to investigate the influence of CDK7 siRNA on the sensitivity of endometrial carci-noma cell line HEC-1-A to cisplatin (DDP)-based chemotherapy. Methods:Different CDK7 siRNA fragments were synthesized based on the designs of the CDK gene sequence and were transfected into HEC-1-A. Real time reverse transcription polymerase chain reac-tion (RT-PCR) and Western blot analysis were employed to demonstrate the effects of transfection. The best CDK7 siRNA was chosen to specifically silence CDK7 expression in HEC-1-A.The sensitivity of the cells to DDP therapy before and after transfection was deter-mined by methyl thiazol tetrazolium (MTT) cytotoxicity assay, flow cytometry, and Hoechst/PI double-staining fluorescence microsco-py. Results:A total of four different CDK7 siRNA segments were designed and successfully transfected into HEC-1-A cells. The inter-ference effect in each group was confirmed by real time RT-PCR and Western blot assays. CDK7-423 was determined as the best per-forming CDK7 siRNA (over 70%) to transfect into HEC-1-A cells. MTT cytotoxicity test showed that IC50 of DDP decreased to a range from 45.122 μg/mL and 3.200 μg/mL after inhibition of CDK7 expression. DDP toxicity to the endometrial carcinoma cells sig-nificantly increased (P<0.05). Flow cytometry revealed that the average cell apoptosis rate significantly increased after the inhibition of CDK7 expression (11.66%to 37.57%, P<0.05). Similar results were observed using Hoechst/PI double-staining fluorescence microsco-py, and the number of apoptotic corpuscle demonstrated an apparent increase in the low CDK7-expressing group compared with the pa-rental cells. Conclusion:After the downregulation of CDK7 expression by CDK7 siRNA transfection, DDP chemotherapy sensitivity and apoptosis of endometrial carcinoma cells significantly increased. Further research is anticipated on the use of CDK7 as a new treat-ment target for endometrial carcinoma.

Objective:The aims of this study are to detect the apoptosis of cancer cells after a single dose of radiotherapy with 99mTc-HYNIC-annexin V and to investigate the correlation among early apoptosis, radio-therapeutic dose, and radio-sensitivity. Methods:Ten days after respective inoculations of EL4 lymphoma and S180 sarcoma in their right upper limbs, the mice were randomly divided into imaging group (Group One) and observation group (Group Two). In Group One, 99mTc-HYNIC-annexin V was injected via the caudal vein after different doses of irradiation. Approximately 2 h later, clinical imaging was conducted by single-photon emission-computed tomography. The mice were sacrificed to evaluate the bio-distribution of 99mTc in each specimen. Cell count during apoptosis was conducted through the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) method. Observation was conducted in Group Two for 2 weeks after the irradiation. Results:Tumor uptake of 99mTc-HYNIC-annexin V significantly correlated with the number of TUNEL-positive cells, which concordantly increased with the increase of dosage (r=0.892, P=0.000). With the same dose (0 or 8 Gy), the values of%ID/g, T/B, T/M, and TUNEL-positive cell number of EL4 lymphoma were significantly higher compared with those of S180 sarcoma. EL4 lymphoma was entirely minimized after irradiation at 8 Gy. Conclusion: 99mTc-HYNIC-annexin V can detect early apoptosis in vivo in tumors receiving radiation. The irradiation-induced apoptosis in vivo determined with 99mTc-HYNIC-annexin V positively correlates with the curative effect of tumors. The detection of tumor cell apoptosis via 99mTc-HYNIC-annexin V helps estimate radio-sensitivity, and can become a predictive index for radiotherapy.

Epithelial-mesenchymal transition (EMT) is an important biological process in embryonic development and tumori-genesis. In this process, epithelial tumor cells can obtain mesenchymal phenotypes and promote tumor invasion and metastasis. EMT is controlled by multiple transcription factors, signal pathways, and microRNAs. EMT and cancer stem cells are closely related. EMT also promotes the self-renewal ability of tumor cells and the overexpression of EMT-related markers in tumor cells with stemness. Some mi-croRNAs can control EMT process and stemness. In this study, recent developments on EMT and cancer stem cells in tumor metastasis were summarized to provide new insights into target therapy of tumor metastasis and recurrence.