In recent years,hepatocellular carcinoma (HCC)has become the second leading cause of cancer-related death worldwide.Due to the insidious onset of this disease,only 20%-30%of the patients with HCC have the opportunity for surgical resection or liver transplan-tation.At present,interventional therapy has become the first choice for patients with intermediate-stage HCC and some patients with late-stage HCC,and more and more scholars have realized the importance and necessity of comprehensive interventional therapy for HCC.The comprehensive interventional therapy of transcatheter arterial chemoembolization (TACE)in combination with various methods (TACE com-bined with local treatment,TACE sequential surgery,or TACE combined with systemic treatment)provides many therapeutic approaches and achieves good therapeutic effects.However,the indications,timing,and recurrence and metastasis after treatment for such combination ther-apies await further investigation.

Objective To evaluate the safety and efficacy of transurethral resection of the prostate(TURP)for high-risk benign prostatic hyperplasia(BPH).Methods Form January 2001 to July 2007,we performed TURP on 303 patients with high-risk BPH.The patients aged form 65 to 89 years with a mean of 76.3.Among them,151 were complicated with cardiovascular diseases,67 had pulmonary diseases,37 had diabetes mellitus,26 had brain disease,16 showed renal inadequacy,and 6 showed abnormal liver function.Results The procedure was completed successfully in all of the 303 cases without death,dysuria,or severe complications.Compared to the examinations carried out before the procedure,the IPSS and QOL scores,and RU decreased significantly,while the Qmax increased 3 months after the prosedure[IPSS:(19.6?7.9)points vs.(6.4?3.3)points,t=26.838,P=0.000;QOL:(4.7?1.5)points vs.(2.3?1.1)points,t=22.459,P=0.000;Qmax:(4.1?2.6)ml/s vs.(13.9?7.1)ml/s,t=-22.561,P=0.000;and RU:(139.0?32.5)ml vs(13.5?8.6)ml,t=55.143,P=0.000].ConclusionsTURP is a safet and effective procedure for high-risk BPH with a low rate of postoperative complications.Proper peri-operative individual management and operation skills are important for the success of the procedure.

Objective To evaluate the methods and efficacy of retroperitoneal laparoscopic nephron-sparing surgery for the treatment of renal tumor. Methods A total of 6 patients with renal tumors underwent retroperitoueal laparoscopie nephron-sparing surgery during warm ischacmia. Among the 6 eases, 2 had malignant tumor with the diameter of 2.5 cm and 2.2 cm,and 4 had renal angiomyolipoma with the diameter from 2.5 cm to 3.5 cm.The renal yes,Is were secured by a self-made equipment. Tumors were excised with a cold Endo-shear. Parenehymal edges were approximated using a absorbable hemostatic gauze. Results All procedures were successfully completed without open conversion. Mean surgical time was 150 minutes (range 120-210 minutes). Mean ischaemia time was 22 minutes (range 18-33 minutes) and the mean blood loss was 170 ml (range 150-200 ml). Surgical margins were negative in all patients.During a follow-up for 6-12 months, no patient had local or port site recurrence. Conclusions Betroperitoneal laparoscopic nephron-sparing surgery for renal tumor by using serf-made equipment is safe and effective. This procedure has the advantages of minimal invasion, less blood loss, good vision, and rapid convalescence and so on.

Postoperative adjuvant therapy for primary invasive breast cancer patients with synchronous ax-illary metastases is mainly based on the characteristics of biomarker of the primary tumor. Recently, some studies have showed the discordance and clinical significance of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status between primary breast cancer and synchronous axillary lymph node metastases. As local metastasis, the synchronous axillary metastases may represent the potentially metastatic breast cancer cells much better than the primary tumor. Hence, determination of biomarkers status should be performed in synchronous axillary metastasis, together with primary tumor, to guide therapy management and evaluate the prognosis of primary invasive breast cancer patients with synchronous axillary metastases.

Objective This study aimed to investigate the incidence and the cause for duodenalbiliary reflux and reflux cholangitis after metallic stent placement in distal common bile duct Methods After percutaneous transhepatic bile duct puncture and biliary outside drainage was performed, 16 cases with malignant distal biliary stricture underwent metallic stent placement in distal common bile duct Before stent placement, the routine laboratory studies including leukocyte, neutrophil percentage and the levels of total bilirubin and direct bilirubin in blood were performed for all patients. Two to five days [ an average of (3.3 ±0. 9) days ] after stent implantation, the above indexes were tested again, and 1 ml of water containing 185 MBq of 99Tcm-DTPA was given orally before extubation, then 99Tcm radioactivity in the bile was detected 2 hours later. For the measurement data obtained from the experiment, t test or Wilcoxon signed rank test was adopted to compare them, and P ＜ 0. 05 was considered to be statistically different Results In 14 cases, radioactivity was successfully detected in the bile 2-5 days after stent implantation. Twelve of them was detected to have radioactivity in the bile 2 hours before extubation with duodenal-biliary reflux. The technetium count in the bile accounted for 1.82% of the total intake dose. There was no radioactivity in the bile in 2 cases. In 14 patients, there were no symptoms of cholangitis such as high fever, chills, increased jaundice, and so on after stent implantation. The mean of white blood cell count was (7.59 t2. 62) × 109/L, and the median of neutrophil percentage was 0. 74. Compared with those before stent implantation, the difference did not reach statistical significance ( t = 0. 423, Z = 1. 036, P ＞ 0. 05 ).After stent implantation, the median of total bilirubin and direct bilirubin were significantly lower, which were 92. 2 and 74. 3 μmol/L. Compared with those before stenting,the difference was statistically significant (Z= -3. 170, -3. 170, P ＜0.05). Conclusions There is a high incidence of duodenal-biliary reflux after stent implantation in distal common bile duct in the early stage. However, there is no simultaneous cholangitis caused by duodenal-biliary reflux.

Objective To explore the method and value of percutanously interventional therapeusis for treatment of obstructive jaundice caused by hepatocellular carcinoma accompanied with bile duct thrombosis.Methods Sixteen cases with bile duct thrombosis proved by pathology and imaging examinations were retrospectively analyzed.According to the clinical symptoms, all the patients received percutaneous transhepatic biliary drainage (PTBD) including permanent external drainage, temporary internal drainage and implantation of covered stents.Serum total bilirubin (TBIL) after the interventional therapeusis were measured and compared with that before the treatments by t test to evaluate the efficacy of these treatments.The relief of clinical symptoms was also reviewed to evaluate the efficacy of these treatments.The patients were followed up within 2 years.Results The PTBD was successfully performed in 16 cases.Permanent external drainage, temporary internal drainage and implantation of covered stents were performed in 2 patients, 7 patients and 7 patients respectively.TBIL after the interventional therapy decreased significantly (t=7.366, P<0.01) to (161.2±80.5) μmol/L averagely from (261.9±77.2)μmol/L before the treatments.All the patients died before the end of followed-up.The average survival time was 204 days (30 to 391 d)and the median survival time was 200 days.Bleeding and infection were the main complications, which could be controlled successfully by routine treatments.Conclusion With high achievement ratio and good efficacy, percutanously interventional therapeusis are good choices for the treatments of obstructive jaundice due to bile duct thrombosis.

Objective To analyze the composition of urinary stones in Taizhou of Zhejiang province.Methods Clinical data of 1 022 patients with urinary stones admitted in Taizhou Hospital of Zhejiang province were retrospectively reviewed.The samples of urinary stones were collected and analyzed by infrared spectrophotometry.Results There were 722 males and 300 females with a male to female ratio of 2.4:1 and with a mean age of (53.4±13.6) years (14-88 years).Among 1 022 patients,the stones with single composition were found in 299 cases (29.3%);the most common single-component was anhydrous uric acid (15.9%),followed by calcium oxalate monohydrate (12.0%).The mixed stones were found in 723 cases (70.7%);the most common mixture was calcium oxalate monohydrate,calcium oxalate dehydrate and carbonate apatite mixture (316 cases,30.9%).Calcium oxalate (58.9%,602/1 022) was the most common major component and frequently seen in upper urinary tract stones,followed by uric acid (21.8%,223/1 022).Uric acid calculi was predominant component in male patients(χ2=30.97,P=0.00),while the rate of infection stones was higher in women (χ2=60.69,P=0.00).The mean age of patients with uric acid stones was 59.4 years,which was older than that with other components (t=7.62,P=0.00).The uric acid stones were more common in upper urinary tract stones(χ2=42.97,P=0.00).The mean age of patients with infection stones was 49 years,which was younger than that with other types of stones(t=4.87,P=0.00).Conclusion Mixed stones with calcium oxalate monohydrate,calcium oxalate dehydrate and carbonate apatite are the predominant urinary stones in Taizhou of Zhejiang province,while the most common single-component stones are anhydrous uric acid stones.Location,age and sex are associated with the types of urinary stones.

Objective To investigate the function of serum Interleukin-6 (IL-6) in the formation of cerebral edema after acute cerebral infarction through dynamic changes of serum IL-6 and MRI indicators.Methods One hundred and twenty-eight patients with cerebral edema after acute cerebral infarction and 30 healthy were selected as our subjects.The serum IL-6 were measured in at 1,5 and 14 d after acute cerebral infarction.MRI scans were performed in the corresponding time,and then processed synthesis of apparent diffusion coefficients (ADC) graph.Cerebral infarction volume,signal intensity ratio (SIR) of each sequence and relative apparent diffusion coefficient(rADC) were measured and calculated.Results The serum IL-6 in patients with acute cerebral infarction at 1 d after cerebral infarction was significantly higher than that in normal control group and reached the peak level at 5th D after cerebral infarction,significantly decreased at 14th d.The serum IL-6 of each time point were significantly higher than that of normal control group(P =0.000).There were liner positive correlation between the serum IL-6 and the volume of cerebral infarction and SIR of T2 weighted image and fluid attenuation inversion recovery (r =0.750,0.621,0.691 ; P =0.000).The serum of IL-6 and SIR of T1 weighted image was showed negative correlation (r =-0.404,P =0.000).The serum of IL-6 and SIR of diffusion-weighted imaging sequence at 1,5 d after cerebral infarction showed a positive correlation (r =0.678,P =0.000).There was liner negative correlation between the serum IL-6 and rADC at 1 d after cerebral infarction (r =-0.826,P =0.000).Conclusion The rise of serum IL-6 may promote the formation and development of ischemic cerebral edema.

Objective To evaluate the response of the lung tumor xenografts in nude mice to antiangiogenic treatment from perspectives of anatomic,vessel function,cellular and molecular level using the multimodality imaging techniques including optical imaging,dynamic contrast enhanced MRI(DCE-MRI)and diffusion weighted imaging(DWI).Methods The green fluorescent protein(GFP)was transplanted labeled using GFP-expressing NCI-H460 cells.After the transfection of GFP,NCI-H460 cells were implanted subcutaneously into nude mice.Ten days after implantion,12 nude mice whose tumor xenografts grew to 0.5-1.0 cm in the maximum diameter were randomly divided into 2 groups,and injected with phosphate-buffered saline and recombinant human endostatin respectively.Then the nude mice in the two groups underwent optical imaging,DCE-MRI and DWI.The volumes,photon counts,the quantitative MR vessel functional parameters including volume transfer constant(Ktrans),rate constant(Kep),volume of extravascular extracellular space(Ve)and maximum area under the enhancement curve(iAUC),and apparent diffusion coefficient(ADC)values of the tumors were recorded.Then tumors were collected and observed using the transmission electron microscopy and pathology examination,including HE staining,microvessel density(MVD)and the expressions of vascular endothelial cell growth factor(VEGF).The Kep and VEGF expressions in experimental group and control group were compared with x2 text,and other values were compared with t test.The Pearson and Spearman test were used for analyzing the correlation of values in the two groups.Results Seven days after inoculation,the fluorescence signals were detected and grew with the growth of the tumors.On the 7 day after starting therapy,the photon counts of experimental group and control group were(2.51 ± 2.43)× 1010(photon/sec)and(5.77 ± 3.25)× 1010(photon/sec),respectively with no significant differences(t =1.964,P ＞0.05).Two sample t test showed that the tumor volumes in experimental group were smaller than those in control group[(365 ± 56)vs(987 ± 265)mm3,t =0.001,P ＜ 0.01].There was a positive correlation(r =0.673,P ＜ 0.05)between the photon counts and the volumes of the tumors.The mean Ktrans,Kep,Ve and iAUC of experimental group were:(0.055 ±0.012)min-1,0.335(0.184—0.894)min-1,0.297 ± 0.041 and 7.334 ± 3.930,and those for control group were:(0.117 ± 0.027)rin-1,0.417(0.324-1.736)min-1,0.326:±:0.062 and 13.280 ± 4.245.There were significant differences of Krans and iAUC(t =5.155,2.518,P ＜ 0.05)between experimental group and control group.And there was a positive correlation(r =0.715,P ＜ 0.0 1)between the values of iAUC and MVD,but not the expressions of VEGF(r =0.484,P ＞ 0.05).The values of ADC in experimental group were higher than that in control group[(791 ± 38)× 10-6 vs(737 ± 43)×10-6 mm2/s],and there were significant differences(t =-2.299,P ＜ 0.05).Two sample t test showed that the MVD in experimental group were lower than that in control group[(11.9 ± 4.8)vs(19.2 ±4.3)item/hpf,t =2.774,P ＜ 0.05].The VEGF expressions in experimental group were lower than that in control group(x2 =4.000,P ＞ 0.05).It was observed that some cells in experimental group had degenerated and apoptotic signs by the electron microscopy.Conclusions Evaluating the response of lung tumor xenografts to antiangiogenic treatment at anatomical,vessel functional,cellular and molecular level using the multimedality imagings is applicable.And it will be in favour of evaluating the therapeutic effect promptly.

Objective:To determine the status of glucose intolerance in breast cancer patients without DM history after combined treatment with surgery and/or chemotherapy through an oral glucose tolerance test (OGTT). Methods:All 121 breast cancer patients more than 3 months after combined treatments with surgery and/or chemotherapy and without the diagnosis of diabetes underwent OGTT and fasting. Then, 2 h glucose levels were measured to identify glucose tolerance and diabetes. Meanwhile, six patients with a history of diagnosed diabetes did not undergo OGTT. Results:The median ages of all breast cancer patients and the mean duration after combined treatments with surgery and/or chemotherapy were 50.4 years and 19 months, respectively. Among the 121 breast cancer pa-tients without the history of diabetes, the incidences of diabetes, prediabetes, and normal glucose intolerance were 19.8%(24 cases), 45.5%(55 cases) and 34.7%(42 cases), respectively. Among all breast cancer patients, the incidences of previously diagnosed diabetes, undiagnosed diabetes, and prediabetes were 4.72%, 18.9%, and 43.3%, respectively. The ratio of previously undiagnosed diabetes was about 80%. About 80.0% of undiagnosed diabetes and 74.5% of prediabetes met the criteria for elevated 2 h plasma glucose levels through OGTT instead of elevated fasting glucose levels. Conclusion: Breast cancer patients during follow-up after combined treat-ments with surgery and/or chemotherapy highly suffer from glucose intolerance, with high incidences of undiagnosed diabetes and pre-diabetes. OGTT should be made for breast cancer patients after combined treatments for early diagnosis, prevention, and treatment of di-abetes.