The article teased the concept of medical futility and analyzed the issues when implement the medical futility policy.It introduced the medical futility policy by the examples of New York Public Health Code Article 29-B:Orders Not to Resuscitate and relevant regulations in Taiwan and presented some reflections on medical futility.The authors suggested that it should cope with the common and troubled cases of medical futility,establish ethics committee,and make the medical futility policy at the stage of tense doctor-patient communication.

Objective To investigate essentiality of bone scintigraphy in patients with renal cellcarcinoma.Methods The clinical data of 152 patients with confirmed renal cell carcinoma from Jan uary 1999 to June 2007 were retrospectively analyzed.There were 106 men and 46 women with a meanage of 56 years (range 11-86 years).The tumor size was 1.5-20.0 cm (mean 6.0 cm).Accordingto the TNM and AJCC staging classification,88 patients had stage I,included of T1a in 47 cases,T1bin 41; 38 had stage Ⅱ; 16 had stage Ⅲ,included of T3a,in 10 cases,T3b in 6; and 10 had stage Ⅳ.Histological grade was well differentiated in 90 cases,moderately in 43,poor in 19.Ten clinical pa thology factors were evaluated by Logistic analysis to present the significant factors related to osseousmetastatic lesions.Results Overall osseous metastatic lesions were present in 22 of the 152 patients(14.5%).Of the 126 patients with clinically localized,11 cases (8.7%) had osseous metastatic le sions.Of the 16 patients with clinically advanced,5 eases (31.2%) had osseous metastatic lesions.Ofthe 10 patients with metastasis,6 cases(60%) had osseous metastatic lesions.Clinical stage was re lated to osseous metastatic lesions by Logistic analysis.The incidence of osseous metastatic lesionswas 40.9% in localized renal cell carcinoma patients with bone pain.Conclusions Bone seintigraphymay be omitted in patients with clinically localized renal ceil carcinoma(stage Ⅰ,Ⅱ) unless bone pain is pres ent.Bone scintigraphy should be performed in patients with stage Ⅲ or Ⅳ regardless of symptoms.

Objective To investigate GRP78 expression in clear renal cell carcinoma (CRCC) and its correlation with survival. Methods Immunohistochemistry was performed using paraffin-embedded specimens of 102 CRCC. GRP78 positivity was determined based on intensity of staining and percentage of cells stained by SP methods. The survival curve was evaluated using Kaplan-Meier plots and the log-rank test. The Cox proportional hazard model was performed to evaluate independent factors for overall survival (OS). Results Compared with patients in lower expression GRP78, the patients in higher GRP78 expression had shorter survival time. A statistically significant correlation was found between GRP78 expression and OS. Positivity of GRP78 expression was an independent risk factor in predicting survival by Cox proportional hazard model. Conclusion There was a significant correlation between GRP78 expression level and prognosis of RCC. GRP78 might be a useful marker to predict survival in patients with RCC.

Objective To investigate the expression of Kruppel like factor 8(KLF8)in human renal cell carcinoma(RCC)specimens and clinical significance.Methods RT-PCR and immunohistochemistry were used to detect the KLF8 mRNA and protein expression respectively in RCC cell strain 786-0,OS-RC-2 with 37 RCC specimens and adjacent normal tissues of the same patients.Results The expression of KLF8 mRNA was high in RCC cell strain 786-0,OS-RC-2,was 0.80±0.28 and 0.41±0.11 in the RCC specimens and normal tissues respectively(P＜0.01).The level of KLF8 protein expression of 37 RCC specimens(17 was expressed at++-+++)was significantly higher than that of the normal tissues(29 was expressed at--+)(P＜0.01).KLF protein was high expressed in RCC cell strain 786-0,OS-RC-2.The levels of KLF8 mRNA and protein expression were positively correlated with the tumor size,cell differentiation,clinical stage,but not correlated with the patients sex and age.Conclusions The KLF8 mRNA and protein expressions are elevated in the human RCC.KLF8 may be involved in the development and progression of RCC.

Objective To investigate the associations between the single nucleotide polymorphisms of TERT rs2736098, CLK3 rs11543198 and bladder cancer. Methods 201 bladder cancer cases and 200 healthy controls were included in the research, and the genotypes of TERT rs2736098 and CLK3 rs11543198 were determined using the PCR-RFLP method. Relationship between genotypes and bladder cancer risks was investigated. Results There were statistical significance in the rs2736098 genotype frequencies and allele frequencies between cases and controls (χ2= 6.973, P = 0.031; χ2= 7.412, P = 0.006). Compared with the individuals with the GG genotype , the risk of bladder cancer increased 2.069 times with the AA genotype (OR = 2.069, 95%CI: 1.181-3.624, P = 0.011). And there were no significant associations between the rs11543198 genotype frequencies and allele frequencies between cases and controls (χ2 = 0.202, P = 0.904; χ2 = 0.188, P = 0.665). Rs2736098 and rs11543198 genotype distribution in bladder cancer pathologic grade and stage had no statistical significance (P > 0.05). Conclusion Rs2736098 polymorphism is associated with risk of bladder cancer and rs11543198 polymorphism was not associated with risk of bladder cancer.

Objective To investigate the hemodynamic parameters to stabilize cerebral blood flow within limits of cerebral autoregualtion. Methods We assessed the flow velocity of middle cerebral artery using transcranial Doppler and recorded invasively the blood pressure simultaneously. We then analyzed the curves of cerebral blood flow autoregulation (CBFA) and calculated upper limit of autoregulation (ULA) and lower limit of autoregulation (LLA). The values of critical closing pressue (CCP) and resistance area product (RAP) were calculated according to previous theory. The relationship between CCP, RAP and MABP were analyzed. Results In the process of increasing or decreasing blood pressure, ULA and LLA of normal rats were 148.12 ± 7.49 mmHg or 62.96 ± 3.34 mmHg, respectively. When mean artery blood pressue (MABP) changed within limits of cerebral autoregulation, the cerebral blood flow velocity changed little (increasing:0.65± 0.27 cm/s/10mmHg MABP, decreasing:0.43±0.23cm/s/10 mmHg MABP), while CCP and RAP changed significantly (in?creasing: 4.60 ± 1.06 mmHg/10mmHg MABP and 0.11 ± 0.04/10 mmHg MABP, decreasing: 6.74 ± 0.59 mmHg/10 mmHg MABP and 0.09 ± 0.02/10mmHg MABP). After fixing change of blood flow velocity, CCP and RAP were correlated with MABP more remarkablely, although all blood flow velocity, CCP and RAP were significantly correlated with MABP. Conclusion Within limits of cerebral autoregulation, stable cerebral blood flow is mainly achieved by the change of CCP and RAP against blood pressure changing on normal rats, especially the increasing or de?creasing of CCP.

ObjectiveTo observe the rehabilitative effect of patients with shoulder-hand syndrome after stroke by manipulation treatment. MethodsThe patients with shoulder-hand syndrome were randomly divided into two groups, manipulation group (180cases) and control group (128 cases). Patients in the manipulation group were regularly given a passive quantitative movement on shoulder, elbow and hand joints,while patients in the control group were irregularly given a passive movement or ordered to perform an autonomic movement. The signs and symptoms of patients in these two groups were not much different. The rehabilitative effects were compared 3 months later. ResultsSigns and symptoms in the manipulation groups improved much better than that of the control group. Conclusions The manipulation treatment for the post-stroke patients with shoulder-hand syndrome is the method that is simple, effective and easy to perform.

Objective To investigate the correlation between the measurement methods of carotidcerebral pulse wave velocity (ccPWV) and the traditional method of brachial-ankle pulse wave velocity (baPWV).Methods A total of 136 healthy volunteers were divided into a youth group (20-39 years),a middleaged group (40-59 years),and an elderly group (more than 60 years) according to their ages.While detecting baPWV,transcranial Doppler ultrasound was used to simultaneously monitor the ipsilateral common carotid artery and the terminal segment of internal carotid artery.The time differences of the beating points of their cardiac cycles and the distanceses of the skin surfaces between the 2 probes were measured and ccPWV was calculated.Results The systolic blood pressure,pulse pressure and mean arterial pressure in the elderly group were signifificantly higher than those in the middle-aged group and the young group.The ccPWVs in the youth,middle-aged and elderly groups were 418 ± 52 cm/s,489 ±54 cm/s,and 599 ± 58 cm/s,respectively.The elderly group was significantly faster than the middle-aged group (t =7.308,P ＜0.001),and the middle-aged group was significantly faster than the youth group (t=6.758,P＜0.001).A Pearson correlation analysis showed that ccPWV was significantly positively associated with the age (r=0.847,P＜0.001) and baPWV (r =0.548,P ＜0.001).The multiple linear regression analysis showed that ccPWV was significantly positively associated with the age and diastolic blood pressure (partial correlation coefficients were 0.742 and 0.293respectively,P ＜0.001 and ＜0.010 respectively).Conchlusions ccPWV is a new measurement method for cerebrovascular stiffneas,and it has a good correlation with the traditional measurement method.

Objective To investigate the expression of allograft inflammatory factor-1(AIF-1)in the testicular model of diabetes mellitus(DM)rats as well as its significance.Methods The rat model of DM testis(DMT)was established,which were randomly divided into the DM testis 4-week group(DMT4W),DM testis s 8-week group(DMT8W)and the DM testis 12-week group(DMT12W).The normal control group(NC group)was randomly divided into three subgroups:NC 4-week(NC4W),NC 8-week(NC8W)and NC 12-week(NC12W).The morphologic changes of testis in the different groups was detected by histopathology.The expression of AIF-1 protein was detected by immunohistochemistry.The expression of AIF-1 and NF-κB p65 protein was observed by immunofluorescence.Results The histopathological results suggested that the numbers of spermatogenic cells,sertoli cells,interstitial cells and sperms in the DMT group were significantly decreased,as compared with the NC group.The immunohistochemistry results showed that the expression of AIF-1 protein was significantly increased in the DMT group,as compared with the NC group(P<0.05).The intensity of AIF-1 and NF-κB p65 in the DMT group was significantly increased by immunofluorescence,as compared with the NC group.Conclusion The over expression of AIF-1 protein in DMT tissue suggests that it may play an important role in the pathological process of DMT and may become a new therapeutic target and diagnostic marker in the future.

Objective To study the effects of dichloroacetate (DCA) on cell colony-forming,cell invasion and cell migration of the bladder cancer cells and to study the underlying mechanism.Methods The bldder cancer cells T24 were randomly divided into two groups:the observation group and the control group.Cells in the observation groups were treated with 5 mmol/L,10 mmol/L and 20 mmol/L dichloroacetate,and the control group was treated with the same amount of dimethyl sulfoxide.Colony formation assays were detected with Giemsa staining.Cell wound scratch assay and Transwell assay were applied to evaluate the ability of the T24 cell invasion and migration.Realtime PCR and Western blot were applied to detect the expression of the epithelial-mesenchymal transition (EMT)-related marker,including E-cadherin,N-cadherin,vimentin,Snail and Slug.Results Compared with the control group,the colony formation assays of T24 cells constantly decreased along with the increased doses in the observation group(P ＜ 0.01).The cell wound scratch assay showed that the scratch width of the observation groups were significantly higher along with the increased doses and prolonged time than that in the control group (P ＜ 0.01).The transwell assay showed that the invasion ability of the observation groups were significantly discreased along with the increased doses than that in the the control group (P ＜ 0.01).The expression levels of E-cadherin mRNA and protein in combination the control group were higher than those in the the observation groups (P ＜ 0.05).However,the expression levels of N-cadherin,vimentin,Snail and Slug mRNAs and proteins in combination the control group were lower than those in the the observation groups (P ＜ 0.05).Conclusion Dichloroacetate can inhibit the colony-forming,invasion and migration of bladder cancer T24 cells,and its mechanism may inhibit the expression of epithelial mesenchymal transition in T24 cells by down-regulating the expression of nuclear transcription factor Snail and Slug.