Objective To evaluate the efficacy and safety ofbevacizumab combined with FOLFIRI regimen as second-line treatment in advanced colorectal cancer.Methods Sixty-five advanced colorectal cancer patients previously treated with oxaliplatin were divided into test group(33 patients) and control group (32 patients) by random digits table method.The patients in test group received bevacizumab combined with FOLFIRI regimen chemotherapy.The patients in control group received FOLFIRI regimen chemotherapy only.The therapeutic effect was evaluated every 4 cycles.Results In test group,1 patient received complete remission,9 patients had partial remission,the rate of efficacy was 30.3％ (10/33).In control group,non patient had complete remission,3 patients received partial remission,the rate of efficacy was 9.4％ (3/32).The rate of efficacy between two groups had significant difference (x2 =4.45,P =0.035).The median duration of survival was 13.0 months in test group,and 10.3 months in control group(HR =0.58,P=0.038).The median progression-free survival duration was 7.5 months in test group,and 4.4 months in control group (HR =0.45,P =0.003).The median treatment cycle was 12 cycles in test group and 8 cycles in control group.The rate of Ⅲ/Ⅳ grade adverse events in test group was higher than that in control group[72.7％(24/33) vs.46.9％ (15/32)] (P ＜ 0.05).None of these events led to death during the study.Conclusions Bevacizumab combined with FOLFIRI as second-line treatment in advanced colorectal cancer can improve the total remission rate,and prolong the progression-free survival duration and total survival duration with an acceptable adverse reaction.

Objective:To observe the efficacy and safety of docetaxel plus apatinib as a second-line treatment for advanced non-squa-mous non-small cell lung cancer. Methods:From February 2015 to August 2016, 39 eligible patients were randomly assigned to experi-mental arm (19 cases) and control arm (20 cases). Patients in the experimental arm received 60 mg/m2 d1 docetaxel and 500 mg d1-21 apatinib for a 21-day cycle until disease progression or unacceptable toxicity occurred. Patients in the control arm received chemother-apy only. Disease control rate (DCR), incidence of adverse event, and progression-free survival (PFS) were analyzed. Results:The dis-ease control rates (DCR) in the experimental and control arms were 63.2% and 30.0%, respectively, with statistical difference (P=0.039). The experimental arm experienced many grades 3-4 hematologic adverse events with statistical difference (P=0.032). The medi-an PFS values were 5.6 months (95% CI=4.8-6.3) and 3.0 months (95% CI=1.8-4.1) with statistical difference (P=0.04). Conclusion:Docetaxel plus apatinib can be delivered safely with careful monitoring for the treatment of advanced non-squamous non-small cell lung cancer, and this treatment can significantly improve the DCR and PFS.

AIM: This study is designed to demonstrate the drug resistance breast cancer cell line MCF-7/ADM has a higher proportion of cancer stem cells than its original parent cell line MCF-7 in vitro.METHODS: Firstly,the drug resistance of MCF-7/ADM was estimated by MTT method,and then higher proportion of cancer stem cells in MCF-7/ADM than that in MCF-7 was demonstrated by three aspects: side population analysis,sphere culture and cell surface markers of breast cancer stem cells.RESULTS: The drug resistance index of MCF-7/ADM compared to MCF-7 was 37.1.The proportion of side population in MCF-7/ADM and MCF-7 was 9.60%?0.66% versus 0.39%?0.11%;The proportion of sphere-initiating cells in MCF-7/ADM and MCF-7 was 10.27%?0.64% versus 1.03%?0.15%,and the proportion of CD+44CD-24 cells in these two cell lines was 64.87%?3.87% versus 3.70%?0.53%,all are statistically significant.CONCLUSION: ADM resistance breast cancer cell line MCF-7/ADM has a higher proportion of cancer stem cells than that in its original cell line MCF-7.

Objective To evaluate the application value of dermoscopy in the diagnosis of genital condyloma acuminatum (CA) in men.Methods A total of 122 warts from 66 male patients with suspected genital CA were firstly diagnosed by experienced dermatologists according to macroscopic morphological characteristics of lesions and clinical history of patients.Afterwards,the warts were examined and diagnosed by dermoscopy,and the two diagnosis results were compared with histopathological findings.Results Of 122 suspected warts,100 were diagnosed as CA by naked-eye examination,112 as CA by dermoscopy and 114 as CA by pathological examination.When histopathological findings served as the gold standard,dermoscopy had a sensitivity of 97.4％ and a specificity of 87.5％,and naked-eye examination had a sensitivity of 87.7％ and a specificity of 100％.Under dermoscopy,most male genital warts were pink (98/114,86.0％) and papillary (98/114,86.0％),and had distinct vascular characteristics (107/114,95.5％),which mainly included pleomorphic vessels (102/114,89.5％) and punctate vessels (98/114,86.0％).Conclusion CA has characteristic structures under dermoscopy,so dermoscopy can be used for the diagnosis of genital CA in men.

Objective To explore the synergetic effect of HBX protein and M2 macrophages in inflammatory microenvironment on invasion and metastasis of hepatocellular carcinoma cells.Methods Hep3B cells were infected with recombinant lentivirus carrying HBx gene,following co-culture with THP-1 original M2 macrophages.The cells were divided into six groups:two infected groups (Hep3B +and Hep3B + + M2),four non-infected groups (Hep3B-,Hep3B-+ LV5,Hep3B-+ M2,Hep3B-+LV5 + M2).Western blot (WB) was used to assess the expression changes of E-cadherin and N-cadherin,markers of epithelial-mesenchymal transition (EMT).The cellular location of EMT markers was observed by immunofluorescence confocal microscopy.Transwell assay was used to evaluate the invasion ability of Hep3B cells.Results HBX protein overexpressed in Hep3B cells by lentivirus infection.After 72 h co-culture with M2 macrophages,WB results showed that E-cadherin descreased significantly in Hep3B+ (0.42 ±0.11) when compared with Hep3B-(1.00 ±0.18) (t =4.762,P ＜0.05),while N-cadherin was significantly higher in Hep3B + (2.85 ± 0.44) than in Hep3B-(1.00 ± 0.17) (t =4.762,P ＜ 0.05).M2macrophages decreased E-cadherin expression in Hep3 B + + M2 (0.1 ± 0.13) compared with Hep3 B + (t =3.255,P ＜0.05),while N-cadherin expression increased in Hep3B+ + M2 (4.18 ± 0.52) (t=10.009,P ＜ 0.05).Non-Infected groups didn't change the markers of E-cadherin and N-cadherin.It was suggested that invasion ability of Hep3B increased by HBx overexpression.Conclusions HBX protein and M2 macrophages synergetically mediated the invasion and metastasis of hepatocellular carcinoma cells by EMT.

Objective:To explore the predictive value of renal resistive index (RRI) joint with semiquantitative power Doppler ultrasound (PDU) score to acute kidney injury (AKI) in non-septic critically ill patients.Methods:This prospective observational study enrolled non-septic critically ill patients admitted to the Emergency Intensive Care Unit of Cangzhou Central Hospital from January 2018 to August 2019. In addition to general data, RRI and PDU scores were measured with medical ultrasonic instrument within 6 h after admission. Renal function was assessed on the 5th day in accordance with kidney disease: Improving Global Outcomes criteria. The patients who progressed to AKI stage 3 within 5 days after admission were classified into the AKI 3 group, and the rest were classified into the AKI 0-2 group. The difference of each index was compared between the two groups in non-septic critically ill patients and patients with acute heart failure (AHF). Normal distributed continuous variables were compared using independent sample t-tests, whereas Mann-Whitney U tests were used to examine the differences in variables without a normal distribution. Categorical data were compared with the Chi-square test. Receiver operator characteristic curves were plotted to examine the values of RRI, PDU score, RRI-RDU/10 (subtraction of RRI and 1/10 of PDU score), RRI/PDU (the ratio of RRI to PDU score), and RRI+PDU (the prediction probability of the combination of RRI and PDU score for AKI stage 3 obtained by logistic regression analysis) in predicting AKI 3. Delong's test was used to compare the area under the curve (AUC) between predictors. Results:A total of 110 non-septic critically ill patients (51 patients with no AKI, 21 with AKI stage 1, 11 with AKI stage 2, and 27 with AKI stage 3) were recruited. Among them, there were 63 patients with AHF (21 patients with no AKI, 15 with AKI stage 1, 7 with AKI stage 2, and 20 with AKI stage 3). Among the non-septic critically ill patients as well as its subgroup of AHF, compared with the AKI 0-2 group, acute physiology and chronic health evaluation-Ⅱ score, sequential organ failure assessment score, arterial lactate concentration, mechanical ventilation rate, proportion of vasoactive drugs, 28-day mortality, serum creatinine, RRI, RRI-RDU/10, RRI/PDU, RRI+PDU, and rate of continuous renal replacement therapy were higher in the AKI 3 group, and urine output and PDU score were lower ( all P<0.05). As for non-septic critically ill patients, RRI/PDU [AUC=0.915, 95% confidence interval ( CI): 0.846-0.959, P<0.01] and RRI+PDU (AUC=0.914, 95% CI: 0.845-0.959, P<0.01) performed best in predicting AKI 3, and the AUCs were higher than RRI (AUC=0.804, 95% CI: 0.718-0.874, P<0.01) and PDU score (AUC=0.868, 95% CI: 0.791-0.925, P<0.01). The optimal cutoff for RRI/PDU was > 0.355 (sensitivity 92.6%, specificity 81.9%, Youden index 0.745). The predictive value of RRI-RDU/10 for AKI 3 (AUC=0.899, 95% CI: 0.827-0.948, P<0.01) was also better than RRI and PDU scores, but slightly worse than RRI/PDU and RRI+PDU, with statistically difference only between RRI and RRI-RDU/10 ( P<0.05). As for patients with AHF, RRI/PDU (AUC=0.962, 95% CI: 0.880-0.994, P<0.01) and RRI+PDU (AUC=0.962, 95% CI: 0.880-0.994, P<0.01) also performed best in predicting AKI 3, and the AUCs were higher than RRI (AUC=0.845, 95% CI: 0.731-0.924, P<0.01) and PDU score (AUC=0.913, 95% CI: 0.814-0.969, P<0.01) with statistically differences (all P<0.05). The optimal cutoff for RRI/PDU was > 0.360 (sensitivity 95.0%, specificity 90.7%, Youden index 0.857). The predictive value of RRI-RDU/10 for AKI 3 (AUC=0.950, 95% CI: 0.864-0.989, P<0.01) was also better than RRI and PDU score, but slightly worse than RRI/PDU and RRI+PDU, with statistically difference only between RRI and RRI-RDU/10 ( P<0.05). Conclusions:The combination of RRI and PDU score could effectively predict AKI 3 in non-septic critically ill patients, especially in patients with AHF. The ratio of RRI to PDU score is recommended for clinical application because of its excellent predictive value for AKI and its practicability.

Objective:To investigate the prevalence of thyroid nodules among students aged 8 - 17 years in Jintan District, Changzhou City, Jiangsu Province, and to explore the risk factors of thyroid nodules among underage students.Methods:In September 2018, two primary and middle schools, one ordinary high school and one vocational high school in Jintan District were selected as the survey sites. Students aged 8 - 17 years were selected as the survey subjects, and questionnaire survey, physical examination and thyroid ultrasound examination were conducted. At the same time, drinking water samples from schools and towns were collected to test water iodine, and urine samples from students and family salt samples were collected to test urinary iodine and salt iodine. Multivariate logistic regression was used to analyze related factors that may affect the occurrence of thyroid nodules.Results:A total of 725 students were surveyed, including 359 (49.5%) boys and 366 (50.5%) girls. Two water samples were collected from each of the four schools, and the mean values of water iodine were 0.3, 8.5, 0.2 and 0.2 μg/L, respectively; two water samples were collected from each of the towns where the four schools were located, and the mean values of water iodine were 6.8, 8.1, 4.8 and 3.7 μg/L, respectively. A total of 725 urine samples were collected, and the median urinary iodine was 209.92 μg/L, ranging from 8.60 to 932.00 μg/L. A total of 725 edible salt samples were collected from students' families, and the salt iodine content was (23.75 ± 7.10) mg/kg, ranging from 0.00 to 60.30 mg/kg, and 95.0% (689/725) of students' families ate iodized salt. A total of 725 students were examined for thyroid gland, and 22 were diagnosed with goiter, with an enlargement rate of 3.0%; and 155 were diagnosed with thyroid nodules, with a detection rate of 21.4%. The detection rates of thyroid nodules in boys and girls were 20.9% (75/359) and 21.9% (80/366), respectively; the detection rates of thyroid nodules in students who participated and did not participate in extracurricular tuition/interest classes in the past month were 28.2% (71/252) and 17.8% (84/473), respectively. The results of multivariate logistic regression analysis showed that girls and participating in extracurricular tuition/interest classes in the past month were independent risk factors for the occurrence of thyroid nodules [odds ratio ( OR) = 2.057, 2.538, 95% confidence interval ( CI): 1.226 - 3.451, 1.532 - 4.204, P < 0.05). Conclusions:The detection rate of thyroid nodules in students aged 8 - 17 years in Jintan District is at a high level. Girls and participating in extracurricular tuition/interest classes in the past month are independent risk factors for the occurrence of thyroid nodules.

OBJECTIVETo investigate the efficacy and safety of pegylated recombinant human granulocyte colony stimulating factor (PEG-rhG-CSF) in the salvage therapy for the grade IV neutropenia induced by concurrent chemoradiotherapy, and to provide evidence for its clinical rational application.

METHODS114 malignant tumor patients suffered with grade IV neutropenia induced by concurrent chemoradiotherapy were treated in the following groups. In the P-50 group, 42 patients received a single subcutaneous injection of 50 µg/kg PEG-rhG-CSF. In the P-100 group, 30 patients received a single subcutaneous injection of 100 µg/kg PEG-rhG-CSF. In the P+R group, 22 patients received a single subcutaneous injection of 50 µg/kg PEG-rhG-CSF and multiple subcutaneous injections of 5 µg×kg(-1)×d(-1) rhG-CSF, until the absolute neutrophil count (ANC) ≥ 2.0×10(9)/L. In the R group, 20 patients received multiple subcutaneous injections of 5 µg×kg(-1)×d(-1) rhG-CSF, until ANC ≥ 2.0×10(9)/L. The P-50, P-100 and P+R groups were experimental groups, and the R group was defined as control group. In each group, the neutrophil proliferation rate and the neutrophil counts at different time points, the period of neutropenia symptom relief, and the rate of adverse reactions induced by above drugs were analyzed.

RESULTSBoth neutrophil proliferation rates and neutrophil counts in the patients of experimental groups at different time points were significantly higher than those in the control group. In the experimental groups the period of the clinical effect began in 12-24 hours, and the conditions of neutropenia were improved in 36 hours. In the experimental groups, the period of the symptom relief such as fever and skeletal muscle pain was (30.00 ± 7.48) hours and (30.00 ± 5.10) hours, respectively, significantly shorter than (72.00 ± 17.89) hours and (59.00 ± 11.46) hours in the control group (P < 0.05). The adverse drug reaction rate was 26.1% in the experimental groups and 25.0% in the control group (P > 0.05).

CONCLUSIONSFor the treatment of grade IV neutropenia induced by concurrent chemoradiotherapy, PEG-rhG-CSF is effective and safe. The recommend dose of this drug for the salvage therapy for those patients is a single hypodermal injection of 50 µg/kg. Usually it becomes effective in 12-24 hours.

Chemoradiotherapy ; Granulocyte Colony-Stimulating Factor ; genetics ; metabolism ; Humans ; Injections, Subcutaneous ; Leukocyte Count ; Neutropenia ; chemically induced ; Neutrophils ; Recombinant Proteins ; Salvage Therapy ; methods

OBJECTIVETo explore the expression of hypoxia inducible factor-1α(HIF-1α) in esophageal squamous cell carcinoma and its correlation with clinicopathological features.

METHODSOriginal literatures in foreign languages regarding correlation between HIF-1α and esophageal squamous cell carcinoma were identified from Cochrane Library, PubMed, EMbase database, and Chinese original literatures were from CBM, CNKI. All analyses were performed by Stata 11.0 software. Histological grade, degree of differentiation, T stage, lymph node metastasis, tumor stage, lymphatic invasion and vascular invasion were analyzed using pooled odds ratio (OR) with 95% confidence interval (CI).

RESULTSA total of 14 studies including 1 121 patients were enrolled in this meta analysis. Comparing with normal tissue, the expression of HIF-1α in esophageal squamous cell carcinoma was significantly enhanced (OR = 0.088, 95% CI: 0.061-0.129, P = 0.000); HIF-1α was significantly associated with T stage and lymph node metastasis (OR = 0.421, 95% CI: 0.222-0.798, P = 0.008; OR = 0.387, 95% CI: 0.207-0.725, P = 0.003). High expression of HIF-1α was correlated with an increased depth of tumor invasion, more lymph node metastasis and advanced tumor stage, whereas there was no relation to the degree of differentiation, histological grade, tumor stage, lymphatic invasion and vascular invasion.

CONCLUSIONSHigh expression of HIF-1α protein correlates with an increased risk of esophageal squamous cell carcinoma. HIF-1α may be an indicator for T stage, lymph node metastasis and tumor stage, but further studies are needed.

Biomarkers, Tumor ; metabolism ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Confidence Intervals ; Esophageal Neoplasms ; metabolism ; pathology ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Lymphatic Metastasis ; Odds Ratio

【Objective】 To explore the effects of early application of erythropoietin (EPO) in patients with anemia after renal transplantation. 【Methods】 Patients who underwent renal transplantation in the First Affiliated Hospital of Soochow University were retrospectively analyzed. According to whether EPO was applied after operation, the patients were divided into EPO group and routine group. Patients with delayed renal function recovery were excluded, and the remaining patients were further analyzed. The general, laboratory and follow-up data of the two groups were compared, and adverse drug reactions were observed. 【Results】 The hemoglobin (P=0.026), red blood cell count (P=0.038) and hematocrit (P=0.011) in EPO group were higher than those in the routine group 2 weeks after operation, while the postoperative serum creatinine level was lower (P=0.001). Since the first week after operation, the reticulocyte count in EPO group was significantly higher than that in routine group (P<0.01). There was a negative correlation between hemoglobin and serum creatinine in EPO group at week 1 (r=-0.375, P=0.010) and week 2 (r=-0.386, P=0.008). During the treatment, 6 patients showed transient elevation of serum potassium, which returned to normal after symptomatic treatment, and no obvious adverse drug reactions were observed. 【Conclusion】 Continuous application of erythropoietin in the early stage after renal transplantation can significantly improve anemia in renal transplant patients and promote the recovery of renal function.