Objective To assess the necessary excision of normal parenchyma tissue in nephron sparing surgery for renal cell carcinoma. Methods 102 specimens from radical nephrectomy for RCC were step sectioned at 3 mm intervals and examined.The tumor and field 20 mm beyond pseudocapsule were continuously sectioned and examined for completeness of pseudocapsule,the presence of micro multifocal carcinoma and for vascular and parenchyma invasion beyond pseudocapsule. Results 49 (48.0%) of the 102 specimens were void of intact pseudocapsule.The presence of extra pseudocapsule cancerous lesions was within 0～8 mm [(1.2?1.9) mm] beyone the capsule,with 30.4% of them within the field of 1～8 mm.with the statistic method of one side analysis of frequency,the percentile value of P97.5 and P100.0 was 7.4 and 8.0 mm respectively. Conclusions These data denote that when nephron sparing surgery is done for renal cell carcinoma,at least 10 mm of normal parenchyma tissue beyond the pseudocapsule should be excised with the tumor.The nucleation techniquc should not be encouraged.

0.4).ConclusionsThese data denote that biological behaviors and malignant features of multifocal tumors are very similar to those of primary ones.In addition,considering the significant relationship of multicentricity with vascular invasion and incompleteness of pseudocapsule of RCC,it is suggested that the secondary tumors might be more likely the result of intrarenal metastasis of the primary tumor rather than the results of multifocal genesis.

Anti-neovascularization is an important research direction in the current treatment of gastric cancer.The inhibitors of vascular endothelial growth factor (VEGF) and vascular endothelial growth factor receptor (VEGFR) are main research focus.At present,the inhibitors of the pathways of VEGF and VEGFR in the treatment of advanced gastric cancer include bevacizumab,ramucirumab,apatinib,regorafenib,sorafenib,et al.These drugs provide more possibilities for the treatment of advanced gastric cancer.

Objective To explore risk factors relating to occurrence of spontaneous rupture (SR)of hepatocellular carcinoma (HCC). Methods We retrospectively reviewed medical records of 409 HCC patients treated in our department from Jan. 1st 2005 to Aug. 31st 2009. Clinicopathologic factors were explored for their possible association with occurrence of SR by univariate and multivariate analysis using Logistic regression model. Results Among 409 patients, SR occurred in 40 patients (9. 8% , 40/409).Type of SR was defined according to presentation of acute abdominal emergency, especially unstable hemodynamic status. Nineteen cases (4. 7%, 19/409) were grouped as type of HCC-SR Ⅰ and 21 cases (5. 1% ,21/409) as HCC-SR Ⅱ. Patients in the two groups possessed similar hepatitis infection status,severity of background liver disease and tumoral factors except for tumoral location, while HCC-SR Ⅰ group often needed emergency treatment demonstrating elevated values of aspartate aminotransferase (AST) and WBC, decreased PLT counts and worse Child-Pugh classification. Patients in the HCC-SR Ⅱ group had more opportunities of receiving curative hepatectomy and had longer overall survival. The 1,2 and 3 year survival rates were 26. 3 % (5/19), 5. 3% ( 1/19 ) and 0% (0/19)in the HCC-SR Ⅰ group and 66. 7% ( 14/21 ),42.9% (9/21)and 19. 5% (5/21) in the HCC-SR Ⅱ group, respectively. Differences reached statistical significance( P = 0. 011,0. 009,0. 049). Multivariate analysis identified that severity of concomitant liver cirrhosis , WBC ＞ 10 × 109/L and AST level more than twice normal (2N) as independent risk factors associating with occurrence of HCC-SR Ⅰ , while elevated values of AFP and presence of tumor thrombi in portal vein branch related to HCC-SR Ⅱ. Conclusions HCC-SR includes two different types, since different risk factors predict occurrence of each HCC-SR type.

Hemodynamic monitoring is an essential part in the care of children with congenital heart disease during perioperative period to guide clinical management.Currently,there are several methods available for hemodynamic monitoring.The invasive methods include the Fick method,thermodilution method,using the Swan-Ganz catheter and the pulse contour method.The noninvasive methods include partial carbon dioxide resorption,impedance method.In this paper,the principle,advantages and disadvantages of these monitoring methods in children undergoing cardiopulmonary bypass surgery were reviewed.

Objective To explore the safety and efficacy of small margin in nephron sparing surgery for early localized renal cell carcinoma (RCC). Methods A total of 325 cases of RCC with normal contralateral kidney and staged as Tla were retrospectivly studied.According to the margin size,125 cases were with surgical margin ≤ 5 mm (group ≤ 5 mm),102 cases with margin 6-9 mm (group 6-9 mm) and 98 cases with margin ＞ 10 mm (group ＞ 10 mm).The margin size and status was pathologically evaluated and clinical results including local recurrence,distant metastasis and overall survival rate were followed up and comparatively analyzed. Results None of the patients had positive surgical margins.The mean and median margin sizes were 2.2 and 2.0 mm for group ≤ 5 mm,6.7 and 6.0 mm for group 6-9 mm and 11.8 and 12.0 mm for group ＞ 10 mm.The difference was statistically significant (P=0.025).The mean and median follow-up time for all the patients were 79 and 83 months (range 15-132 months),with 69 and 73 months (range,15-130 months) for group ≤ 5 mm,83 and 86 (range,17-132 months) for group 6-9mm and 82 and 82 (range 60-103 months) for group ＞ 10 mm.Three patients in group ≤ 5 mm,5 in group 6-9 mm and 2 in group ＞ 10 mm died of no-cancer related disease during follow-up.One patient in group ≤ 5 mm (0.74％) experienced ectopic recurrence in the same kidney and one in group 6-9 mm was detected local recurrence in situ (0.98％).No distant metastasis was detected in all the patients.The overall 5-year survival rate for patients in groups ≤ 5mm,6-9 mm and ＞ 10 mm were 99.2％,99.0％ and 98.0％,respectively.(Kaplan-Meier survival analysis,Log Rank,x2 =1.511,P=0.470). Conclusions Small margin in nephron sparing surgery is safe and effective in treating RCC with stage T1a,which provides excellent renal function preservation,favorable long-term progression-free survival rate,and is not associated with an increased risk of local recurrence.

Objective To inquive into 125I seeds interstitial brachytherapy on the malignant tumor in digestive tract.Methods Analyse retrospectively 104 patients with different malignant tumor of stage Ⅱ and stage Ⅲ in digestive tract.All patients received radical resection.125I intraoperative implantation to tumor bed and regional lymph nodes.Complete bland count was determined during postoperative 5-7 days and immuoassay,and X-ray film were taken to observe the distribution of 125I seeds,understand tumor recurs or shifie the situation.Results All patients are followed up a case by regular,Don't have death.Among them one of interstitial Lou happens 8 patients WBC count decreased to 3×109/L within one week and rose to 4×109/L after suit the remedy to the case.Immunity ralve was below normal survive patient apper serious complication that lead to the fact because plant into 125I seeds follow up a case by regular visits to.while being other.Conclusion 125I seeds interstitial beraehytherapy for the malignant tumor of stage Ⅱ and stage Ⅲ in digestive tract is simple,safe and effective especially good application prospects in basic wint.

Objective To study the incidence of multi ce ntricity in renal cell carcinoma (RCC). Methods 102 kidn eys from radical nephrectomy for RCC were step sectioned at 3 mm intervals and a ny abnormal tissue were removed, stained and examined. The tissue 2.0 cm beyond pseudocapsule and tissue of renal hilum were continueously or interruptedly sect ioned and examined for any tumor invasion of the pseudocapsule, micro-multifoca l carcinoma and vascular invasion beyond pseudocapsule. The relationship between the pathological findings of the primary tumors and multicentricity was evaluat ed. Results The total incidence of multifocal carcinoma in this group was 15.7%.It was 4.9% in primary tumors 4 cm or less and 23.0% in tumors larger than 4 cm (P= 0.014). Vascular invasion and interrupted pseud ocapsule were two significant predictors of multicentricity of RCC (P=0.017 and 0.006). Conclusions In the RCC patients with normal contralateral kidneys, nephron-sparing surgery should be performed only in tumo rs 4 cm or less. In patients nephron-sparing surgery is imperative, even tumors 7 cm or less might be in consideration, but intensive followup is necessary due to the increased incidence of multicentricity.In most cases, a partial nephrect omy instead of tumor enucleation should be performed.

Objective Basing on overall survival(OS)of HBsAg-positive hepatocellular carcinoma(HCC)patients we evaluate several currently used HCC staging systems for OS predictivity.Methods This retrospective study included 775 patients with HBsAg-positive HCC treated in our department during 11-year period from Jan.2000 to Feb.2010.Clinicopathologic factors were evaluated for their possible association with OS in univariate and multivariate analysis using Cox proportional hazard model.Receiver operating characteristics(ROC)analysis with calculation of the area under the curve (AUC),sensitivity,and specificity was applied to define cutoff point values where appropriated and to assess HCC staging systems for their predictive ability of OS.Results The 1-,2-,3-and 5-year OS rates were 21.3％(165/775),9.4％(73/775),4.9％(38/775)and 1.7％(13/775),respectively.Multivariate analysis identified that severity of concomitant liver cirrhosis(B =4.519),treatment modality (B =4.888),ALT≥2N(B =4.068),portal vein tumor thrombi(B =0.537),spontaneous rupture(B =5.033)and inferior vena cava tumor thrombi(B =7.049)as independent risk factors influencing OS.NSMCS(North Sichuan Medical College Score)exhibited best performance predicting OS with AUC 0.801 (95％ CI 0.761-0.840),sensitivity of 78.8％,specificity of 69.3％ at NSMCS ≥-2.Median survival time reached statistically significant difference(13.6 mons,3.4 mons vs.1.3 mons,x2 =467.636,P =0.000).Conclusions Multiple factors determine OS in patients with HBsAg-positive HCC.NSMCS staging system demonstrates better predictability for the survival of HBsAg positive HCC patients.

Objective To investigate whether maternal antibody to hepatitis B surface antigen (anti-HBs)in infants may interfere with the antibody response to hepatitis B vaccine. Methods Infants from singleton pregnant mothers,who delivered at full term at the Affiliated Drum Tower Hospital of Nanjing University Medical School from October 2006 to January 2007,were divided into two groups based on their mothers'status of anti-HBs(43 positive and 29 negative).All infants were vaccinated with hepatitis B vaccine at birth and one month thereafter.Serum anti-HBs were quantitatively determined for the mothers before delivery and for infants in cord blood at delivery and in serum at the age of 1 and 3.5 months. Results Anti-HBs of all 43 newborns in the positive group were positive in cord blood with the coefficiency of 0.98 to the maternal serum anti-HBs level(t=39.05,P<0.01).Forty-two out of the 43 infants remained anti-HBs positive at the age of 1 month.Anti-HBs was negative both at birth and 1 month old in infants of the negative group.However,all infants in both groups were anti-HBs positive at 3.5 months of age,while the average concentration of anti-HBs in infants of the negative group was significantly higher than that of the positive group [(466.9±86.7)mIU/ml vs(151.2±23.1)mIU/ml,t=2.72,P=0.011].Among the 5 infants whose maternal anti-HBs level>1000 mIU/ml,3 did not produce active antibodies against two doses of hepatitis B vaccination. Conclusions Passively acquired maternal anti-HBs in infants can inhibit the active antibody response to hepatitis B vaccine,and the extent of this effect is associated with maternal anti-HBs level.