Objective To investigate the effect of pidotimod granules and Carboxymethyl starch sodium solution in treating children with recurrent respiratory tract infection curative effect and effect on immune function of children.Methods 128 cases of children with recurrent respiratory tract infection in our hospital from June 2013 to June 2016 were selected and divided into treatment group and control group with 64 cases in each group. Children in the control group were treated with Carboxymethyl starch sodium solution, the treatment group was given pidotimod granules on the basis of the control group.Two groups of children were treated for 12 weeks.The therapeutic effects of the two groups were compared, the changes of immune function before and after treatment, cough, fever, lung rales disappear time, and the incidence of adverse reactions.Results The total effective rate of the treatment group (90.62%) was higher than the control group (75.00%), the difference was statistically significant (P<0.05), the levels of IgA, IgM and IgG increased after treatment in both groups, the levels of IgA, IgM and IgG in the treatment group were higher than those in the control group, the difference was statistically significant (P<0.05), the levels of CD3 +, CD4 +and CD4 +/CD8 +increased after treatment in both groups, and the levels of CD3 +, CD4 +and CD4 +/CD8 +in the treatment group were higher than those in the control group, the difference was statistically significant (P<0.05), the treatment group in children with cough, fever, pulmonary rales disappeared faster than the control group, the difference was statistically significant (P <0.05), two groups were no obvious adverse reactions.Conclusion Pidotimod granules combined with carboxymethyl starch sodium solution in treating children with recurrent respiratory tract infections is effective, and could significantly improve the immune function of children.

Objective To explore the technological and therapeutic value of endoscope for removal of hepatobiliary necrosis after liver transplantation.Methods Data of 36 patients with suspected hepatobiliary diseases,who underwent choledochoscopy or duodenoscopy to remove necrosis after liver transplantation,were reviewed.Liver function before and after the treatment were compared.Results Hepatobiliary necrosis located in common bile duct (n =6),intrahepatic bile duct (hilar bile duct included) (n =24) and intraand extra-hepatic duct (n =6).The total success rate was 72.2％ (26/36).Full clearance of bile duct necrosis was accomplished in 16 patients,partial clearance in 15 patients and the necrosis could not be removed in 5 others.The serum bilirubin and transaminase decreased significantly,compared with those before endoscopic treatment (P ＜ 0.05).No serious complications or death related to endoscopy occurred during the treatment.After 6-84 month follow-up,in 17 survivals,3 patients underwent a second liver transplantation with good prognosis.All the survivals had a life of good quality with no placed drainage tube except for one with drainage tube for four years with unstable serum bilirubin.Nineteen patients died from biliary tract related complications or other diseases during the long-term follow-up,among which eleven patients survived beyond four years.Conclusion Endoscopy for hepatobiliary necrosis removal,a minimally invasive method,is effective and safe.

Objective To review the diagnosis and treatment of basal cell carcinoma of the scrorum. Methods Clinical data of 7 patients with basal cell carcinoma of the scrotum were analyzed retrospectively. The mean age of the patients was 66 years. The most common presenting symptom was a plaque or nodular lesion with pruritis on the scrotum. The lesions ranged from 1.5 cm to 4.5 cm in diameter. Five of the 7 patients had a history of misdiagnosis. The diagnosis was established by biopsy of the lesion in all the patients. All of the 7 patients had no distant metastasis at the time of diagnosis and were treated by wide surgical resection.Results Histopathologic examination of the specimens confirmed the negative surgical margins in all cases.The most common histological feature was lobules, columns, bands and cords of basaloid cells associated with a surrounding loose fibromucinous stroma.One patient developed left inguinal lymph node metastasis at 21 months postoperatively,and was treated by bilateral inguinal lymph node dissection.The patient was free of cancer for 36 months after that. Another patient developed lung metastasis 48 months after the first operation.He was treated by systemic chemotherapy with cyclophosph amide, epirubicin and cisplatin for 6 cycles and obtained complete remission.This patient was free of cancer for 13 months after the chemotherapy.The remaining 5 patients were all free of cancer after the operation. Conclusions Basal cell carcinoma of the scrotum is rare.Wide surgical resection alone is usually considered to be curative. Because of its potential of metastasis, long-term followup is indicated for this disease.

Objective To study the short-term clinical outcomes of unicompartmental knee arthroplasty for medial compartmental knee osteoarthritis,and to compare 2 kinds of unicompartmental prosthesis.Methods From March 2010 to June 2013,data of 43 patients underwent unicompartmental knee arthroplasty (UKA) were retrospectively analyzed.17 patients (17knees) used rotating platform prosthesis,and 26 patients (28 knees) used fixed bearing prosthesis.There were 7 males (7 knees)and 9 females (10 knees) in rotating platform group,with an average age of 64.1 years (range,54-82 years);while 10 males (10knees) and 17 females (18 knees) in fixed bearing group,with an average age of 62.2 years (range,43-79 years).All patients presented signs of narrowed medial joint space,medial tenderness and pain on weight-bearing.X-ray and MRI were used for documenting joint narrowing and cartilage defect.The pain and the knee functions were recorded both pre and post-operatively with knee society score (KSS),2 cases of simultaneous anterior cruciate ligament (ACL) reconstruction were assessed with TegnerLysholm knee scoring scale as well.Results All 43 patients were followed up for 6 month to 37 months,and the average duration was 21.1 months.There were no dislocations,joint infection,deep venous thrombosis,prosthetic loosening,etc.The KSS in rotating platform group was 56.11 ±9.51 preoperatively,and 92.23±5.46 postoperatively.While the KSS in fixed bearing group was 57.11 ±9.56,and 93.69±6.37,respectively.There were statistical differences comparing between preoperative and postoperative KSS knee scores.There was no significant difference in KSS scores between rotating platform group and fixed bearing group.Conclusion Unicompartmental knee arthroplasty is a less invasive and effective method for knee osteoarthritis in medial compartment with less complications.There was no significant difference in clinical outcomes between rotating platform and fixed bearing design in terms of patients' satisfactory rate,clinical and functional outcomes in this short-term follow-up study.

ObjectiveTo estimate the clinical efficacy and immunomodulatory effect of polysaccharidenucleic acid fraction of bacillus calmette guerin(BCG-PSN) combined with a traditional Chinese medicine in patients with vitiligo.MethodsThis study recruited 99 patients with vitiligo aged from 13 to 65(35,6 ± 5.8) years.The patients were classified into 3 groups to be treated with BCG-PSN and a traditional Chinese medicine (Baidianfeng granules) alone or in combination.BCG-PSN was intramuscularly injected at a dose of 2 ml every other day and baidianfeng granules were given orally thrice a day,for 3 months.Peripheral blood samples were obtained from the patients at the baseline and after the end of treatment and from 30 healthy controls.Flow cytometry and enzyme linked immunosorbent assay(ELISA) were performed to detect T cell subsets and expression level of Fas and Fas ligand(FasL),respectively.Data were analyzed by t test and chi-square test.Results The response rate was significantly higher in patients treated with BCG-PSN combined with Baidianfeng granules than in those with BCG-PSN alone(82.86％ vs.40.63％,P ＜ 0.01 ).Before the treatment,patients showed a lower percentage of CD3+ cells,CD3+CD4+ cells and CD3+CD8+ cells in peripheral blood(all P ＜0.01 ),weaker expression of Fas (P ＜ 0.01 ),but a higher CD4/CD8 ratio (P ＜ 0.01 ) compared with the controls.The treatment with BCG-PSN and Baidianfeng granules alone or in combinatiou all induced an increase in the percentage of CD3+ cells,CD3+CD4+ cells and CD3+CD8+ cells in peripheral blood(P ＜ 0.05) and in the expression of Fas(P ＜ 0.01),but a decrease in CD4/CD8 ratio(P ＜ 0.05).ConclusionsBCG-PSN may induce the normal apoptosis in lymphocytes via reversing the abnormality in the expression of Fas/FasL by peripheral blood lymphocytes,and the effect of BCG-PSN may be enhanced by a traditional Chinese medicine,Baidianfeng granules.

Objective To evaluate the clinical efficacy and side effects of sunitinib in the treatment of advanced renal cell carcinoma. Methods Forty-five patients with advanced renal cell carcinoma and an average age of 48.6 yrs were treated with sunitinib. Among the study group, 25 were male and 20 were female. In group one, patients received sunitinib treatment in repeated six week cycles consisting of four weeks of sunitinib 50 mg daily followed by two weeks off treatment (schedule 4/2). In group two, a single daily dose of sunitinib 37.5 mg was administrated to 20 patients without off treatment. A CT scan was used to evaluate the treatment efficacy after each cycle and the side effects were recorded accordingly. Results Clinical efficacy could be evaluated in 40 patients. Of these, two achieved complete response, eight achieved partial response, 27 were stable and the remaining eight experienced disease progression with four patients dying during the study period. The side effects of sunitinib in group one and in group two included hypertension 32% (8/25) and 10% (2/20), P=0.02; liver function impairment 32% (8/25) and 20% (4/20), P=0.011; hand-foot skin reaction 68% (17/25) and 60% (12/20), respectively. The incidence of major side effects of sunitinib were different in Chinese patients than from what had been previously reported in studies conducted in US and Europe. Generally, most of the sunitinib side effects were easy to manage. Conclusions There weredifferences between the two groups of Chinese patients treated with different sunitinib protocols. The protocol of sunitinib 37.5mg daily without off-treatment was better than the protocol of sunitinib 50mg daily (schedule 4/2) in regard to liver function impairment and hypertension.

Objective To compare two different methods to detect the differences of gene mutation rate, sensitivity, specificity and coincidence rate of epidermal growth factor receptor (EGFR) in non-small-cell lung cancer (NSCLC) so as to assess the clinical value of qRT-PCR method and its environmental-friendly technologyplatforms.One uses environmental fixative poly hydroxyl acrylic acid and green transparent liquid dewaxing Van-clear alone or in combination to replace the traditional fixative 4％ (volume fraction) neutral buffered formalin and the traditional transparent dewaxing liquid xylene in application of quantitative real-time polymerase chain reaction (qRT-PCR).The other uses traditional reagents in direct sequencing.Methods We selected 91 cases of primary NSCLC specimens resected between May 2013 and March 2016 in Zhongshan Bo`ai Hospital and Zhongshan Hospital of Traditional Chinese Medicine.Five samples were taken from the same tumor lesion.We used a random number table to randomly divide these samples into Groups A, B , C, D, and E.Group A received direct sequencing method in detection of EGFR gene mutations.Besides, during the experiment, 4％ neutral buffered formalin was used for fixing, and xylene transparent dewaxing was used to make slices for DNA extraction dewaxing.Group B received qRT-PCR method to detect EGFR gene mutations.Meanwhile, during the experiment, 4％ neutral buffered formalin was used for fixing, and xylene transparent dewaxing was used to make slices for DNA extraction dewaxing.Group C received qRT-PCR method in detection of EGFR gene mutations.At the same time, during the experiment, polyhydroxy acrylic acid was used for fixing, and xylene transparent dewaxing was used to make slices for DNA extraction dewaxing.Group D received qRT-PCR method to detect EGFR gene mutations.In the meantime, 4％ neutral buffered formalin was used for fixing, Van-clear transparent dewaxing was used to make slices for DNA extraction dewaxing.Group E received qRT-PCR method in detection of EGFR gene mutations.In addition, during the experiment, polyhydroxy acrylic acid was used for fixing, and Van-clear transparent dewaxing was used to make slices for DNA extraction dewaxing.In addition, during the experiment, polyhydroxy acrylic acid was used for fixing, and Van-clear transparent dewaxing was used to make slices for DNA extraction dewaxing.The mutations of Exons 18, 19, 20, and 21 in EGFR genes were respectively determined in the five groups of NSCLC.Results ① Groups B, C, D, E and A did not significantly differ in the percentage of people with mutations or target site mutation rates of EGFR genes in NSCLC (P> 0.05).② The detection results of EGFR target site mutation in Groups B, C, D, E and A had good sensitivity, strong specificity, and high compliance rate.Conclusion The green transparent liquid dewaxing Van-clear alone or in combination to replace the traditional fixative 4％ neutral buffered formalin and the traditional transparent dewaxing liquid xylene in the application of qRT-PCR so as to detect EGFR gene mutations in NSCLC has good consistent results compared with the method that uses traditional reagents in direct sequencing.It has the significance and value in clinical application.

Objective To investigate the efficacy of Sunitinib in treating metastatic non-clear cell renal cell carcinoma (RCC).Methods Twenty-two metastatic non-clear cell subtype renal cell carcinoma patients with a median age of 46 years (29 -76 years) were treated with Sunitinib.Fourteen cases were found have metastasis post radical nephrectomy,and the remaining eight cases with metastasis received cytoreductive surgery.Pathological diagnosis showed 12 papillary RCCs,one chromophobe RCC,three collecting duct RCCs,and six unclassified RCCs.The metastatic lesions were located in the lung,lymph nodes,adrenal gland,bone,liver,and thyroid gland.The patients were given the treatment of sunitinib 50 mg qd four weeks on and two weeks off.The median time of treatment was 11 months (4.5 - 24 months).Results The objective control rate was 73％.Three papillary RCC and one chromophobe RCC reached partial remission (PR) and 12 cases maintained stable disease (SD) for more than 12 weeks.And the remaining six cases progressed (PD).Conclusions Sunitinib has definitive efficacy in metastatic papillary RCC,chromophobe RCC,collecting duct RCC and unclassified RCC.Metastatic lesions in lungs and lymph nodes might be more sensitive to Sunitinib.

Objective To analyze the predictive factors of anti-androgen withdrawal in the treatment of androgen independent prostate cancer. Methods 347 cases of advanced metastatic prostate cancer in our prostate cancer database were filtered. All the cases were treated with maximal androgen blockade and had full pathological and clinical information. 237 cases developed to the androgen independent stage during the maximal androgen blockade treatment. Among them, 90 cases were treated with anti-androgen withdrawal. This 90 cases were followed up and the last follow-up date was 30 September 2009. The Logistic regression of univariate and multivariate analysis were used to find the predictive factors for the effectiveness of anti-androgen withdrawal, which including baseline PSA, Gleason score, clinical stage, way of castration, kind of anti-androgen, PSA nadir during maximal androgen blockade, time to PSA nadir, PSAV at the time of AIPC, PSADT at the time of AIPC, the effective duration of maximal androgen blockade, age at the time of AIPC and PSA at the initiation of anti-androgen withdrawal. Results Of the 90 cases treated with anti-androgen withdrawal, 3 cases were excluded for analysis because of the incomplete information. Among the 87 cases, 17 cases were effective with the anti-androgen withdrawal treatment while the other 70 cases were ineffective. At the last follow-up, 3 cases were still effective. The median effective duration of anti-androgen withdrawal was 4 months. The univariate analysis indicated that PSAV at the time of AIPC (P=0.033), PSADT at the time of AIPC (P=0.009) and PSA at the initiation of anti-androgen withdrawal (P=0.002)were predictive factors. The multivariate analysis indicated that PSAV (P=0.042) and PSADT at the time of AIPC (P= 0.036) were independent predictive factors for the effectiveness of anti-androgen withdrawal. Conclusions Among the androgen independent advanced metastatic prostate cancer patient, there were about 19. 5% cases effective with the anti-androgen withdrawal treatment and the median effective duration was 4 months. PSAV and PSADT at the time of AIPC were independent predictive factors for the effectiveness of anti-androgen withdrawal.

Objective To find the predictive factors that related to the effect of hormonal therapy and the survival of advanced metastatic prostate cancer. Methods Three hundred and Sixty-four cases of metastatic prostate cancer were treated with hormonal therapy in Cancer Hospital Fudan University in Shanghai from December 1996 to March 2008. The patients were followed up to the 31 March 2008 and the median follow-up time was 24 months. Two hundred and fifty cases have progressed into the stage of hormonal independent. The statistic software used in this study was SPSS 15. 0. Cumulative survival was analyzed by Kaplan-Meier method. Cox regression was used for univa-riate and multivariate analysis. Log-rank method was used for the significance test. The statistical difference was accepted when the P-value was lower than 0. 05. Results The effective rate of hormonal therapy for advanced metastatic prostate cancer was 98%. The median time of progression free survival of hormonal therapy was 20 months, and the one-year, two-year, three-year progression free survival rate was 69%, 39%, 27%, respectively. The survival analysis indicated that baseline PSA level more than 20ng/ml, with visceral organ metastasis, the PSA nadir more than Ing/ml during hormonal therapy, the time from the start of hormonal therapy to the PSA nadir less than 5 months were poor prognostic factors of progression free survival. Conclusions The baseline PSA level, clinicalstage, the PSA nadir during hormonal therapy and the time form the start of hormonal therapy to the PSA nadir could be the factors that predict the progression free survival time during hormonal therapy.