Objective　In order to predict or exclude early ectopic pregnancy.Methods　Endomertrium of 49 early intrauterine and 52 ectopic pregnancy were observed by transvaginal ultrasonography. Trophoblastic artery flow were investigated surrounding the intrauterine embryo or within the endometrium.Results　An endometrial three-line pattern resembled late proliferative endometrium of the normal menstrual cycle were seen in 42 ectopic pregnancy(80.8%). An endometrial three-line pattern were not seen in 49 early intrauterine pregnancy. Thirty-nine early intrauterine pregnancy had trophoblastic artery flow surrounding the intrauterine embryo or within the endometrium. None of ectopic pregnancy had trophoblastic artery flow within the endometrium.Conclusion　Observation of endometrial three-line pattern and trophoblastic artery flow by transvaginal ultrasonography were useful for diagnosing eraly ectopic pregnancy.

As a new type of intercellular signaling rector, extracellular vesicles (EV) are involved in almost the whole process of tumorigenesis, progression, metastasis, and drug resistance. Therefore, EV have become the ideal biomarker candidates and research hotspots for cancer diagnosis and treatment. However, EV tumor biomarker research mainly focused on RNA and protein, and a small part of the research focused on lipids at the early stage. EV DNA has received little attention and its diagnostic value has gradually been recognized in recent years. Study on the biological characteristics and function of EV DNA may highlight its potential in tumor diagnosis.

ABSTRACT:Objective To investigate the roles of Ku70,epidermal growth factor receptor (EGFR),nuclear factor-kappa B (NF-κB)and Bcl-2 genes in the pathogenesis of Graves’disease.Methods Fine needle biopsies of 59 patients [M:F 1 6:43;mean age (44.66 ± 12.94)y)]diagnosed as having Graves’disease and 27 [M:F 6:21;mean age (44.64± 14.27)y]control normal tissues were collected.The mRNA expressions of EGFR,Ku70,NF-κB,and Bcl-2 were detected by Real-time polymerase chain reaction (RT-PCR).The Student’s t test was performed to analyze differences between patients with Graves’disease and control subjects.Pearson correlation analysis was applied to detect the relationship between gene mRNA expression and serological indexes.Results Compared with those of control subjects,the mRNA expression levels of EGFR (0.859 ±0.125 vs .1.752 ±0.660,P <0.05)and Ku70 (0.768±0.102 vs .3.304±0.402,P <0.001)were significantly higher in Graves’disease patients.However, the mRNA expressions of Bcl-2 (1.235±0.261 vs .0.834±0.086,P <0.05)and NF-κB (0.578±0.066 vs .0.884 ±0.085,P <0.05)were much lower in Graves’disease patients.Furthermore,the mRNA expression of Bcl-2 was positively correlated with that of NF-κB (r =0.399,P <0.05 ).The Pearson correlation analysis showed that the higher expression of Ku70 was positively associated with the serum TgAb level (r = 0.263,P < 0.05 ),but expressions of the other target genes were not significantly related to the serological indexes (all P > 0.05 ). Conclusion The signal transduction pathways mediated by Ku70,EGFR,NF-κB and Bcl-2 may participate in the occurrence and development of Graves’disease.

Objective:To explore the effect of probiotics on reducing ventilator-associated pneumonia (VAP) in sepsis patients.Methods:A total of 94 cases were randomly (random number) divided into the probiotic group ( n = 46) and the control group ( n = 48). All of the patients were given enteral nutrition therapy by nasogastric tube within 24-72 h after admission. And patients in the probiotic group were given live combined bifidobacterium, lactobacillus and enterococcus powder besides the regular therapy. The incidence of VAP, bacteremia, mortality, mechanical ventilation time and length of ICU stay were compared between the two groups. Results:Compared with the control group, the incidences of VAP and bacteremia in the probiotics group were significantly lower (χ 2=4.763, P=0.029; χ 2=4.438, P=0.035). There were no significant differences in 28-day mortality and the length of hospital stay between the two groups (χ 2=2.02, P=0.167; t=1.29, P=0.208). Mechanical ventilation time in the probiotics group was significantly shorter than that in the control group ( t=2.16, P=0.038). The Log-Rank test showed that the time of VAP-free in the probiotics group was significantly longer than that in the control group ( P < 0.05). After adjusting for APACHEⅡ score and age, COX proportional risk model analysis showed that the RR values of the probiotics group and the control group for 28-day VAP were 0.18 (95% CI: 0.12-0.74, P=0.025) and 0.21 (95% CI: 0.19-0.95, P=0.042), respectively. Conclusions:Probiotics treatment can reduce the incidence of VAP in sepsis patients.

Objective:To study and compare the prognosis of different pathological subtypes of renal cell carcinoma (RCC).Methods:Clinicopathological and prognostic data of 1 346 cases of postoperative renal cell carcinoma during July 2002 to June 2014 in West China Hospital were collected retrospectively.There were 839 males and 507 females, aged (55.1±13.4)years, including 1 120 cases of clear cell RCC, 62 cases of papillary RCC, 79 cases of chromophobe RCC and 85 cases of the other pathological types respectively. ECOG 0 and ≥1 were 911 and 435 cases, with; T 1, T 2, T 3 and T 4 of 1 019, 177, 102 and 48 cases respectively; WHO nuclear grade for well, intermediate, poor differentiation and unknown were 587, 530, 85 and 144 cases separately.Tumor size <5cm, 5-10cm, ≥10cm and unknown were 685, 541, 104 and 16 cases.Combined with necrosis or sacromatoid differentiation were 200/1 146 and 27/1 319 cases separately. Meanwhile, data of 80 439 cases from Surveillance, Epidemiology, and End Results Program (SEER) were also collected.There were 51 371 males and 29 068 females, aged (60.9±12.4) years; , with 66 261, 8 680, 5 022 and 476 cases of White, Black, Asian, American native, or unknown race separately. There were 62 600 of clear cell RCC, 12 170 of papillary RCC, 4 354 of chromophobe RCC and 1 315 of other pathological types, with T 1, T 2, T 3 and T 4 of 55 332, 8 687, 15 516 and 904 cases respectively; WHO nuclear grade for well, intermediate and poor differentiation were 52 323, 22 700 and 5 416 cases separately.Tumor size <5cm, 5-10cm, ≥10cm were 46 741, 25 760 and 7 938 cases respectively. Kaplan-Meier survival analysis were performed on these two group of cases, with different factors between subgroups (gender, age, pathological types, tumor stage, size and nuclear grade) evaluated by log-rank test. To evaluate accuracy of outcome prediction models of SSIGN, Leibovich and UISS score, concordance index of these models were evaluated. Results:In 1 346 cases of our cohort, those with chromophobe RCC were well prognostic, survival were relatively better in clear cell RCC than that of papillary RCC, and worst prognosis were demonstrated in those with other types of RCC (5 year overall survival rate: 97.5%, 87.9%, 79.7% and 68.4% separately). Poor prognosis were seen in those older than 50 years, with poor T stage or nuclear grade, large tumor size and tumors with necrosis or sacromatoid differentiation ( P<0.05). In 80 439 seer cases, the best prognosis was also seen in chromophobe RCC and the worst in other type of RCC separately (5 year overall survival rate: 96.3% and 85.3%). In addition, longer survival was seen in papillary RCC than clear cell RCC (5 year overall survival rate: 92.5% and 88.9%). However, similar results with our cohort were seen in Asian and American native subgroup of SEER cases (95.1%, 88.6%, 86.7%, 80.2% for chromophobe, clear cell, papillary and other types of RCC respectively). Poor prognosis were seen in those older than 50 years, males, Asian/ American Indian, poor T stage or nuclear grade and large tumor size ( P<0.05). Concordance index for SSIGN, Leibovich and UISS models in our cohort were 0.763-0.781, 0.725-0.752 and 0.641-0.660, respectively. The chromophobe RCC subgroup was relative better based on predictive value of prognosis models(c-index of UISS of 0.670-0.781, SSIGN and Leibovich of 0.733-0.903). Conclusions:In Asian RCC population, prognosis of chromophobe RCC is best, clear cell RCC is slightly better than papillary RCC, and the prognosis of other types of RCC is the worst. Concordance index of SSIGN and Leibovich in our cohort were higher than that of UISS, and the use value for predictive model was better in the chromophobe RCC subgroup.

Objective To evaluate the benefit of radical prostatectomy (RP) in patients with lymph node-positive prostate cancer.Methods A systematic review of the studies about radical prostatectomy for the prognosis of node-positive prostate cancer was performed.An electronic search was completed on the basis of PubMed,Embase,Cochrane library,China Biology Medicine disc (CBM),China National Knowledge Infrastructure (CNKI),VIP and Wanfang database from inception up to November 2018.The outcomes are overall survival (OS) and cancer-specific survival (CSS).Results Six studies incorporating 7 890 patients were eligible for the present meta-analysis.6 247 patients underwent RP,the remaining 1 643 patients did not undergo RP.Lymph node-positive patients treated with RP had improved OS (HR =0.55,95％ CI 0.49-0.62,P ＜0.001) and CSS (HR =0.49,95％ CI 0.42-0.57,P ＜ 0.001).Conclusions Radical prostatectomy may be a beneficial option for patients with lymph node metastases at initial diagnosis,which also improve the OS and CSS.More randomized controlled trials are needed to give more evidence further.

Objective: To investigate the effects of prostate cancer exosomes on the migration and invasion ability of stromal cells (WPMY-1), and to explore its mechanism. Methods: Exosomes in LNCaP-AI+F prostate cancer cell supernatant were isolated by ultracentrifugation and the typical structure of exosome was captured by electron microscope. The particle size distribution was analyzed by Zetaview, and Wb was used to identify the marker proteins and other proteins.After co-incubation of WPMY-1 cells and prostate cancer exosomes (40 µg/ml), laser confocal microscope was used to observe the uptake of PKH67-labeled exosomes by WPMY-1 cells; Transwell assay was used to detect the migration and invasion ability of WPMY-1 cells; qPCR was performed to detect the expression of three cancer-associated fibroblast (CAF)-related molecules (IL-8, PDGFB and MMP9) at mRNA level; and the phosphorylation of EGFR and ERK1/2 was analyzed by Wb. Results: Typical cup-shaped structure of exosomes was observed under electron microscope. The Zetaview results showed that the particle size distribution was concentrated at about 100 nm. The expression of exosome marker proteins CD63 andALIX further verified that the isolated particles were exosomes. Besides, EGFR, HER2 and SRC, which were related to the progression of prostate cancer, were also enriched in exosomes. After co-incubation, confocal microscope imaging showed a number of PKH67 labeled exosomes in recipient WPMY-1 cells. Transwell experiments showed that exosomes could significantly enhance the migration and invasion ability of WPMY-1 cells (all P<0.01). Compared with the control group, increased secretion of IL-8, PDGFB and MMP9 was observed after exosome treatment (40 µg/ml) (P<0.05 or P<0.01). Wb indicated that exosomes could promote the phosphorylation of EGFR and ERK1/2 of WPMY-1 cells (P<0.01). Conclusion: Prostate cancer cell exosomes could act on the stromal cell WPMY-1 to highly express multiple CAF-related molecules, promote the phosphorylation of EGFR and ERK1/2 and enhance the migration and invasion ability of WPMY-1 cells.