Objective The aim of this study was to investigate the distribution and clinical significance of CD8+ T cells in bladder cancer tissues in situ.Methods Immunohistochemistry were used to examine the distribution of CD8+ T cells in bladder cancer tissues,which were obtained from January 2003 to December 2009 from 302 patients.Among all the patients,262 were male while 40 were female;mean age is 60 years;tumor size ≤ 3 cm was in 235 and tumor size ＞ 3 cm was in 67;Unifocal tumor was in 214 and multifocal tumors were in 88.Amount of tumor stage Ta-T1 was 212 and T2-T4 was 90.Sixteen patients have lymph node metastasis.Histological low grade was diagnosed in 175 and histological high grade was diagnosed in 127.According to the differences between anatomic structure and cellular composition,bladder tumor tissues can be classified to two localization patterns:(1) intratumoral regions,defined as tumor cell nests;(2) stromal regions,defined as stromal areas that lack direct contact with tumor cells.Therefore,we divided 302 bladder cancer patients into two groups based on the median frequency of intratumoral CD8+ T cells (median,3/× 400 high resolution) and stromal CD8+ T cells (median,37/× 400 high resolution),respectively.x2 analysis was used to evaluated the correlation between CD8+ T cell density and clinicalpathological variables.Kaplan-Meier analysis and Cox proportional hazards regression models were applied to estimate overall survival (OS).Results CD8+ T cells were predominantly located in the intratumoral regions (mean,14 ± 2/× 400 high resolution) rather than in associated stromal regions (mean,50 ± 3/× 400 high resolution,P ＜ 0.05).The density of intratumoral CD8+ T cells was inversely associated with age (P =0.026),tumor size (P ＜ 0.05) and tumor stage (P ＜ 0.05),and could represent a favorable prognostic predictor of OS (HR =0.427,P =0.003).However,the density of stromal CD8+ T cells was positively associated with age (P =0.004) and histological grade (P ＜ 0.01),and could represent an adverse prognostic predictor of OS (HR =2.206,P =0.009).Conclusions Our findings suggest that intratumoral/ stromal CD8+ T cells could potentially serve as favorable/ adverse prognostic markers for bladder cancer patients,respectively.

Objective To evaluate the causes,prevention and treatment ot laparoscopic comphca- tions in urologic surgery.Methods From May 2000 to May 2004,135 urologic laparoscopies were per- formed,including 17 transperitoneal laparoscopies and 118 retroperitoneal laparoscopies.Of the135 cases,26 had adrenal adenoma extirpation;31 had roof-removal and decompression of renal cyst;25 had radical ne- phrectomy;6 had pyeloplasty;2 had partial resection of renal capsula and encapsulation of the great omen- tum;2 had partial nephrectomy;4 had pelviureteral resection;13 had ligation of renal pedicle lymphatic ves- sel;2 had ureterolysis;7 had ureterolithotomy;12 had ligation of spermophlebectasis;5 had exploration,re- duction and fixation of undescended testis.The intra-and post-operative complications were retrospectively reviewed and clinically analyzed.Results Overall,14 cases(10.4%)had complications.Intraoperative complications occurred in 10 cases,including 6 cases of peritoneal injuries,which were clamped during oper- ation;4 of vascular injuries,which resulted in conversion to open surgery.Postoperative complications oc- curred in 4 cases,including 2 of subcutaneous emphysema,which was spontaneously absorbed at 5 and 7 d after operation;1 of incision seepage,which was drained for 40 d and then disappeared;and 1 of urine reten- tion,for which urethral catheterization was kept for 3 d and then the patient had voluntary voiding.No death occurred in this series.Conclusions Understanding the characteristics of laparoscopic complications in u- rologic surgery and systematic training of the surgeons can reduce the occurrence of complications.

Objective To investigate the safety and efficacy of the modified laparoscopic radical cystectomy and standard pelvic lymph node dissection for female bladder cancer patients.Methods Fortyone female patients with bladder cancer who underwent laparoscopic radical cystectomy(LRC) and standard pelvic lymph node dissection(sPLND) in our hospital from June 2003 to January 2016 were retrospectively analyzed.The patients were divided into two groups according to the surgical procedure.There were 15 patients with ≤ cT2 tumor and 1 patient with cT3 in the modified group.The average age was (62.2 ± 11.5) years.The median BMI was 20.7 kg/m2,ranging 18.4 to 22.2 kg/m2;The ASA level was less than Ⅱ in 9 (56.2％) cases and was level Ⅲ in 7 (43.8％) cases.There were 22 patients with ≤ cT2 tumor and 3 patients with cT3 in the traditional group.The average age was (60.4 ± 12.9)years.The median BMI was 21.7 kg/m2,ranging 18.4 to 23.1 kg/m2.ASA was less than level Ⅱ in 15(60.0％) cases and level Ⅲ in 10(40.0％) cases.All operations are performed under general anesthesia.In the traditional group,the plane between rectus and uterus is separated first.Then open the posterior cervical fornix and cut off the lateral bladder pedicle,cardinal ligament of uterus and urethra.The bladder and uterus are removed together.The sPLND is performed at last.In the modified group,the sPLND is performed first.Then separate the bladder and uterus until the anterior wall of the vagina can be exposed.The bladder and uterus are removed separately.Data of the operation and the complications were collected and analyzed.Results All patients were performed the operation successfully.No open conversion was recorded during the operation.No patient died during the peripheral operative phase.In modified group,10 patients received orthotopic ileal neobladder (OIN),5 patients received ileal conduit and 1 patient received ureterostomy.In traditional group,19 patients received OIN,3 patients received ileal conduit and 3 patients received ureterostomy.No significant difference of surgical method was noticed in those group.The median operative time in modified group and traditional group was 290 min (ranging 265-335 min) and 315 min (ranging 270-380 min),respectively(P ＞ 0.05).The median estimated blood loss in modified group and traditional group was 100ml (100,100) and 200ml (200,400),respectively (P ＜ 0.05).The rate of transfusion in modified group and traditional group was 6.3％ (1/16) and 18.5％ (5/27),respectively (P ＜0.05).The incidence of early complications between two groups showed no statistically difference.No major (Clavien grade 3 to 5) complications occurred in modified group.However major complications occurred in 3 patients in traditional group,followed by 2 neobladder vagina fistula,1 ileal anastomotic stoma fistula.All those complications were cured by operation.All patients were diagnosed urothelium carcinoma.In modified group,the tumor stage included carcinoma in suit in 2 cases,pTa-pT1 in 7 cases,pT2 in 6 cases,pT3 in one case.In traditional group,the tumor stage included pT1 in 12 cases,pT2 in 10 cases,pT3 in 3 cases.The numbers of resected lymph node in modified group and conventional group were 16 (ranging 7-19) and 10 (ranging 7-13),respectively (P ＞ 0.05).Conclusions The modified laparoscopic radical cystectomy and pelvic lymph node dissection for female bladder cancer patients could reduce the blood loss and incidence of neobladder vaginal fistula comparing with the traditional operation.

1. 5 cm) sessile colorectal polyps referred for EMR. After submucosal injection of epinephrine, either en bloc or piecemeal snare polypectomy were performed. All resected specimens were retrieved for pathologic study. Follow-up colonoscopy was performed in all patients after EMR. Results All 157 polyps were removed completely. All lesions are larger than 1. 5cm, but 3 less than 1 cm on the submucosa of rectum. The largest one is 13 cm X 12 cm. No complication occurred. Histopathologic assessment of the resection specimens revealed the following: adenoma, 123; dysplasia, 80; mucosal carcinoma, 11; hyperplastic polyps, 20; rectal carcinoid, 3. Two patients who had rectal adenoma that was larger than 7cm recurrence happened at the resection site after 1 and 3 months follow-up respectively, than removed completely by hot biopsy forceps showed hyperplastic and villous adenoma on pathological study. No more residual tumor was detected for 6-12 months. Conclusion EMR with an intensive follow-up program is a safe and effective treatment for large sessile colorectal polyps and mucosal carcinoma.

Objective To explore the methylation status of hMLH1 and hMSH2 promoter region in the epithelial ovarian cancer and its role in oncogenesis.Methods Methylation status of hMLH1 and hMSH2 promoter region was assayed in 20 normal ovarian tissues,25 benign epithelial tumor,56 malignant epithelial tumor and cell lines SKOV3,3AO by methylation-specific PCR (MSP).SKOV3 and 3AO were analyzed before and after 5-aza-2′-deoxycytidine (5-Aza-CdR) treatment.In addition,an alterations of mRNA expression of hMLH1 and hMSH2 was observed by reverse transcription polymerase chain reaction (PT-PCR).Results No methylation of hMLH1 and hMSH2 promoter was found in normal ovarian tissues. CPG islands methylation of hMLH1 and hMSH2 was observed in 4% (1/25),8% (2/25) respectively in benign epithelial tumor,30.4% (17/56),51.8% (29/56) respectively in malignant epithelial tumor. Methylation status in promoter showed obvious correlation with pathological grade and lymph node metastasis (P

Objective To evaluate the clinical outcomes of external fixator with lumbopelvic distraction spondylodesis in treatment of vertically unstable pelvic fractures. Methods From January 2008 to March 2009, 9 patients (4 males and 5 females) with a vertically unstable pelvic fracture were treated with modular external fixator with lumbopelvic distraction spondylodesis. According to the classification of Tile, 9fractures were classified as type C. This fixation construct comprises a vertical lumbopelvic distraction component which fixed L4.5 and the posterior superior iliac spine and a transverse fixation which fixed anterior iliac spine with external fixator. Results All patients were followed up 12-18 months after surgery, with an average of 14.3 months. Postoperative X-ray showed satisfactory reduction of pelvic fracture. Pelvic fractures healed in all patients without loss of reduction 3-6 months after operation. According to Matta reduction evaluation criteria, 6 patients were excellent and 3 good. For the two patients with sacral neurological injuries,appropriate surgical decompression was performed to improve the symptom and minimize the deformity. No iatrogenic complications of neurovascular injury occurred. Patients now walk unassistedly without pain in the waist or legs, and with no shortening of lower limbs or claudication. By considering symptom and satisfactory scores, the Majeed functional assessment revealed that seven patients had excellent results and two good at one year. Conclusion External fixator with lumbopelvic distraction spondylodesis that allowed early mobilization and ambulation, with general applicability and definite safety, is an effective surgical technique for the treatment of vertically unstable pelvic fracture.

OBJECTIVETo explore potency material bases of Xuebijing (XBJ) formula, and to analyze its effects at the molecular network level.

METHODSTotally 16 sepsis-related targets were selected and classified into three categories such as inflammation, immune, and coagulation referring to biological roles. Then molecular database of chemical compositions in XBJ formula were constructed to explore mutual actions with inflammation, immune, and coagulation targets.

RESULTSDanshen root and safflower, with more effector molecules with immune and coagulation targets, have extensive anticoagulation and anti-inflammation effects. The former 10 molecules with better mutual actions with sepsis targets were sequenced as tryptophane, danshensu, gallic acid, salvianolic acid D, protocatechuic acid, salvianolic acid A, danshensu C, vanillic acid, rosmarinic acid, phenylalanine. There existed two phenomena in XBJ formula as follows. One component had stronger actions with multi-targets, for example, danshensu had actions with 13 targets. Meanwhile, different components acted on the same target protein, for example, 8 molecules acted with MD-2.

CONCLUSIONXBJ formula had certain potential synergistic effects with sepsis targets, which could provide certain referential roles for findina new type anti-septic drugs.

Caffeic Acids ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; therapeutic use ; Gallic Acid ; Hydroxybenzoates ; Inflammation ; Lactates ; Sepsis ; drug therapy

OBJECTIVETo investigate the clinical effects of close reduction and minimally invasive percutaneous plate osteosynthesis in treating proximal humerus fractures in the aged.

METHODSFrom February 2012 to December 2013,39 patients with proximal humerus fractures were treated with minimally invasive percutaneous plate osteosynthesis (MIPPO group, 21 cases) and open reduction internal fixation (ORIF group, 18 cases). Including 17 males and 22 females in the study, and aged from 67 to 88 years old with an average of (71.8 ± 5.2) years old. In MIPPO group, there were 11 males and 10 females with an average age of (70.0 ± 5.3) years old;and in ORIF group, there were 10 males and 8 females with an average age of (72.0 ± 4.2) years old. Operation time, blood loss during operation, fracture healing time and postoperative complications were recorded. The functions of the shoulder joints were assessed according to Constant-Murley score at final follow-up.

RESULTSAll the patients were followed up from 11 to 27 months with an average of 18.1 months. The mean blood loss of the MIPPO group was (176.0 ± 57.4) ml,while the ORIF group was (356.0 ± 66.9) ml (t = 7.22,P = 0.01). The operation time of the MIPPO group was (47.4 ± 14.9) min, while the ORIF group was (92.7 ± 15.8) min (t = 0.79, P = 0.03). Fracture healing time in the MIPPO group and ORIF group was (17.6 ± 5.8), ( 21.7 ± 4.9) weeks, respectively (P < 0.05). The mean Constant-Murley score at final follow-up was 89.7 ± 14.5 in MIPPO group, and 81.8 ± 13.2 in ORIF group (P < 0.05).

CONCLUSIONMIPPO has advantages of little trauma, less blood loss, rapid recovery, less vascular damage and so on and can effectively treat the proximal humerus fracture in the aged.

Aged ; Aged, 80 and over ; Bone Plates ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Shoulder Fractures ; surgery

AIM and METHODS: To study the culture met ho d of human neural stem/progenitor cells, these cells derived from human fetal fo rebrains were maintained and expanded in serum-free defined medium containing ba sic fibroblast growth factors (bFGF), epidermal growth factor (EGF) and B27. Whe n they formed neurosphere, these three factors and supplemented FBS were removed to induce differentiation. Cell were cultured for 12-14 d, then fixed for immun ocytochemistry examination. RESULTS: This period of expansion resulted in a 107-fold incre ase in this heterogeneous population of cells. Upon differentiation, they form n eurons, astrocytes and oligodendrocytes, the three main phenotypes in the CNS. CONCLUSION: These results demonstrate the feasibility of long-t erm in vitro expansion of human neural progenitor cells. The advantages of s uch a population of neural precursors for allogeneic transplantation, including t he ability to provide an expandable, well-characterized, defined cell source, ca n form specific neuronal or glial subtypes.

Objective To evaluate the functional outcomes and complications of patients with bone tumors who were treated with the excision-alcoholization-replantation (EAR) method. Methods From August 1965 to August 2003, 191 patients treated with the EAR method who had suitable follow-up were evaluated in our department, including 102 males and 89 females with an average age of 20 years (range, 10-62). On the basis of Enneking tumor staging, 136 patients were identified II B stage, 25 I B stage, and 30 invasive benign tumors and tumor-like lesion. The length of the resected part ranged from 5 cm to 26 cm, with marginal resection in 30 cases, wide resection in 116. The oncological parameters that were evaluated included survival of the patients, local recurrence, and metastasis. Complications included non-union, infection, and fracture of the grafts. Mankin evaluation system was used to assess functional outcomes. Results The mean follow-up time was 32 months (range, 1-372), 52 patients died with disease at the final follow-up. Five-year survival rates of high grade sarcoma and low grade sarcoma were 59% and 90%, respectively, with statistical significance (P=0.02). Lung metastasis were demonstrated in 52 patients (27.2%, 52/191), 51 (26.7%, 51/191) had local recurrence. Except the tumor factor, the total complication rate was 50.3%(96/191). Local complications included 33 nonunion (17.3%, 33/191), 39 fracture of the grafts (20.4%, 39/191), 39 infections of the graft (20.4%, 39/191), 15 fracture of internal fixation (7.9%, 15/191), 5 instability or semiluxation of the joint (2.6%, 5/191). The 5-year survival rate of inactivated bone was 55%. On the basis of Mankin functional evaluation, the satisfied rate was 50.3%. At last there were 141 patients (73.8%, 141/191) preserved their extremities. Conclusion Compared to other methods in the same period, EAR method is considered on the same level of safety in oncology, which superiorities are economic-applicable to patients and the well fitness of bone graft with the defects.