Objective To investigate the patterns of intrathoracic lymph node metastasis in nonsmall cell lung cancer (NSCLC) and to provide a theoretical basis for the delineation of radiotherapy target volume.Methods A retrospective analysis was performed on the clinical data of 314 NSCLC patients after operation.Our focus was to investigate the distribution characteristics and metastatic extent of intrathoracic lymph nodes and their relationship with tumor size,pathological type,and primary site.Comparisons between groups were made by one-way analysis of variance.Results The frequencies of metastases to lymph nodes at stations 4,5,7,10,and 11 were all above 12％,while those at stations 1,2,3,6,8,and 9 were all below 12％.The lymph node metastasis rate was similar on the primary tumor site (P =0.102).The patients with T3 and T4 NSCLC had a significantly higher frequency of N2 lymph node metastasis than those with T1 and T2 NSCLC (17.0％ vs.11.6％,P =0.002) ;the patients with adenocarcinoma had a significantly higher frequency of N2 lymph node metastasis than those with squamous cell carcinoma (34.5 ％ vs.23.2％,P =0.008).Conclusions For patients with T3 and T4 NSCLC of adenocarcinoma subtype,we should highlight the lymph nodes at stations 4,5,7,10,and 11 when delineating the radiotherapy target volume after operation.

Objective To evaluate the efficacy of imipenem-cilastin sodium as subsequent therapy on peritoneal dialysis(PD)-related peritonitis.Methods From January 2007 to December 2010,44 PD-related peritonitis patients in our hospital were enrolled in the study.These patients presented cloudy fluid after 3 days initial treatment,and bacterial culture was Gram-negative bacteria or negative.Thirteen peritonitis episodes were treated with ceftazidime,while 36 episodes with imipenem-cilastin sodium.Efficacy,outcome,pathogen and drug-resistance were analyzed retrospectively.Results The effective rates 2 d later of ceftazidime and imipenem-cilastin sodium were 23.1％ and 72.2％ respectively with significant difference (P＜0.05).Gram-negative bacteria of ceftazidime and imipenem-cilastin sodium groups were 69.4％ and 65.2％ respectively without significant difference (P＞0.05).The cure rates 3 weeks later of ceftazidime and imipenemcilastin sodium groups were 23.1％ and 72.2％ respectively with significant difference (P＜0.05).Conclusion As subsequent therapy for PD-related peritonitis,imipenem-cilastin sodium can improve the cure rate.

Objective To investigate the feasibility of reducing the radiation dose in adult pelvic CT using automatic tube current modulation (ATCM) and adaptive statistical iterative reconstruction (ASIR).Methods Totally 45 patients who underwent routine and low-dose pelvic CT examination were enrolled in our study.Three groups of images were acquired:group A (routine scan with FBP reconstruction) ;group B1 (low-dose with ASIR0) and group B2 (low-dose with ASIR50％).The scores of image quality was abtained by two radiologists.Results The CTDIvol,DLP and E of group B were significantly reduced respectively(t =12.30,12.10,12.15,P ＜ 0.05) compared with group A.Group B1 had higher noise(t =9.14,8.95,P ＜ 0.05)and lower score,SNR and CNR(t =8.72,10.62,11.83 and 8.40,9.55,11.42,P ＜ 0.05) than the others.And there was no difference in image quality between group A and group B2.Conclusions Using automatic tube current modulation and adaptive statistical iterative reconstruction could significantly reduce the noise but keep the image quality in adult pelvic CT examination.

Objective To study the value of three dimensional dynamic contrast and digital subtraction MRI in diagnosing breast cancer.Methods 52 patients with breast diseases were enrolled in this study,including 27 malignant lesions and 36 benign lesions verified by histopathology.the morphologic features and enhancement kinetics of breast lesion on MRI were observed.The morphologic manifestation,early-phase enhancement rate,peak enhancement rate,peak time and time-signal intensity curve were evaluated.Results The benign lesions were mainly characterized by regular mass,well-defined border,internal septation,homogeneous enhancement,and the malignant lesions by irregular shape,speculated margin,rim enhancement,inhomogeneous enhancement.The early-phase enhancement rate,peak time and curve type were significantly different between breast benign and malignant lesions(P

Objective To investigate the efficacy of regional lymphadenectomy for patients with T2 gallbladder cancer. Methods From January 1990 to December 2009, 48 patients with T2 gallbladder cancer received regional lymphadenectomy following radical surgery at the Xinhua Hospital of Shanghai Jiaotong University, and their clinical data were retrospectively analyzed. Patients were divided into two groups according to the range of lymphadenectomy. Standard group (23 patients): lymph nodes in the regions of bile duct, common bile duct and hepatoduodenal ligament were dissected; extended group (25 patients): lymph nodes in the regions of hepatoduodenal ligament, head of pancreas, duodenum, portal vein, common hepatic artery and celiac axis were dissected).The condition of patients in the two groups were compared after the treatment. The morbidity and survival rate were analyzed by using Fisher exact test and Kaplan-Meier method, respectively, and the survival rates between the two groups were compared by using Log-rank test. Results No perioperative death was found in the two groups. The morbidities was 17% (4/23) in the standard group and 24% (6/25) in the extended group, with no significant difference between the two groups ( P ＞ 0.05 ). The 5-year cumulative survival rate and median survival time were 40% and 29.8 months in the standard group, and 66% and 53.2 months in the extended group, with significant differences between the two groups ( x2 = 4. 687, P ＜ 0.05 ). Conclusion Extended regional lymphadenectomy should be performed on patients with T2 gallbladder cancer if the primary lesions can be dissected radically.

Objective To explore the correlation of the distance between anastomosis and dentate line in patients with severe circumferential prolapsed haemorrhoids treated by stapled haemorrhoidectomy with the patients' postoperative clinical manufestival score, and assess its value in the choice of anastomosis site in stapled haemorrhoidectomy. Methods One hundred and six patients with severe circumferential prolapsed haemorrhoids was treated by stapled haemorrhoidectomy. The distance between anastomosis and dentate line was documented during the operation, effect of the treatment and complications were also documented postoperatively. All above-mentioned data were analysed statisticaly by one-way ANOVA and ridit test.Results Four groups were established in 106 patients according to the distance between anastomosis and dentate line. Patients with distance less than 1.0cm were defined as group A, between 1.0 cm and 1.5 cm as group B, between 1.5 cm and 2.0 cm as group C, more than 2.0 cm as group D. Concerning the postoperative incontinence score, satisfaction index and complications such as haemorrhage,ederma of anal everage,residal skin-tags, there was no significant difference between all groups. But there was significant difference between four groups in score of pain. Conclusions Patients with severe circumferential prolapsed haemorrhoids treated by Stapled haemorrhoidectomy tend to have good clinical outcome. The appropriate distance between anastomosis and dentate line should be chosed by the status of prolapsed haemorrhoids.

Objective To discuss the value of different staging systems for gallbladder cancer.Methods The clinical data of 132 patients with gallbladder cancer who had been admitted to Xinhua Hospital from October 1992 to December 2006 were retrospectively analyzed.The clinical stage and postoperative survival of patients in each stage were analyzed by Nevin staging system,staging systems of AJCC 5th and 6th edition.The survivals of patients were analyzed by Kaplan-Meier method and the comparison between groups was analyzed by Log-rank test.Results According to the Nevin staging system,the accumulative survivals of patients with stages Ⅰ,Ⅱ,Ⅲ,Ⅳ or Ⅴ were 80.3%,75.6%,43.2%,16.2% and 6.5%,respectively.The accumulative survivals of patients with stages Ⅰ,Ⅱ or Ⅲ were significantly higherthan those with stages Ⅳ or Ⅴ(χ~2=7.239,6.152,3.992,12.354,13.171,15.084,P＜0.05).According to the AJCC 5th edition staging system,the accumulative survivals of patients with stagesⅠ,Ⅱ,Ⅲ or Ⅳ were 71.4%,40.9%,10.2% and 5.8%,respectively.The accumulative survivals of patients with stages Ⅰ or Ⅱ were significantly higher than those with stages Ⅲ or Ⅳ (χ~2=18.286,23.729,5.541,13.607,P＜0.05),and the survivals of patients with stage Ⅲ were significantly higher than those with stage Ⅳ (χ~2=7.758,P＜0.05).According to the AJCC 6th edition staging system,the accumulative survivals of patients with stages Ⅰ,Ⅱ,Ⅲ or Ⅳ were 51.1%,11.7%,8.2% and 6.5%,respectively.Patients with stages Ⅰ or Ⅱ had a comparatively low survival,while the survivals of patients with stage Ⅰ were significantly higher than those with stages Ⅱ,Ⅲ or Ⅳ(χ~2=15.300,21.956,31.397,P＜0.05).Patients with stage Ⅱ had a higher survival than those with stage Ⅳ(χ~2=8.789,P＜0.05).There was no significant difference in survival between patients with stage Ⅱ and Ⅲ,and between patients with stage Ⅲ and Ⅳ.Conclusions The AJCC 5th edition staging system is still the perfect staging system of gallbladder cancer.The Nevin staging system is not integrating enough,while AJCC 6th edition staging system is too strict.

BACKGROUND:Hot-melt adhesive is safe and environmental friendly adhesive due to free of solvent, which is particularly suitable for medical applications. OBJECTIVE:To describe the types and characteristics of currently used hot-melt adhesives and to prospect the technical research and development of hot-melt adhesive for polyolefin tubes or catheters as wel as to point out the corresponding key points to the hot-melt adhesion. METHODS:Literature search was carried out in SCI, Elsevier, and CNKI with the key words of“hot melt adhesive, medical application”in English and Chinese, respectively, for the initial retrieval of relevant articles or patents published January 1995 to December 2015. RESULTS AND CONCLUSION:To date, the medical hot-melt adhesives reported in the literature could be grouped as amorphous polyolefin, thermoplastic elastomer, acrylic and polyurethane types. The heat resistance of the most of the hot-melt adhesives does not meet the requirement for steam sterilizing process. In the present review, a strategy is proposed to develop a novel hot-melt adhesive which is good for binding polyolefin parts and can undergo the sterilization process. Given this, it is essential to choose a kind of polypropylene random copolymer with a suitable melting point as a substrate. With the aid of an adjuvant agent, therefore, we can develop a novel hot-melt adhesive that exhibits a lower melting point than the polyolefin tube, withstands steam sterilization temperature to ensure that the tube is not deformed during melt adhesion and is not become invalid during sterilization.

Purpose To investigate the occurrence of echinoderm microtubule-associated protein-like 4 (EML4) gene and the anaplas-tic lymphoma kinase (ALK) gene rearrangements in lung squamous cell carcinomas (SCC), and to provide with a test for targeted therapy of SCC. Methods In this study, we analyzed ALK protein expression with a specific rabbit monoclonal Ig antibody ( D5F3 clone) in 219 cases of lung SCC. The positive cases were confirmed with ALK fluorescence in situ hybridization ( FISH) . Results 4 out of 219 (1. 8%) cases of lung SCC were ALK positive detected by immunohistochemistry (IHC) staining, which were confirmed by ALK FISH. Conclusions There are SCC having EML4-ALK gene rearrangement. The response of SCC patients with ALK expression to targeted therapy of Crizotinib should be explored. Strong positive expression of ALK protein can be interpreted as EML4-ALK gene rearrangement.

Purpose To investigate the clinicopathological and immunohistochemical features of primary small cell carcinoma of the cervix ( SCCC) and its prognosis. Methods 18 cases of primary cervical small cell carcinoma were evaluated by histopathology, in si-tu hybridization and immunohistochemistry and relevant literatures were reviewed. Results The age of the patients ranged from 30 to 69 years ( mean age, 40 years) . Major clinical manifestation was irregular colporrhagia. Colposcopy often revealed a cervical mass or cervical erosion. Microscopically, the tumor cells were small and round and arranged in a solid distribution. The cell had little cyto-plasm and increased karyoplasmic ratio with deeply stained granular chromatin and increased pathological mitosis. Immunohistochemi-cally, the tumor cells were often positive for CKpan, variable positive for Syn, NES, CgA, CD56 and p16. HPV 16/18 were positive in 4 cases. Conclusion SCCC is a neuroendocrine tumor of high malignancy and poor prognosis with a possible pathogenesis of HPV 16/18 infection. CKpan, Syn, CgA, NSE and CD56 are useful markers for the diagnosis of SCCC.