Adenocarcinoma, Mucinous ; pathology ; Breast Neoplasms ; pathology ; Carcinoma, Ductal, Breast ; pathology ; Carcinoma, Renal Cell ; pathology ; Carcinoma, Squamous Cell ; pathology ; Cystadenocarcinoma, Mucinous ; pathology ; Cystadenoma, Mucinous ; pathology ; Female ; Giant Cells ; pathology ; Humans ; Osteoclasts ; pathology ; Ovarian Neoplasms ; pathology ; Pancreatic Neoplasms ; pathology ; Thyroid Carcinoma, Anaplastic ; Thyroid Neoplasms ; pathology ; Tongue Neoplasms ; pathology ; Urologic Neoplasms ; pathology

Objective To investigate the effect of costimulatory molecules 4-1BB/4-1BBL on T cell activation with systemic lupus erythematosus(SLE)patients.Methods The expression of NF-kB mRNA and p38 MAPK mRNA of T cells with 20 SLE patients and 20 normal controls before activation,after activation and blocked bv 4-1BB/4-1BBL were detected bv RT-PCR.The protein levels of p-p38 MAPK and NF-kB were detected by Western blot.Results The expression of NF-kB mRNA and p38 MAPK mRNA and the protein expression of NF-kB and p-p38 MAPK of T cell with SLE patients were higher than that of normal controls(P＜0.01).There were more expression of NF-kB mRNA,p38 MAPK mRNA,NF-kB protein and p-p38 MAPK protein of T cell with SLE patients stimulated by anti-CD3 monoantibody(P＜0.01).In anti-4-1BB monoantibody blockage group,there were decreased expression of p38 MAPK mRNA and p-p38 MAPK protein(P＜0.01).but not the decreased NF-kB mRNA and protein expression.Conclusion Costimulatory molecule 4-1BB plays a critical role in T cell activation of SLE by p38 MAPK signal pathway.

Objective To observe the effects of soluble epoxide hydrolase inhibitors tAUCB on cholesterol efflux in adipocytes. Methods 3T3-L1 preadipocytes were induced to differentiation and maturation. Cells were stimilated with 100μg/L LPS after starved for 24 hours, then tAUCB in various concentrations(1 ,10,50,100 μmol/L)were added for 24 h, or incubated with the peroxisome proliferator activated receptor gamma (PPARy) antagonist GW9662 (5 μmol/L).0μmol/L tAUCB treated group was taken as empty control. After then, the mRNA expression of PPARγ and adenosine triphosphate binding cassette transporter Al (ABCA1) in cells were determined via realtime-PCR, the amounts of protein expression of PPARγand ABCA1 in cells were detected by Western blot, the efflux rates of 3H-cholesterol in cells were detected by means of liquid scintillation counter. Results tAUCB could dose-dependently increase the apolipoprotein A1 (apoA1)-mediated cholesterol efflux in adipocytes. After stimulated by 1, 10,50,100 μmol/L tAUCB, cholesterol efflux rates were (5.93±0.66) %, (7.40 ± 0. 43) %, (8. 30 ±0. 34)% ,(9.77±0.42)% respectively, there were significant difference after treated by 10-100 μmol/L tAUCB compared with control(5.67±0.17)%(P＜0.05). With the concentration of tAUCB increased,ABCA1, PPAR mRNA and protein expression were also dose-dependently up-regulated. GW9662 could significantly inhibit the effects of tAUCB, and then reduce the cholesterol efflux and the expression of PPARγ and ABCA1 in adipocytes. Conclusions tAUCB could up-regulate PPARγ expression in adipocytes, and promote the cholesterol efflux of adipocytes via apoA1-ABCA1 pathway, which might decrease the cellular cholesterol accumulation in adipocytes.

OBJECTIVETo study the consistency between DR and high-kV chest radiographs in diagnosis of pneumoconiosis and to explore the feasibility of DR chest radiograph in the diagnosis of pneumoconiosis.

METHODSTwenty five coal miners were examined with DR and high-kV chest radiographs at the same time. Image post-processing parameters (density, contrast, etc.) were set to ensure the quality of DR chest radiograph in Philips Essenta DR machine. In order to avoid the repetitive numbers, 50 chest radiographs were numbered at random. Pneumoconiosis diagnosis was conducted by six independent certified occupational physicians of pneumoconiosis by blind method. The consistency between 2 kinds of chest films was assessed.

RESULTSAll chest radiographs (25 cases, 50 chest films) were excellent. The diagnosis results of six readers on the 15 pairs of DR and high-kV chest radiographies were summarized. For high-kV chest radiographs, the consistency of pneumoconiosis classification for 12 pairs of readers was more than 68%, the consistency of total density for 11 pairs of readers was more than 68%. For DR chest radiographs, the consistency of pneumoconiosis classification for 13 pairs of readers was more than 60%, the consistency of total density for 14 pairs of readers was more than 60%. The consistency of pneumoconiosis classification between two chest radiographs was 72% (value: 0.69, 95% CI: 0.46-0.92), the consistency of total density between two chest radiographs was 80% (value: 0.78, 95% CI: 0.61-0.95).

CONCLUSIONWhen the chest radiograph quality was good and the difference of reading films was low, there was a good consistency of pneumoconiosis diagnosis between DR chest radiographs and high-kV chest radiographs.

Objective To investigate the efficacy and safety of endovascular treatment for subclavian steal syndrome (SSS). Methods During the period from April 2004 to Feb. 2013 at authors’ hospital, a total of 12 patients with SSS, including subclavian artery stenosis (n = 7) and occlusion (n = 5), underwent endovascular treatment. Percutaneous transluminal angioplasty (PTA) was carried out in 4 cases and stent implantation in 8 cases. The clinical data were retrospectively analyzed. Results Technical success rate was 100%(12/12). The diseased side/healthy side blood pressure ratio increased from preoperative (0.46 ± 0.28) to postoperative (0.89 ± 0.32), and the difference was statistically significant (P < 0.05). After the treatment, the clinical symptoms were improved in different degrees in all patients. During the follow - up period lasting for (16.7 ± 7.9) months, restenosis occurred in one case with left SSS thirteen months after PTA, and the condition was improved after stenting angioplasty. Another patient with severe subclavian artery stenosis developed peripheral micro- vascular thrombosis of the diseased limb in 23 days after PTA, which was relieved after medication to improve microcirculation and vasodilation. No severe complications such as stroke occurred. Conclusion For subclavian artery steal syndrome, endovascular management is a minimally invasive, safe and effective treatment. It can significantly relieve the clinical symptoms due to vertebral- basilar artery insufficiency caused by subclavian steal syndrome, and improve limb weakness, low body temperature, etc. Therefore, this technique should be recommended in clinical practice.

Objective To investigate the serum concentration of 25-hydroxyl vitamin D in the common autoimmune diseases and whether the differences of the 25-hydroxyl vitamin D level exist in different autoimmune diseases.Methods 137 cases of autoim-mune diseases,including 71 cases of rheumatoid arthritis(RA),36 cases of systemic lupus erythematosus(SLE),16 cases of Sjogren syndrome(SS)and 14 cases of ankylosing spondylitis(AS),in our hospital from January 2012 to April 2013 were selected as the re-spondents.The serum samples were collected for detecting the 25-hydroxyl vitamin D level by the electrochemiluminescence method and comparing the differences of the 25-hydroxyl vitamin D level among different autoimmune diseases.At the same time whether the differences in the proportion of the normal level,insufficiency and lack of 25-hydroxyl vitamin D exist among different kinds of disease.Results The serum 25-hydroxyl vitamin D concentration had statistically significant difference among the patients with dif-ferent autoimmune diseases(P =0.006),which in the RA group was significantly higher than that in the other groups;the propor-tion of 25-hydroxyl vitamin D insufficiency in RA,SLE,SS and AS were 29.6%,52.8%,62.5% and 57.1% respectively,which in the SLE,SS and AS groups was significantly higher than that in the RA group(P <0.05).Conclusion The 25-hydroxyl vitamin)D insufficiency is general in common autoimmune diseases,the vitamin D supplements needs to be strengthened.

Objective To evaluate the efficacy and safety of induction concurrent chemoradiation therapy with weekly docetaxel and cisplatin(DP) for stage Ⅲ A-N2 lung cancer.Methods Eighteen patients diagnosed of stage Ⅲ A-N2 NSCLC in our center were enrolled from March,2011 to November,2013.The induction regimen consisted of 5 cycles of docetaxel(20 mg/m2) and cisplatin(20 mg/m2) administered intravenously on days 1,8,15,22 and 29 with concurrent thoracic radiotherapy in fractions of 1.8Gy,to a total dose of 45Gy.Patients proceeded to surgery,if no progressive disease occurred,followed by adjuvant chemotherapy with DP strategy.Results Eighteen patients were enrolled and 12 underwent surgery.The tumor response for the induction therapy was 1 CR,10 PRs,6 SDs and 1 PD.Five of 18 patients presented with level 3 or above adverse effects,among which were 2 neutropenia,1 liver toxicity,1 anemia and 1 lymph node infection.The median operation time was 290 min,intraoperative blood loss was 350 ml,length for postoperative drainage was 5 d,and time to discharge was 7 d.The mediastinal lymphnodedownstaging rate was 50％ (3 pN0 cases and 3 pN1 ones),92％ of the operated patients reached complete resection.One-year survival was 75.9％ and 1-year progression free survival was 49.2％.Conclusion Weekly docetaxel and cisplatin strategy in induction concurrent chemoradiotherapy for stage Ⅲ A-N2 NSCLC patients has been validated to be safe and effective.

Objective Summarize all cases received completely thoracoscopic lobectomy,analyze the influence of lymph nodes in conversion thoracotomy and its measurements.Methods Between September 2006 to April 2013,1006 patients (545 males,461 females,median age 60 years,ranged from 13 to 86 years)received completly thoracoscopic lobectomy,including segmectomy(n =13),simple lobectomy(n =846),compound lobectomy(n =131),pneumonectomy (n =8),sleeve lobectomy(n =8).The main procedure was completely video-assisted anatomical lobectomy with mediastinal lymphadenectomy as we have reported.Results The average operative time in the conversion thoracotomy group was significantly longer[(272.7 ± 67.2) min versus (186.9 ± 58.1) min,P =0.001] compared with completely endoscopic surgery group,the average blood loss was significantly increased[(564.2 ±507.7) ml versus(158.0 ± 121.0) ml,P =0.001],the drainage time was significantly longer [(8.9 ± 5.0) days versus (6.6 ± 3.5) days,P =0.001] and the postoperative hospital stay was significantly longer [(12.5 ± 7.7) days versus(9.2 ± 5.8) days,P =0.001].Conclusion Interference of lymph doeds was the main reason for conversion to thoracotomy on VATs lobectomy.It may prolonged the operative time,increase the blood loss in operation and delay the postoperative recovery of the patients.Select the proper indication of conversion thoracotomy may reduce the negative effects of conversion thoracotomy.

Objective Summarize cases of blood loss exceed 400 ml in completely video-assisted lobectomy procedure,and retrospective analysis the cause of injury of blood vessels in the operation and discuss the intro-operative measurement.Methods From September 2009 to April 2013,1006 patients underwent VATs lobectomy in our institution,with a median blood loss of 206.7 ml.There were 125 patients that the blood loss were exceed 400 ml (82 male,43 femal) with a median age of 62.0 years.The median diameter of the solid tumor was 3.2 cm.The lobectomy consist of 42 cases of right upper lobe,40 cases of left upper lobe,19 cases of right lower lobe,15 cases of left lower lobe and 9 cases of right middle lobe.The procedure consist of 99 cases of simple lobectomy,4 cases lobectomy combine with partial chest wall resection,16 cases of compound lobectomy,3 cases of sleeve lobectomy with bronchoplasty and 3 casesof pneumonectomy.The main procedure was completely video-assisted anatomical lobectomy with mediastinal lymphadenectomy as we have reported.Results All procedures were uneventful,with a median operative time of 269.3 minutes,a median blood loss of 666.1 ml.Among 125 cases with ＞ 400 mlof blood loss,there were 3 cases of injury of pulmonary vein,2 cases were repaired endoscopiclly (In one ease,the bleeding point was clipped directly and repaired with 5-0 non-absorbable suture.In another case,the pericardium was opened,the hilar vessels were blocked,and the wound was repaired with 5-0 non-absorbable suture) and 1 case that the vein was torn and massive bleeding occurred when passing an instrument through the posterior wall of the vein and conversion to open thoracotomy was performed to control bleeding and repair the vein with 5-0 non-absorbable suture.There were 13 cases of injury of pulmonary artery,in 2 cases that the proximal trunk of ipsilateral pulmonary artery was blocked endoscopically and hemostasis was assured and then repaired the pulmonary artery with 5-0 non-absorbable suture endoscopiclly and in 11 case,conversion to open thoracotomy was performed to control bleeding and to repair the artery.The median duration of chest tube drainage was 8.0 days; median length of hospital stay was 11.1 days.There were 22 cases need blood transfusion in the operation or postoperation.All patients recovered well,47 patients (36.0％) experienced a minor complication.Conclusion Injury of blood vessels was common and troublesome in completely thoracotomy lobectomy,and always lead to conversion to thoracotomy.The surgeon should deal with it based on the character of vessles,condition of injury and experience of the surg con.

ObjectiveTo study the risk factors of mediastinal lymph node metastasis in patients with ≤3 cm peripheral non-small cell lung cancer.MethodsFrom January 2000 to December 2010,a total of 281 patients with NSCLC[152 men and 129 women,aged ( 60.31±12.13) years;≤ 3 cm in diameter]underwent lobectomy or partial resection with systematic mediastinal lymphadenectomy in hospital .Clinical data included age,gender,symptoms,history and quantity of smoking history,history of tumor,family history of tumor,site,diameter,calcification,speculation,border,lobulation,traction of pleural,vascular convergence sign,cavity were collected compaired and analyzed.Single and multi-variate analysis was performed to determine the independent risk of occult N2 nodal involvement.ResultsLogistic regression analysis show seven clinical characteristics (fleshless( OR:22.262),history of tumor(OR:5.485),diameter( 0R:3.788),density( OR;5.850),traction of pleural (OR:1.371),border ( OR:8.259) and cavity (OR:7.124) were risk factors.ConclusionFleshless,history of tumor,diameter,density,traction of pleural and the border and cavity were independent predictors of malignancy in patients with ≤3 cm peripheral non-small cell lung cancer.