Objective To evaluate the relationship between the CT features and pathology of peripheral adenocarcinoma.Methods Eighty patients with peripheral pulmonary adenocarcinoma (including 44 well-differentiated,23 moderate and 13 poorly one)confirmed by pathology were collected in this series.The comparative study on CT finding and pathologic data was done.Results Air bronchograms were seen in 35 cases (79.6%)in high differential adenocarcinoma and were seen in 7 cases(30.4%) in moderate differential adenocinoma but not seen in low differential ones.The emergeua rate of lobular sign,burr sign,sign of hollowed and sign of blood vessel bundle was high in low differentiated adenocarcinoma.Lymphnode metastases and distant matestasis in moderate-low differentiated adenocarcinoma were much more than that of high differentiated ones. Conclusion The air bronchogram in nodule on CT image is important in evaluating diagnosis and progrosis of peripheral adenocarcinoma.

Objective To evaluate the efficacy and safety of sorafenib in combination with interferon-alpha(IFN-α)as the first-line treatment in patients with advanced renal cell carcinoma.Methods Since Dec 2007 to Jun 2008,137 legal patients with advanced renal cell carcinoma (RCC)were enrolled in the trail from 22 hospitals in China.All the patients continuously received the treatment of sorafenib plus IFN-α untill disease progressed or patients were unable to tolerate.The primary end points were objective response,disease control rate and adverse effects rate.Results This interim analysis was based on the data collected from the study initiation date to 2009/3/20.The overall response rate(ORR),including complete response (CR) and partial response(PR),was 32.8%(45/137).The median follow-up time was 11.9 months,only 25 patients progressed at the cut off time.The most common adverse events were hand-foot skin reaction(48.2%),alopecia(23.4%),rash (20.4%),diarrhea(19.7 0A),fever(16.8%),lassitude(10.2%),etc.The incidence of 3 or 4 grade hand-foot skin reaction was 8.8%.Conclusions Sorafenib in combination with IFN-α as the firstline treatment in patient with advanced RCC could be effective and safe.

Objective To investigate the prevalence of sexual dysfunction in aged men and associated risk factors in Beijing. Methods A cross-sectional study was performed in communities of Beijing involved 1656 men aged over 50 years.The International Index of Erectile Function-5 (IIEF-5),Brief Male Sexual Function Inventory for Urology ( O'Leary 1995 ) and the International Prostate Symptom Score (IPSS)questionnaires was recorded.The body mass index (BMI),prostate size was measured.The survey was conducted to make sure if the patients had diabetes,high blood pressure,hyperlipidemia,cerebrovascular history,and smoking and drinking situation.Pearson's X2 test and unconditional logistic regression were used to investigate the factors associated with sexual dysfunction. Results 1644 subjects were enrolled.The incidence of ED,reduction of sexual desire and defective ejaculation was 90.45％,60.04％ and 38.81％ respectively,and significantly different according to age ( P ＜ O.05 ). Age was positively correlated with ED (3 =0.12,P＜0.05),reduction of sexual desire (β =0.10,P＜0.05) and defective ejaculation (β =0.10,P ＜ 0.05 ) ; ED was significantly associated with BMI (β =0.07,P ＜ 0.05 ).Hypertension and prostate size were risk factors for reduction of sexual desire and defective ejaculation; There was correlation between drinking and defective ejaculation ( β =- O.31,P ＜ 0.05 ). Conelusions Compared with high prevalence of ED and lower sexual desire,the incidence of defective ejaculation were lower; this may reflect the sexual activities of aged male were more active compared with the less success of really erection.The prevalence of ED,reduction of sexual desire or defective ejaculation increased with age.BMI was the risk factor for ED.Enlarged prostate and hypertension was associated with reduction of sexual desire,and drinking was the risk factor for defective ejaculation.

Objective To investigate the effectiveness of Uromentor virtual reality simulator in flexible ureteroscopy training for catechumen.Methods Fifty-one catechumen were selected.After 1 hour training of basic operation in Uromentor virtual reality simulator, all trainees performed special-purpose exercise ( kidney inspection with flexible ureteroscopy ) for 3 hours. Using right kidney inspection, a preliminary assessment for each trainee was made before the special-purpose exercise and data such as total time, number of trauma from the scopes and tools, percentage of kidney surface examined and global rating scale ( GRS ) were recorded.The same assessment was performed once again after the special-purpose exercise ( secondary assessment ) , and data were recorded and compared to the preliminary assessment. Results Each trainee made a significant improvement in flexible ureteroscopic skill after the special-purpose training.The parameters such as total time, number of trauma from the scopes and tools, percentage of kidney surface examined and GRS of all trainees in preliminary assessment were 14.63 ±1.01 min, 8.62 ± 2.67, 51.05%±20.79%and 10.31 ±2.53, respectively;while in secondary assessment, parameters were 7.71 ±1.13 min, 1.67 ±1.23, 98.04% ±5.42% and 29.14 ±3.01, respectively.The differences between the preliminary assessment and the secondary assessment of each parameter were significant ( P<0.01).Conclusions The Uromentor virtual reality simulator can improve the trainee′s skills of flexible ureteroscopy.It is a good instrument of the flexible ureteroscopic training for catechumen.

Objective To investigate the production of carbapenemase and 16S rRNA methylase in five isolates of pan-drugs resistant E.cloacae recovered in Ruijin hospital.Methods MICs of the five isolates to 10 antibiotics were determined by E test.Six kinds of 16S rRNA methylase genes and a series of β- lactamase genes were amplified by PCR.Shotgun cloning was performed to detect carbapenem resistance determinant.The conjugal transfer of carbapenemase gene and 16S rRNA methylase gene was performed in broth culture with E.coli J53 as the recipient.Pulsed-field gel electrophoresis (PFGE) was carried out to analyse the genotyping.IEF was performed to detect β-1actamases.Southern blot was performed to determine the location of carbapenem resistance determinant.Results The MICs of 10 antibiotics were ＞32 mg/L.Four β-1actamases with pIs of 5.4 ( TEM-1 ),6.7 ( KPC-2 ),8.2 ( SHV-12 ),8.4 (CTX-M-14) were determined.The insertion sequence in the recombinant plasmid was blaKPC-2 flanked by a transposon.blaKPC-2 was located on a large non-conjugative plasmid whereas armA was located on an other conjugative plasmid.PFGE patterns of 5 isolates were identical.Conclusion KPC-2 was responsible for carbapenem resistance in pandrugs resistant Enterobacter cloacae.There was no relationship between blaKPC-2 and armA.Although pandrug resistant Enterobacteriaceae remain rare,the emergence of this group of organism merits monitoring.

Objective To investigate the expression of bone morphogenetic protein-7(BMP-7)in the tissue of prostate cancer(PCa). Methods The pathological samples of 87 cases of PCa were collected.The average age was 66(59-78)years,preoperative of t-PSA was 45.7(2.4-138.2)ng/ml.Gleason score:37 cases were≤6,18 cases were 7,32 cases were≥8.Stages:stage I(T1aN0M0)+stageⅡ(T1bN0M0,T1cN0M0,T2N0M0)20 cases;StageⅢ(T3N0M0)20;Stage Ⅳ(T4N0 M0,TxN1 M0,TxN0 M1)47 cases.According to bone scan or positron emission computed tomography-CT test results,patients were divided into PCa without bone metastasis,42 cases and PCa with bone metastasis,45 cases.Thirty cases of BPH were set as controls.BMP-7 in the PCa and BPH were detected by PV immunohistochemical study.Statistical analysis was done between two groups to compare the differential expression of BMP-7 and serum t-PSA in PCa, and BPH tissues.Results BMP-7 expression in the absorbance A value in benign prostatic hyperplasia was 70.55±5.41, in prostate cancer tissue 70.47± 6.18, no significant differences between the 2 groups(P>0.05).BMP-7 expression in the absorbance A value in prostate cancer without bone metastasis was 65.94 ± 1.76, but with bone metastasis 74.80±5.76.There was a significant difference (P<0.05).Gleason score≤6 absorbance A value was 65.96 ± 1.56, Gleason 7 absorbance A value 65.83 ± 2.75,≥8 absorbance A value 78.06±1.39.Compared with Gleason score≥8, BMP-7 expression in the absorbance A value were significantly lower than the latter (P<0.05).Clinical stage grouping of BMP-7 expression in the absorbance A value: Stage Ⅰ + Ⅱ 65.86±1.72, Stage Ⅲ 65.87±1.85, Stage 74.49±5.83.There was a significant difference (P<0.05).In PCa tissues, BMP-7 of the absorbance A value and the serum t-PSA values showed a positive correlation (r=0.77,P,<0.05). Conelusions The expression level of BMP-7 has occurred in the high pathological Gleason score, late clinical stage, particularly in bone metastasis cases.The expression level of BMP-7 and serum t-PSA have a positive correlation.

BACKGROUND:Displacement of the distal fracture fragment is one of the most important facts that lead to cubitus varus fol owing pediatric supracondylar humeral fracture. Mainstream technique emphasized the restoration of posterior-ulnar deviation of the distal fragment. However, there is an absence of supportive evidences from biomechanical studies. OBJECTIVE:To establish models of extension-ulnar type of supracondylar humeral fracture and investigate the mechanical stability of reduced fracture with residual displacements within functional restoration standard, so as to provide mechanic evidences supporting the empirical rule of manipulative reduction-“better anterior than posterior, better radial than ulnar”. METHODS:The fresh cadaveric bone of right upper extremity from a 7-year-old child was scanned using CT. Models of supracondylar humeral fracture differing in contact area of the fracture site and displacement direction of the distal fragment were established and underwent loading tests. Stress in both anterior and posterior margin of the fracture site and Baumann angle were recorded, and data were analyzed and compared. RESULTS AND CONCLUSION:In comparison of stress in the posterior margin, the value was significantly greater in the posteromedial-displacement group than the others. Stress value in fracture with 75%contact area was significantly greater than the other three groups. In comparison of stress in the anterior margin, a significantly greater value was obtained in the posteromedial-displaced group. Stress value in fracture with 85%contact area was significantly greater. When comparing stress in posterior margin and anterior margin, the absolute increment of stress value was greater in posterior displacement group than in anterior displacement group. Baumann angle increased significantly when fragment displaced medial y. Above findings indicated that displacement direction altered the location of stress concentration. Stress augmentation was greater in posterior displacement group. Stress in related area significantly increased constantly when contact area of the fracture site reduced. Baumann changed obviously when fragment displaced medial y. The results preliminarily verify the hypothesis that displacement of the distal fragment was the main contributor to cubitus varus fol owing supracondylar humeral fracture. These findings provided certain evidences supporting the empirical rule“better anterior than posterior, better radial and ulnar”.

Objective To seek an effective surgical procedure to treat patients with the varying degrees of breast ptosis and micromastia.Methods Patients were classified into Ⅰ-Ⅳ degrees based on different breast ptosis,and treated by different methods.Degree Ⅰ was treated with implanting prosthesis to the post-pectoralis major space; degree Ⅱ patients were repaired with avulsion of deeper mammary gland and pectoralis major and hanging fixed breast tissue,based on the degree Ⅰ procedure; degree Ⅲ was fixed with breast tissue flap,excised redundant epidermis by the method of double-rings and the complex of nipple and areola was shifted,based on the degree Ⅱ procedure; degree Ⅳ was repaired with implanting prosthesis and the method of lines to hanging fixed breast.Results In 116 cases of this study,there were no hematoma,infection and nipple and areola necrosis by the combined strategies.The follow-up period after the surgery was 6-31 months (mean 13.3 months).All cases had voluptuous and upright breasts,rectified breast ptosis,with the normal sense of nipple and areola.Conclusions For breast ptosis and hypoplasia,the combined strategies have better clinical therapeutic effects.

Objective To investigate antibiotic resistance and molecular epidemiology profile of methicillin-resistant Staphylococcus aureus (MRSA) in Shanghai. Methods The antibiograms of 140 MRSA isolates from 5 hospitals for 13 drugs were analyzed by agar dilution and broth dilution. The PVL gene and SCCmec were detected by PCR; The clonal relatedness of 140 isolates were determined by PFGE and 39 strains were chosen to be characterized further by spa typing. Results All 140 MRSA are PVL negative and most of them were identified as SCCmec Ⅲ [45.7% (64/140)], followed by SCCmec Ⅲ a [25.0% (35/140)], SCCmecⅢb [14.3% (20/140)], SCCmecⅡ [10.7% (15/140)] and SCCmecⅣ [4.3% (6/140)]. All isolates were susceptible to vancomycin, teicoplanin and daptomycin. The resistance to gentamicin, sulphamethoxazole and clindamycin was 98. 6% (138/140), 98. 6% (137/140) and 97. 9% (137/140), respectively. Resistance to erythromycin, ciprofloxacin and tetracycline was above 80%, and resistance to rifampicin was 10. 7% (15/140). Sixteen different PFGE patterns(A-P) were found and most of MRSA belonged to group C[30. 7% (43/140)] ,B[13.6% (19/140)]and Ⅰ [10. 7% (15/140)]. Among 39 strains with prevalent PFGE patterns, 4 spa genotypes were identified: t002133. 33% (13/39)] ,t030 [12. 82% (5/39)] ,t037[51.28% (20/39)]and t459[2. 57% (1/39)]. Conclusions Sixteen different PFGE patterns and 4 spa genotypos were found from 5 hospitals in Shanghai. The most popular MRSA clone is PVL negative, SCCmec Ⅲ, with resistant profile of erythromycin, ciprofloxacin,clindamycin,etracycline, gentamicin,and sulphamethoxazole [E-C-L-T-G-M-]. This result suggests that hospital infection control and reasonable antibiotic usage are critical.

Objective To evaluate the efficacy and safety of sorafenib in the treatment of Chi-nese patients with metastatic renal cell carcinoma. Methods This muhicenter phase Ⅱ clinical trial was performed from May 2006 to December 2006. Sixty-two patients with metastatic renal cell carci-noma not suitable for curative treatment were enrolled. All patients received oral sorafenib as single a-gent at the dose of 400 mg twice a day until disease progression or intolerable toxicities occurred. Re-salts Partial responses were recorded as best response in 11 patients, while complete remission was found in 1 patient and stable diseases were found in another 35 patients. According to the intents-to-treatment population, the overall response rate was 19.4% (12/62), and the disease control rate was 77.4%(48/62). The median progression free survival time was 9.6 months with 1-year progression-free survival rate of 41.9%. However, the median survival time had not reached due to the short fol-low-up. The most frequent adverse events included alopecia (66.1%), diarrhea (62.9%), hand-foot syndrome (58.1%), anorexia (40.3%), rash(37.1%), fatigue (37.1%), hypertension (35.5%), hoarseness(32.3%), joint pain (25.8%), hypophosphatemia (21.0%), fever (19.4%), nausea (19.4%), abnormal transeaminase( 11.3% ), elevated total bilirubicin( 16.1% ), leucopenia( 12.9% ), bleeding under nail(16.1%), and gum bleeding(11.3%). Grade 3 adverse events included hand-foot syndrome (16.1%), hypertension (12.9%), diarrhea(6.5%), hypophosphatemia (4.8%), joint pain (3.2%), and leucopenia(3.2%). Conclusions Sorafenib has prominent anti-tumor activity in Chi-nese metastatic renal cell cancer patients with most adverse events being grade 1 or 2. More attention should be paid to hypertension and cardio-cerebral vascular events during the application of sorafenib.