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 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 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 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 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.

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 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.

Purpose To investigate the clinicopathlogical characteristics, diagnosis and differential diagnosis of ovarian small cell car-cinoma hypercalcemic type ( OSCCHT) associated with acute renal dysfunction. Methods A case of OSCCHT associated with acute renal dysfunction was reported. The clinical and pathologic data, treatment and pathological examinations were analyzed and the related literatures were reviewed. Results A 29-year-olds women was presented to hospital with inappetence and significant weight loss for 2 months. The laboratory examination showed abnormal renal function, and pelvic cavity mass, possibly coming from adnexa of the uterus was seen by radiography. Serum levels showed significantly increased serum calcium with acute renal dysfunction. An emergency opera-tion was performed just after renal function partially recovered by 2 times hemodialysis. During surgery, right ovary tumor with a size of 12 cm × 10 cm × 10 cm was inspected. Microscopically, the tumor cells were arranged in a diffuse solid pattern, mutiple nodules were separated by fibrous tissue. some small folliculars and pseudoglandular cavities with acidophilia secretion within nodules could been ob-served. Tumor cells were medium to large with eosinophilic cytoplasm, round or oval vesicular nucleus, increased karyoplasmic ratio and pathologic mitosis. Immunohistochemistry revealed that the tumor cells expressed EMA, CKpan, C-erbB-2 ( +) , CA125 ( focal+) and Ki-67 proliferation index was about 60%, while ER, PR, Syn, CgA, PTH, Inhibin, CD99, AFP, PLAP, CD30 and CD20 were not expressed. Conclusion Ovarian small cell carcinoma hypercalcemic type with acute renal dysfunction is a very rare with a rapidly progressive and highly malignant tumor. The final diagnosis mainly lies on clinical information ( hypercalcaemia) , morphology and immunohistochemistry, combined with electron microscopy and molecular biological detection when necessary.

Purpose To investigate the expression and significance of HLA-G in ovarian serous carcinoma ( OSC) . Methods HLA-G antigen was immunohistochemically labeled on paraffin-embedded sections of 108 OSCs. The relationship between HLA-G expression and the clinicopathologic parameters was studied. Results The positive expression of HLA-G was observed in 58. 33% (63/108) of OSC tissues. Positive expression of HLA-G was significantly related with lymph node metastasis, recurrence, occurrence site, FIGO stage and MDACC grading system (P<0. 05). In survival analysis, the expression of HLA-G was significantly relevant to prognosis (P=0. 015). Multivariate Cox analysis showed the expression of HLA-G was an important prognosis factor of OSC (P=0. 01). Con-clusion The positive expression of HLA-G could predict high grade and advanced stage of OSC as well as poor prognosis. Also it could distinguish high-grade OSC from low-grade OSC.