Objective To explore the diagnosis and treatment of penile verrucous carcinoma,a distinctive variant of squamous cell carcinoma. Methods The clinical data of 8 patients (mean age,46 years) with penile verrucous carcinoma were analyzed retrospectively.All the tumors showed exophytic,papillary lesions,ranging from 2 to 6 cm in the greatest dimension.The tumors were located at glans in 5 patients and invaded to shafts in the other 3.The diagnosis was established by biopsy of the lesion.Three patients with tumor invading to shafts and 1 patient with large tumor at glans underwent partial penectomy, while the other 4 with the tumors localized at glans were treated by local excision. Results Histopathologic examination of the specimens confirmed tumors-free surgical margins in all the cases.The tumor cells were mostly well-differentiated.Fourteen months postoperatively,local recurrence occurred in 1 patient with local excision and partial penectomy was performed; postoperative follow-up of 9 years showed no recurrence and metastasis. During a follow-up of 4 to 13 years,the other 7 patients were disease-free.The patients with local excision of the tumors reported satisfaction of their sexual lives. Conclusions Verrucous carcinoma of penis is characterized by slow growth and a locally aggressive nature.It seldom develops metastasis to regional lymph nodes or distant areas.The prognosis is favorable after appropriate treatment.

Objective To investigate the effect of astilbin on expressions of perforin and granzyme B in activated T cells of mouse heart transplantation model with acute rejection.Methods Cardiomyocytes of BALB/C mouse and spleen cells of C57BL/6 mouse were harvested and made into single cell suspensions.The cardiomyocytes(2?10~5 ml~(-1))as stimulators and spleen cells(1?10~6 ml~(-1)) as responsers were mixed and cultured.The model of mouse heart transplantation with acute rejection in vitro was therefore established.There were two groups in the experiment.Control group is the mixed culture of the cardiomyocytes and spleen cells;Astilbin group is the mixed culture of the cardiomyocytes and spleen cells with astilbin(15?g/ml).Apoptosis of T cells were analyzed by TUNEL assay.The expressions of perforin and granzyme B were measured by RT-PCR.Results Apoptosis of activated T cells in Astilbin group was significantly increased than that of the control group(P

Objective To study the clinical experience and determine the optimal timing for periop-erative internal aortic balloon pumb (IABP) support in high-risk patients who had coronary artery bypass grafting (CABG) had been demonstrated. Methods Fifteen cases of emergency CABG with IABP were performed from September 2003 to April 2008. Eight cases were supported by IABP before operation,1 case was supported after succeeding in cardiopulmonary resuscitation,2 cases were supported by IABP for acute myocardial infarction,5 cases were supported by IABP for acute coronary syndrome. Seven cases were supported by IABP in the time of intra-or postoperation,2 cases were supported by IABP in order to help re-moving cardiopulmonary bypass in the operation. Result Three cases supported by IABP in the time of in-tra-or postoperation were dead, the other 12 cases were healed. Conclusions IABP can improve the heart function effectively and therefore can increased the success rate of operation.The beneficial effect of preoperative IABP in high-risk patients who have CABG is confirmed.

Objective To investigate the impact of surgical resection on patients with Ⅱ-Ⅲ A stage small cell lung carcinoma (SCLC). Method Data of 61 in-patients who diagnosed as Ⅱ-ⅢA stage SCLC from Jan 1st 2009 to Feb 1st 2014 were analyzed. 23 patients underwent surgical resections were enrolled as the treatment group, while 38 patients without surgical resection were enrolled as the control group. Disease progression was confirmed by monthly examination. The grouping is balanced by propensity score match. The progression-free survival (PFS) time and overall survival(OS) were analyzed with Kaplan-Meier survival method and Cox regression is applied to analyze the covariates. Fisher's exact test was applied to compare one-year survival rate and two-year survival rate. Results The PFS and OS of the treatment group is longer than that of the control group (P < 0.05). Both one-year and two-year survival rates of the treatment group outnumber those of the control group (P < 0.05). Cox regression indicates that surgical resection is an independent prognostic factor (P < 0.05). Conclusion Surgical resection on tolerable patients with stage Ⅱ-Ⅲ A small-cell lung carcinoma is effective on improving the progression-free survival time,one-year and two-year survival rates,and also shows a propensity of a higher overall survival time.

Objective To investigate the consistency in 18F-deoxyglucose positron emission tomography (18F-FDG PET-CT) examination and histopathological analyses in the diagnoses of resectable lung tumors. Methods Retrospective reviews over the clinical data of lung tumor patients by preoperative PET-CT diagnosis and postoperative histopathological diagnosis were conducted to investigate the effects of the two diagnostic methods in terms of lung tumor properties , mediastinal lymph node metastasis , and pulmonary hilar lymph node metastasis. Results The diagnoses by preoperative PET-CT was consistent in differentiation of non-malignancy and malignancy of pathologic lung tumors by 87.3%, at a medium level (κ = 0.401, P < 0.001). McNemar test showed P = 0.508, indicating the two diagnostic methods were insignificantly different in the diagnosis of pulmonary tumors. The preoperative PET-CT was consistent in the diagnosis of the metastasis of pathologic mediastinal lymph node by 85.9%, at a medium level (κ = 0.697, P < 0.001). McNemar test showed P =0.754, indicating no significant difference between the diagnostic methods. The preoperative PET-CT was consistent with postoperative pathological examinations in the differentiations of the metastasis of pulmonary and hilar lymph node by 77.4%, at a medium level (κ=0.523, P < 0.001). McNemar test showed P = 0.454, indicating the two diagnostic methods were no significantly different. Conclusion Preoperative PET-CT and histopathologic examinations may be consistent in lung tumor diagnosis , which provides a basis for a certain significance in the surgical options.

OBJECTIVETo investigate the effects of spironolactone on the concentration of collagen type I, III in the myocardium of spontaneous hypertension rats (SHR).

METHODSTwenty 8-week male SHR were assigned randomly into spironolactone (SHR-SPIRO, n=10) and control groups (SHR-CON, n=10), sex-age matched Wistar Kyoto rats (WKY group, n=7) were also served as controls. The rats of SHR-SPIRO group were given 20 mg/(kg*d) of spironolactone, the rats of SHR-CON and WKY groups were given the same volume of distilled water. After 16 weeks, the concentration of collagen type I was analyzed with Western blot. The areas of collagen type I and III were observed under polarized light microscopy and the ratio of type I/III collagen was calculated through accumulation score.

RESULTSCompared with WKY group,the concentration of collagen type I in SHR-CON group was significantly higher (1.87 ±0.2 Compared with 1.21 ±0.7, P<0.05). After 16 weeks of treatment the concentration of collagen type I (1.42 ±0.05 Compared with 1.87 ±0.2, P<0.05) and I/III ratio in SHR-SPIRO group were significantly reduced (15.64 ±1.34 Compared with 20.8 ±3.04, P<0.05) compared with SHR-CON group; but there were no differences in accumulation area scores of collagen type III among three groups (368.3 ±30.2 Compared with 481.6 ±32.4 Compared with 406.2 ±45.3, P>0.05).

CONCLUSIONThe deposition of collagen type I in myocardium may be involved in myocardial fibrosis of SHR, and spironolactone can decrease the concentration of collagen type I, which may be one of the mechanisms for its therapeutic effects.

Animals ; Collagen Type I ; metabolism ; Collagen Type III ; metabolism ; Male ; Mineralocorticoid Receptor Antagonists ; pharmacology ; Myocardium ; metabolism ; Rats ; Rats, Inbred SHR ; Rats, Inbred WKY ; Spironolactone ; pharmacology

Objective To evaluate the role of nutritional parameters in prognosis,especially in the early and late mortality of hospital-acquired acute kidney injury (AKI) patients.Methods This study was a prospective cohort study conducted in a hospital comprising 1500 beds in Shanghai, China. One hundred ninety-four patients with hospital-acquired AKI, as determined using the RIFLE staging criteria,were enrolled as subjects after obtaining informed consent.Patients with AKI caused by postrenal obstruction,glomerulonephritis,interstitial nephritis or vasculitis were excluded.Nutritional evaluation,including subjective global assessment (SGA),anthropometric and laboratory examination,was conducted. Other laboratory measurements and clinical data were recorded.The primary outcome was early mortality (≤ 7 days) and late mortality (8-28 days) after enrolling into the study. Results AKI patients at enrollment were characterized by a high prevalence of malnutrition as determined by SGA, anthropometric and laboratory examination.Univariate analysis showed that the SGA,the serum levels of prealbumin,cholesterol and total lymphatic cells, and the Maastricht index were significantly different among early mortality,late mortality and survival groups.The serum prealbumin and cholesterol levels in the early death group were significantly lower than those in the survival and late death groups (P＜0.05).Multivariate analysis revealed that SGA,albumin,prealbumin and cholesterol remained independently and significantly associated with early mortality after adjusting for age,sex,dialysis,ventilation,hemoglobin,platelets,bilirubin,and Glasgow coma score.The areas under the receiver operating characteristic curve to predict early mortality for albumin,prealbumin and cholesterol were 0.591,0.736 and 0.603,respectively,with that of prealbumin significantly higher than others (P＜0.05). Conclusion Low levels of serum prealbumin,albumin and cholesterol at enrollment are independtly associated with increased early mortality in hospital-acquired AKI patients.

OBJECTIVETo assess the feasibility and safety of thoracoscopic bulla resection under laryngeal mask anesthesia with low tidal volume high-frequency lung ventilation.

METHODSSixty patients with pulmonary bulla were randomized into two groups (n=30) to undergo video-assisted thoracoscopic surgery (VATS) for bulla resection with laryngeal mask anesthesia and high-frequency low tidal volume lung ventilation general anesthesia and or with intubation anesthesia and one-lung ventilation through double-lumen endotracheal intubation.

RESULTSNo significant differences were found in anesthesia time, surgery time, intraoperative lowest SpO2, intraoperative highest PetCO2, operative field, anesthetic effects, or blood loss between the two groups. The post-operative WBC and NEU% showed significantly smaller increments in the mask anesthesia group than in the intubation group, and the postoperative awake time, initial eating time, ambulation time, in-hospital stay, and drainage time were significantly shortened in the former group with also lower incidences of gastrointestinal reactions, throat discomfort and hoarseness.

CONCLUSIONThoracoscopic bulla resection under laryngeal mask anesthesia with low tidal volume high-frequency lung ventilation is safe and feasible and results in better patient satisfaction and shorter in-hospital stay than procedures performed under intubation anesthesia with one-lung ventilation.

Adolescent ; Adult ; Aged ; Anesthesia, General ; methods ; Blister ; Child ; Female ; High-Frequency Ventilation ; Humans ; Intubation, Intratracheal ; Laryngeal Masks ; Lung Diseases ; surgery ; Male ; Middle Aged ; One-Lung Ventilation ; Thoracic Surgery, Video-Assisted ; Young Adult

BACKGROUNDThere are a lot of studies on relationship of surface adhesion molecule (CD44) and matrix metalloproteinase (MMP) with tumors in recent years, however study on osteopontin (OPN) is still few. The aim of this study is to investigate the levels of OPN, CD44v6 and MMP-2 in squamous cell carcinoma and adenocarcinoma of the lung, and to clearly understand their roles in growth, invasion and metastasis of squamous cell carcinoma and adenocarcinoma.

METHODSOPN, CD44v6 and MMP-2 were detected in 69 patients with squamous cell carcinoma and adenocarcinoma by immunohistochemical method.

RESULTSThe expression rate of OPN, CD44v6 and MMP-2 was significantly related to histological classification, TNM stages and lymph node metastasis (P < 0.05), but not to cell differentiation (P > 0.05). There was a positive correlation between OPN and CD44v6 expression (P < 0.001), as well as between OPN and MMP-2 expression (P < 0.001). There was no correlation between CD44v6 and MMP-2 expression.

CONCLUSIONSOPN, CD44v6 and MMP-2 expression is related to the histology, TNM stages and lymph node metastasis of lung cancer. They might be used as clinical indicators to predict the progress and metastatic potential for squamous cell carcinoma and adenocarcinoma of the lung.

Objective To introduce a new method for preparation of bioactive β-tricalcium phosphate (β-TCP) by rapid stem cell screen-and-enrich-and-combine circulating system (SECCS) and evaluate its efficacy in the treatment of fresh fractures and bone defects.Methods Twenty-two patients with fresh fracture and bone defects were treated with SECCS from July 2013 to April 2016.They were 16 males and 6 females with an average age of 52.2 years (from 27 to 81 years).There were 15 tibial plateau fractures and 7 calcaneal fractures.The average size of bone defects was 12.5 mL.Bioactive β-TCP was prepared by SECCS intraoperatively and implanted back immediately into the bone defects.Radiographic examination,Lysholm knee scoring and Maryland foot scoring were used for assessment of curative efficacy.Results The 22 patients were followed up for an average of 25.7 months (from 12 to 46 months).By SECCS,the enrichment efficiency of bone marrow stromal cells (BMSCs) reached up to 82.4％ and the cell viability was not affected.The tibial plateau fractures were re-transplanted with 13,381.3 BMSCs on average and healed after an average of 8.9 weeks (from 6 to 15 weeks).The Lysholm knee scores at one year postoperatively averaged 93.6 points (from 84 to 100 points),yielding 10 excellent cases,4 good cases and one fair case.The calcaneal fractures were implanted back with 16,677.7 BMSCs on average and healed after an average of 9.4 weeks (from 8 to 13 weeks).The average Maryland foot score at one year after operation was 93.6 points (from 85 to 98 points),yielding 6 excellent cases and one good case.Conclusion Bioactive materials prepared by SECCS are good bone grafts for fresh fractures and bone defects.