Background and purpose:With the recognition of prognostic factors and application of surgical- pathological staging,the treatment strategy of endometrial cancer has greatly changed.In this study,we investigated the treatment strategy,survival rate and prognostic factors of endometrial cancer.Methods:Five hundred and fifty-nine patients of endometrial cancer underwent primary surgical treatment from January 1996 to December 2006 in Cancer Hospital,Fudan University.The clinicopathologic parameters and prognosis were analyzed retrospectively.Results: Patients were followed up with the median period 36 months,25 cases experienced local relapse,24 cases were found to have distant metastases.The 3-year overall survival(OS)was 88.7%,3-year and 5-year disease free survival(DFS) was 82.7% and 80.9%.The 3-year overall survival(OS)were 95.5% in stageⅠ,95.3% in stageⅡ,75.9% in stageⅢand 32.4% in stageⅣrespectively(P

Objective The aim of this study was to find whether modified radical hysterectomy or radical hysterectomy improves local-regional control for patients with stage Ⅰ endometrioid carcinoma. Methods The medical records of patients with stage Ⅰ endometrioid carcinoma who were enrolled in Cancer Hospital of Fudan University between 1996 to 2008 after undergoing modified radical hysterectomy or radical hysterectomy were reviewed.The Kaplan-Meier method was used for time-to-event analysis with recurrence and death as the end points. Results Among 518 women with stage Ⅰendometrioid carcinoma, 474 underwent modified radical/radical hysterectomy and bilateral salpingo-oophorectomy±pelvic lymphadenectomy±peri-aortic lymphadenectomy+cytology.Twelve patients (2.5%) received neoadjuvant chemotherapy or vaginal brachytherapy before operation, and 73 patients (15.4%) received postoperative adjuvant therapy (pelvic external beam radiotherapy or chemotherapy or combination).After a median follow-up of 30 months,16 relapses were observed.Eight patients suffered with distant metastases, 4 with vaginal recurrences and 4 with pelvic recurrences.The 3-year and 5-year cumulative vaginal recurrence rates were 1.4% and 2.0%. The 3-and 5-year cumulative local-ragional recurrence rates were 2.5% and 3.1%. The 3-and 5-year actuarial overall survival rates were both 98.1%.The 5-year local-regional recurrence rates for stage Ⅰa, stage Ⅰb, stage Ⅰc were 3%, 3.7% and 0 (P=0.649), and the 5-year survival rates were 98.3%, 97.8% and 100% (P=0.399). There was no evidence of benefit in terms of lympnadenectomy in patients with stage Ⅰ endometrioid carcinoma(P value were 0.525 and 0.665,respectively).The median operating time was 135 minutes, the median blood loss was 300 mL, and 15.4% of the patients needed blood transfusion. Surgery associated morbidity was 7%, and no one died of surgery associated morbidity. Conclusions Modified radical hysterectomy or radical hysterectomy is a viable and possibly preferable option for patients with stage Ⅰ endometrioid carcinoma.Randomized clinical trials were urgently needed to address the utility of modified radical hysterectomy in stage Ⅰ endometrial cancer.

Adolescent ; Adult ; Blood Donors ; Child ; Child, Preschool ; Female ; Gastrointestinal Diseases ; drug therapy ; etiology ; Graft vs Host Disease ; drug therapy ; etiology ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Hormones ; administration & dosage ; therapeutic use ; Humans ; Male ; Middle Aged ; Transplantation, Homologous ; Young Adult

Brain ; diagnostic imaging ; pathology ; DNA Mutational Analysis ; Exons ; Galactosylceramidase ; genetics ; metabolism ; Humans ; Infant ; Leukodystrophy, Globoid Cell ; diagnosis ; enzymology ; genetics ; pathology ; Magnetic Resonance Imaging ; Male ; Mutation ; Radiography

Background and purpose: The role of lymphadenectomy for endometrial cancer is still controversial. Few gynecologists in China carry out pelvic and/or para-aortic lymphadenectomy for patients with endometrial cancer. The aim of the current study was to investigate the role of systematic lymphadenectomy in the treatment strategy of endometrial cancer and the feasibility in carrying out the surgery. Methods: We performed a retrospective chart review of all patients with endometrial cancer who experienced surgical staging at Cancer Hospital, Fudan University from January 2005 to July 2008. Lymph nodes metastatic status, alteration of adjuvant therapy and surgical complications were discussed. Results: Nineteen (14.8%) of 128 patients undergoing systematic lymphadanectomy had lymph node metastases: both pelvic and para-aortic in 7 patients, only pelvic in 8 patients, and exclusively isolated to the para-aortic area in 4 patients. Therefore, more than half of the patients with lymphatic dissemination had para-aortic lymph nodes metastases. Tumor grade, histological type, myometrial invasion and lymph-vascular space invasion were associated with lymph nodes metastases. Adjuvant chemotherapy and/or tumor-directed radiotherapy were needed for 15 patients upstaged due to lymph-nodal invasion (P<0.05). Furthermore, adjuvant therapy was eliminated for 50 intermediate/intermediate-high risk patients with negative lymph nodes and extrauterine spread. Complications were found in 8 patients: 3 pelvic infection, 2 residual vaginal bleeding, and 1 pero-bowel obstruction, 1 deep venous thrombosis accompanied with lymphocyst, and 1 lacunar infarction. The median time of the procedure was 150 minutes, median blood loss was 300 mL, and 27 patients received blood transfusion. Conclusion: The findings of the current study suggest that it is safe and feasible to carry out systematic lymphadenectomy in women with endometrial cancer. Surgical staging can assess the status of lymph nodes, provide accurate prognostic information, and help to formulate adjuvant therapy after surgery.

Insulin receptor substance-1 (IRS-1) mRNA and protein were assayed in rat muscle of hindlamb by RT-PCR and immunohistochemistry respectively.Smoking decreased the expressions of IRS-1 mRNA and protein in rat muscle of normal chow smoking group,high fat chow smoking group and diabetic smoking group as compared with matched control groups (P

Objective To determine the difference of macrophage RAW264.7 apoptosis induced by Brucella melitensis virulent strain 16M and attenuated strain M5-90 and elucidate the regulatory role of caspases 3,8 and 9.Methods The best multiplicity of infection (MOI) was determined through kinetic analysis of Brucella melitensis strain 16M and M5-90 induced mouse macrophages apoptosis(bacterium ∶ cell =100 ∶ 1,50 ∶ 1,10 ∶1).The infection model was established using the best MOI =50 ∶ 1.The numbers of in vivo bacteria by colony formation units were calculated after macrophages were infected for different times,including 2,4,8,12,24 and 48 h,and the infected cells were collected.The ratios of apoptosis were detected and the regulation of caspases 3,8 and 9 in apoptosis pathway was elucidated by flow cytometry.Results The numbers of 16M in vivo bacteria were 105.4,104.8,105.8,106.5,108.0 and 109.0,respectively and of M5-90 were 106.1,106.2,106.4,106.3,106.1 and 105.0,respectively.The number of in vivo bacteria of 16M was significantly increased than that of M5-90 after infected for 24 h to 48 h.The ratios of apoptosis induced by 16M after infected for 2,4,8,12,24 and 48 h was (2.67 ± 0.09)％,(13.13 ± 0.30)％,(6.56 ± 0.42)％,(6.49 ± 0.28)％,(16.07 ± 0.86)％ and (24.23 ± 1.67)％,respectively,and by M5-90 was (3.62 ± 0.02)％,(32.01 ± 2.59)％,(17.58 ± 0.44)％,(16.09 ± 0.10)％,(62.53 ± 2.70)％ and (85.53 ± 0.15)％,respectively,and by control group was [(1.90 ± 0.20)％,(1.92 ±0.16)％,(1.99 ± 0.03)％,(2.48 ± 0.11)％,(3.56 ± 0.07)％,(5.26 ± 0.33)％].The differences were statistically between groups in same time.The Brucella melitensis vaccine strain M5-90 was more powerful than virulent strain 16M in respect of inducing macrophage apoptosis after infected for 24 to 48 h.Twenty-four hours after infection,the expression of caspases 3,8 and 9 was (1.47 ± 0.05)％,(1.52 ± 0.02)％ and (2.47 ± 0.12)％,respectively,in control group and the expression was (9.70 ± 0.46)％,(6.08 ± 0.56)％ and (35.08 ± 1.64)％,respectively,after infected for 24 h induced by M5-90.The expression of caspases 3,8 and 9 was significantly higher than that control group (P ＜ 0.01).Twenty-four hours after given caspases 3,8 and 9 inhibitor,apoptosis rate in control group was (66.72 ± 1.28)％,in M5-90 group was (22.58 ± 0.55)％,(53.15 ± 1.85)％ and (29.18 ± 0.23)％,respectively,and compared with control group,apoptosis rate of caspases 3,8 and 9 was significantly lower(P ＜ 0.01).Conclusions Apoptosis of macrophage can be induced by Brucella melitensis virulent vaccine strain 16M and attenuated strain M5-90.M5-90 is stronger than that of strain 16M.Caspases 3,8 and 9 can regulate macrophage apoptosis after M5-90 infection.

Objective To investigate the effect of intraocular injection of mixed crystalline in vivo on survival of retinal ganglion cells(RGCs)after optic nerve cut.Methods Twenty Long-Evens rats were divided into normal control,and 7 day,14 day,and 21 day groups after optic nerve was cut off.There were 5 eyes in each group.Mixed crystallin(1x10~(-4)g/L)and isotonic saline solution were injected into the vitreous of fight eye and left eye respectively.The number of RGCs was counted 7,14 and 21 days after optic nerve cut.Results The density of RGCs declined clearly 7 days after optic nerve cut.In the group with crystallin injection,the density of RGCs declined to 71%,32% and 15% of the control group repec- tively,much higher than that of the controls on days 7,14 and 21 after optic nerve was cut off(P

Hyponatremia is relatively common in patients with neurologic disorders, while its diagnosis and treatment remain controversial. Osmotic demyelination syndrome (ODS) has shown to be closely associated with hyponatremia. ODS patients often present as central pontine myelinolysis, extrapontine myelinolysis, or both. This article reviews the clinical manifestations, pathogenesis, and risk factors of ODS in patients with hyponatremia caused by neurologic disorders.
Demyelinating Diseases ; etiology ; therapy ; Humans ; Hyponatremia ; complications ; etiology ; Nervous System Diseases ; complications

OBJECTIVETo compare the clinical curative effect of thoracolumbar burst fracture treated by the posterior unilateral approach corpectomy fusion screw-rod fixation and anterior corpectomy bone fusion screw plate fixation.

METHODSFrom January 2008 to May 2014,36 cases of thoracolumbar burst fracture underwent operation of decompression, fusion, and internal fixation was retrospective analyzed. Among them, 16 patients were treated through posterior approach as posterior group, including 13 males and 3 females aged from 37 to 62 years old; 9 cases caused by falling injury, 3 cases by traffic accident injury,4 cases by heavy aboved;the injury segment was on T₁₂ in 2 cases, L₁ in 5 cases, L₂ in 7 cases, L₃ in 2 cases; according ASIA grade, 3 cases were grade A, 2 cases were grade B, 2 cases were grade C, 5 cases were grade D, 4 cases were grade E; the time between injury and operation ranged from 5 to 15 days. Other 20 patients were treated through anterior-lateral approach as anterior-lateral group, including 15 males and 5 females with age from 27 to 62 years old; 12 cases caused by falling injury, 4 cases by traffic accident injury, 4 cases by heavy aboved; the injury segment was on T₁₂ in 2 cases, L₁, in 7 cases, L₂ in 9 cases, L₃ in 2 cases; for ASIA grade: 4 cases were grade A, 2 cases were grade B, 4 cases were grade C, 6 cases were grade D, 4 cases were grade E; the time between injury and operation ranged from 4 to 12 days. The operation time, bleeding during operation and postoperative drainage volume were observed in two groups,and the changes of nerve function of ASIA grade, clinical efficacy,improved degree of thoracic and lumbar lordosis,and bony fusion were compared between two groups.

RESULTSAll patients were followed up from 12 to 24 months with an average of (15.8 ± 3.3) months. The operation time, bleeding during operation, and postoperative drainage volume had no significant different between two groups (P > 0.05). As compared with preoperative, ASIA grade of two groups at last follow-up had statistically significantly different (P < 0.01), the neural function of two groups after operation was recovered for different extent. The JOA score of two groups was compared between last follow-up and preoperative, the difference had statistically significant (P < 0.01), the two groups showed good clinical effect. The clinical results of ASIA grade, JOA score and RIS had no significant differences between two groups. All patients of two groups were obtained fusion. Thoracic and lumbar lordosis angle improvement degree had no significant difference between two groups ,it bad significant difference had statistical significance compared with preoperative, the two approaches could effectively restore the spinal sequence.

CONCLUSIONFor patients with thoracolumbar burst fracture just treated by anterior decompression and reconstruction of anterior column, according to the degree of operation performer' skill proficiency and the patient' condition to choose, but for patients must performed the spinal canal decompression anterior and posterior, the three column-reconstruction to required anterior-posterior approach, the posterior unilateral approach corpectomy fusion screw-rod fixation obviously shorten operation time, reduce the operation wound, it is worth the clinical promotion.

Adult ; Decompression, Surgical ; methods ; Female ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Pedicle Screws ; Reconstructive Surgical Procedures ; Retrospective Studies ; Spinal Fractures ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; injuries ; surgery