Objective To investigate the common reasons for the misdiagnosis of rectal cancer. Methods A retrospective study was performed in 568 cases of rectal cancer in the Changhai Hospital from January 2007 to December 2008. Age at diagnosis, gender distribution, symptom, delay in diagnosis, TNM stage, and grade of differentiation were recorded and analyzed. The importance of digital examination and colonoscopy were addressed. Results Two hundred and seventy-one(47.7%) out of 568 patients were misdiagnosed for iatrogenic reasons. Rectal cancer patients who presented hematochezia were more likely to be misdiagnosed. There were 110 cases of stage Ⅲ(40.6%) and 68 cases of stage Ⅳ(12.5%) in patients who were misdiagnosed, which was significantly higher than those who were diagnosed correctly(P＜0.05). Patients under 40 years old were more likely to be misdiagnosed, and their correct diagnosis was often delayed longer and the tumors were in more advanced stage as compared to the older groups(P＜0.05). Conclusions The misdiagnosis rate of rectal cancer is high. Tumor stage of patients misdiagnosed is significantly more advanced than those who are correctly diagnosed. Digital examination and colonoscopy should be emphasized, especially for patients under the age of 40.

Objective To investigate the common reasons for the misdiagnosis of rectal cancer. Methods A retrospective study was performed in 568 cases of rectal cancer in the Changhai Hospital from January 2007 to December 2008. Age at diagnosis, gender distribution, symptom, delay in diagnosis, TNM stage, and grade of differentiation were recorded and analyzed. The importance of digital examination and colonoscopy were addressed. Results Two hundred and seventy-one(47.7%) out of 568 patients were misdiagnosed for iatrogenic reasons. Rectal cancer patients who presented hematochezia were more likely to be misdiagnosed. There were 110 cases of stage Ⅲ(40.6%) and 68 cases of stage Ⅳ(12.5%) in patients who were misdiagnosed, which was significantly higher than those who were diagnosed correctly(P＜0.05). Patients under 40 years old were more likely to be misdiagnosed, and their correct diagnosis was often delayed longer and the tumors were in more advanced stage as compared to the older groups(P＜0.05). Conclusions The misdiagnosis rate of rectal cancer is high. Tumor stage of patients misdiagnosed is significantly more advanced than those who are correctly diagnosed. Digital examination and colonoscopy should be emphasized, especially for patients under the age of 40.

BACKGROUNDTuberculum sellae meningiomas (TSMs) present a special symptom because of the adherence and compression to the optic nerve, optic artery, and the chiasm. A significant number of patients with TSMs appear visual deficits. This study aimed to investigate the surgical indications of exploring the optic canal and visual prognostic factors in the neurosurgical treatment of TSMs.

METHODSTotally 21 patients with TSM, who were operated from September 2007 to August 2011 in the Department of Neurosurgery, Tongren Hospital were enrolled in this study. Results of orbital computed tomography (CT) and magnetic resonance imaging (MRI), visual acuity, Goldmann visual field test, orbital color Doppler flow imaging (CDI) test in these patients were retrospectively analyzed.

RESULTSVisual deficit and optic canal involvement (OCI) were detected in all the 21 patients. Fourteen patients had bone proliferation within the area of the optic canal. After the operation, visual outcomes were improved in 13 patients, unchanged in 7 patients, and deteriorated in 1 patient. All the 21 patients performed orbital CDI test preoperatively, the results showed that if the peak systolic velocity (PSV) of central retinal artery (CRA) value was ≤ 8 cm/s, the visual outcome would be better.

CONCLUSIONSThe surgical indications of exploring optic canal in TSM cases included: (1) The neuroimaging evidences of OCI (CT and/or MRI); (2) PSV of CRA in orbital CDI test was ≤ 8 cm/s; (3) visual acuity was below 0.1; (4) visual field deficit. The PSV of CRA in CDI test could be a prognostic factor for visual outcomes of TSMs.

Adult ; Aged ; Female ; Humans ; Male ; Meningeal Neoplasms ; pathology ; surgery ; Meningioma ; pathology ; surgery ; Middle Aged ; Neurosurgical Procedures ; methods ; Retrospective Studies ; Sella Turcica ; pathology ; surgery ; Skull Base Neoplasms ; pathology ; surgery ; Visual Acuity

OBJECTIVETo explore the hemodynamic changes in cynomolgus monkeys with mild carotid atherosclerotic (CAS) plaques after therapy with pushing manipulation on Qiaogong acupoint (MPQ).

METHODSNine cynomolgus monkeys were equally randomized into MPQ group, mild CAS model group and blank control group. Mild CAS models were established in the monkeys in MPQ and model groups, and the monkeys in MPQ group received treatment with MPQ intervention after the modeling. The conditions of the carotid artery and the hemodynamic changes in the 3 groups were evaluated after the treatment.

RESULTSFormation of CAS plaques was detected in monkeys in both MPQ and model groups. The vascular cross?sectional area, plaque cross?sectional area and stenosis rate of the plaques in the two groups all differed significantly from those in the blank control group (P<0.05), but these parameters were similar between MPQ group and the model group (P>0.05). Compared with those in the blank control group, the hemodynamic parameters showed significant changes in MPQ and the model groups (P<0.05) but remained similar between the latter two groups (P>0.05).

CONCLUSIONCAS plaques can cause changes in hemodynamic parameters. Short?term therapy with MPQ does not affect the stability of the plaques or cause adverse effects on hemodynamics in cynomolgus monkeys with mild CAS plaques.

BACKGROUNDAmong patients with advanced multivessel coronary disease, left ventricular (LV) function is widely variable, and clinical and angiographic correlates of ventricular dysfunction remain to be defined.

METHODSAmong 73 339 patients undergoing diagnostic cardiac catheterization at a single center in China, patients with left ventriculographic assessment were identified with three-vessel coronary disease with or without left main involvement. Clinical and angiographic characteristics were examined among patients with normal or varying extent of LV dysfunction, and predictors of LV impairment (ejection fraction (EF): < 25%, 25% - 40% or > 40%) were determined.

RESULTSAmong 11 950 patients identified with three-vessel coronary disease, the sample distribution of LVEF was > 40%, n = 10 776; 25% - 40%, n = 948; < 25%, n = 226. Patients with reduced LV function (< 40%) more commonly were male and had a history of myocardial infarction (MI), diabetes or unstable angina. Hypertension was more frequent in those with LVEF ≥ 40%. In a multivariate Logistic regression analysis, prior MI (odds ratio (OR), 3.37; 95% confidence interval (CI), 2.96 - 3.84) was most predictive of LVEF < 40%, followed by male gender, diabetes, and presentation with unstable angina. For LVEF < 25%, only prior MI was identified as a significant correlate of severe LV dysfunction (OR 4.06, 95%CI 3.06 - 5.39). Following exclusion of patients with previous MI (n = 7416), male gender and diabetes were predictive of LVEF < 40%, yet presentation with unstable angina was the only factor significantly associated with LVEF < 25%.

CONCLUSIONAmong individuals identified with three-vessel coronary disease with or without left main involvement, previous MI was the most significant risk factor of LV dysfunction.

Aged ; Coronary Angiography ; Coronary Disease ; pathology ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Ventricular Dysfunction, Left ; pathology ; physiopathology

OBJECTIVETo study the clinical efficacy and safety of dexamethasone of different doses combined with bortezomib and thalidomide for treatment of primary multiple myeloma.

METHODSNinety-six patients with multiple myeloma from January 2013 to January 2014 were randomly divided into group A (high-dose dexamethasone + bortezomib + thalidomide, 32 cases), group B (low-dose dexamethasone + bortezomib + thalidomide, 32 cases) and group C (placebo + bortezomib + thalidomide, 32 cases). The clinical efficacy and safety of patients was compared among 3 groups.

RESULTSThe overall remission rate (ORR) in group A and B was significantly higher than that in group C (P<0.05), but the ORR was not significant difference between group A and group B (P>0.05). After treatment, the KPS and RNS score in 3 groups were significantly higher and lower than those before treatment, respectively; the KPS score in group A and B was significantly higher than that in group C (P<0.05), the RNS score in group A and B was significantly lower C (P<0.05). After treatment, the positive expression rates of CD38, CD56 and CD138 as well as small residual lesion (SRL) positive rate in 3 grops were significantly lower than those before treatment, but the positive expression rate of CD19 was significantly higher that before treatment; the positive expression rates of CD38, CD56 and CD138 as well as SRL positive rate in group A and B were significantly lower thant those in group C, while the positive expression rate of CD19 was significantly higher that in group C (P<0.05), but the positive expression rates of CD19, CD38, CD56 and CD138 as well as SRL positive rate were not significantly different between group A and B (P>0.05). The incidence of fatigue, rash, peripheral neuropathy, anlmia, granulocyte deficiance and so on in group B and C was significantly lower than that in group A(P<0.05), but the difference in group B and C was not significant (P>0.05).

CONCLUSIONThe therapeutic efficacy of different doses of dexamethasone combined with bortezomib and thalidomide for patients with multiple myeloma is similar, can obviously enhance remission rate, prolong the survival time, promote life quality, but the incidence of adverse reactions in low dose dexamethason rigemen is significantly reduced, and the safety is better.

Antineoplastic Combined Chemotherapy Protocols ; Bortezomib ; Dexamethasone ; Disease-Free Survival ; Humans ; Multiple Myeloma ; Thalidomide ; Treatment Outcome

OBJECTIVEThis study was aimed to detect the change of T-lymphocyte functional subsets marked by CCR7 and CD45RA in the aGVHD within 100 days after allo-HSCT and to explore its clinical significance.

METHODSThe peripheral blood of 42 patients after allo-HSCT was collected every two weeks since hematopoietic reconstitution. The expression of CD3, CD4, CD8, CCR7 and CD45RA-marked T-lymphocytes was detected by flow cytometry, the relationship between their expression and the prognosis of aGVHD was analyzed.

RESULTSThe percentage and the absolute count of CCR7(+) T lymphocyte were significantly reduced in aGVHD. The percentage of T(naïve), T(CM), T(EM) and the absolute count of T(naïve), T(EM), TTD were sharply reduced in aGVHD, moreover has changed correspondingly with outcome of aGVHD. The percentage of CD3, CD4, CD8-marked T-lymphocyte subsets did not significantly changed.

CONCLUSIONT-lymphocyte functional subsets marked by CCR7 and CD45RA are a valuable indicator to monitor early immune reconstruction for patients with the aGVHD after allo-HSCT.

Acute Disease ; Flow Cytometry ; Graft vs Host Disease ; Humans ; T-Lymphocyte Subsets

OBJECTIVETo analyze the relationship between the early treatment response and the pregnosis in children with acute lymphoblastic leukemia(ALL).

METHODSTwo hundred and Seventy-eight ALL children diagnosed and treated in Hainan general hospital from March 2013 to March 2017 were collected. All ALL children received therapy with CCLg-ALL-2008 regimen. The 3 year event-free survival (EFS) rate of ALL children in different groups was analyzed in terms of 4 indexes including sensitivity response to prednison at day 8 (D8-SRP), bone marrow remission at day 15 (D15-BMR) and at day 33 (D33-BMR), and minimal residual disease at day 33 (D33-BMR), and minimal residual disease at day 33(D33-MRD). These 4 indexes and other indexes possibly affecting the prognosis of ALL children were enrolled in Cox regression model for analysis of independent factors affecting the prognosis of ALL children.

RESULTSThe D8-SRP test showed that among 269 ALL children, 240(89.22%) cases displayed prednisone poor response (PPR); the 3-year EFS rate in predrisone good response(PGR) group was significantly higher than that in PPR group(P<0.05). The D15-BMR detection showed that among 262 ALL children, the bone marrow remission(BMR) as M1 was observed in 230 cases (87.79%), M2 in 20 cases (7.63%) and M3 in 9 cases (4.58%); the 3-year EFS rate showed as follows:M1 group >M2 group >M3 group(P<0.05). The D33-BMR detection showed that among 257 ALL children, the BMR as M1 was observed in 227 cases (88.33%), M2 in 21 cses(8.17%) and M3 in 9 caes (3.51%); the 3-year EFS rate in 3 groups showed as follows: M1 group >M2 group >M3 group(P<0.05). The D33-MRD detection showed that among 185 ALL children, MRD<10 was found in 128 cases (69.19%), MRD≥10-10 in 43 cases (23.24%), MRD ≥10 in 14 cases (7.57%); the 3-year EFS rate in 3 groups showed as follows: MRD <10 group > MRD≥ 10-10 group>MRD≥10 group. The Cox regression analysis showed that PPR in D8-SRP test, M2 and M3 in D15 and D33 BMR detection, and MRD≥10 in D33 MRD detection as well as T-ALL typing were independent risk factors affecting the prognosis of ALL children.

CONCLUSIONThe early treatment response can predict the prognosis of ALL children, which is an independent prognostic factor for ALL children.

Child ; Disease-Free Survival ; Humans ; Neoplasm, Residual ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Prednisone ; Prognosis

OBJECTIVETo investigate the effect of CXCR4 gene on the proliferation, adhesion, invasion and tumorigenicity of a human monocytic leukemic cell line SHI-1.

METHODSThe lentivirus vector silencing the expression of CXCR4 was constructed for infection of SHI-1 cells silencing expression of CXCR4 in SHI-1 cells. The expression of CXCR4, MMP-2 and MMP-9 was detected by real time PCR. The expression of CXCR4 on membrane of SHI-1 cells was detected by flow cytometry. The SHI-1 cell proliferation ability was detected by MTT. The co-culture system of the leukemia cells and bone marrow stromal cells was used to detect the adhesion and migration ability of leukemia cells. SHI-1 cells were inoculated subcutaneously in nude mice to investigate the growth ability in vivo.

RESULTSAfter SHI-1 cells were infected by lentivirus silencing expression of CXCR4, the expression of CXCR4 mRNA in SHI-1 CXCR-4i cells decreased by 76% as compared with expression of SHI-1/NC of negative control virus, the expression of CXCR4 on membrane of SHI-1/CXCR4i obviously downregulated; the expression of MMP-2 and MMP-9 in SHI-1/CXCRi cells also declined by 63% and 62% respectively; the proliferation ability of SHI-1/CXCR4i in vitro did not obviously changed, but the adhesion and trans-matrigel invasion ability significantly decreased, the SHI-1/CXCR4i cells could not form neoplasm subcutaneously in mice, but the SHI-1 and SHI-1/NC cells could form neoplasm subcutaneously in mice, and there was no significant difference in volumn of neoplasm mass.

CONCLUSIONThe silencing expression of CXCR4 can decline the adhesion and migration ability of SHI-1 cells, and can completely suppress the formation of neoplasm subcutaneously, so the CXCR4 may serve as a target for treating leukemia.

Animals ; Cell Adhesion ; Cell Line, Tumor ; Cell Proliferation ; Coculture Techniques ; Humans ; Lentivirus ; Leukemia, Monocytic, Acute ; pathology ; Matrix Metalloproteinase 2 ; metabolism ; Matrix Metalloproteinase 9 ; metabolism ; Mesenchymal Stromal Cells ; Mice ; Mice, Nude ; Neoplasm Invasiveness ; RNA Interference ; RNA, Messenger ; Receptors, CXCR4 ; genetics ; Signal Transduction

OBJECTIVETo investigate the immunophenotype of leukemia promyelocytes (LP) in bone marrow of patients with acute promyelocytic leukemia (APL) and to explore their characteristics and significance.

METHODSThe immunophenotypes of leukemia cells in 43 patients with APL were analyzed by means of 4 color immunophenotypes; the cell population in which CD45 strength localized at 10(2) and the SSC strength locatized at 10(2) was defined as R3, the cell population in which CD45 strength localized at 10(3) and the SSC strength localized at 10(2) was defined as R5, moreover the ratio of positive cells >80% was defined as strong positive expression, the ratio of positive cells between 20%-80% was difined as weak positive expression, the ratio of positive cells <20% was difined as negative by gating method of CD45/SSC.

RESULTSThere was a abnormal cell population (R3) in 79.07% cases; the immunophenotypes of R3 was cheracteried by high SSC, weaker expression of CD45, the rate of CD38, CD9 and CD13 all was 100%, moreover their bright expression (>80%) was 86.05%, 90.70% and 86.05%, respectively; the positive expression rate of CD33, CD117 and CD64 was 97.67%, 95.35% and 83.80% respectively, moreover thier bright expression was 84.04%, 69.77% and 30.23% respectively; the CD15 was weakly expressed in 39.53% cases, the CD34 and HLA-DR were weakly expression in 16.28% and 6.98% cases respectively. All the cases did not express CD116. There were 2 cell populations (R3 and R5) in 20.93% cases, the immunophenotypic features of R3 were cosistant with above mentioning, while the immunophenotypes of R5 were lower than those of R3 SSC; the fluorescence intensity of CD45 was higher, but lower than that in normal lymphycytes, the positive rate of CD9, CD13, MPO was 100%, moreover thier fluorescence intensity was high; they did not expressed CD123, CD25, CD22, CD4, CD64 and CD14. Thereby it can be concluded that the typical immunophenotypes is characterized by CD13(+) CD9(+) CD38(+) CD33(+) CD117(+) CD64(+) CD11b(-) CD34(-) HLA-DR(-) in APL. There was a special immunophenotype in the APL with basophilic granules. Conclusoin: APL has a characteristic immunophenotypic profile, whose typical immunophenotype is characterized by CD13(+) CD9(+) CD38(+) CD33(+) CD117(+) CD64(+) CD11b(-) CD34(-) HLA-DR(-). The special immunophenotype exists in the APL with basophilic granules. Flow cytometric immunophenotyping may be a useful for rapid recognition of APL and has significant for prognosis.

Antigens, CD ; metabolism ; Cell Count ; Flow Cytometry ; Granulocyte Precursor Cells ; classification ; HLA-DR Antigens ; metabolism ; Humans ; Immunophenotyping ; Leukemia, Promyelocytic, Acute ; classification ; immunology ; Leukocyte Common Antigens ; metabolism ; Prognosis