Objective To study the influence of microvascular invasion (MVI) on progression-free survival (PFS) in patients with a solitary small hepatocellular carcinoma,and to analyze the risk factors of MVI.Methods 126 patients with a solitary small hepatocellular carcinoma who underwent liver resection at Tianjin Medical University Cancer Hospital from January 2010 to December 2012 were retrospectively studied.Their demographic and clinicopathological characteristics including age,gender,HBV infection,HCV infection,alcohol consumption,comorbidity,liver cirrhosis,ascites,tumor size,tumor differentiation,MVI,satellite lesion,AFP,CA19-9,ALT and TBil were analyzed.Results The 1-,2-and 3-year PFS rates of patients with a solitary small hepatocellular carcinoma were 81.0％,60.3％ and 47.3％ after surgical resection,respectively.Univariate analysis revealed that MVI,comorbidity,non-well-differentiated tumor,tumor size ＞4 cm were risk factors of PFS.Multivariate analysis demonstrated that only MVI and comorbidity were independent factors of PFS.MVI occurred in 43.7％ of the patients.The median PFS of patients without MVI was 45 months,and the 1-,2-and 3-year PFS rates of these patients were 91.5％,67.6％ and 56.0％,respectively.The median PFS of patients with MVI was 30 months,and the 1-,2-and 3-year PFS rates were 67.3％,50.9％ and 35.4％,respectively.On univariate analysis,AFP ＞ 100 μg/L,non-well-differentiated tumor and satellite lesions were significantly associated with MVI.On multivariate analysis only non-well-differentiated tumor was independently associated with MVI.Conclusions MVI was an important factor affecting PFS in patients with a solitary small hepatocellular carcinoma.AFP ＞ 100 μg/L,non-well-differentiated tumor and satellite lesions were risk factors of MVI.

Objective To evaluate the effect of prefilling blood reservoir with mannitol-adeninephosphate MAP) solution on the damage to erythrocytes in intraoperative salvaged blood in patients.Methods One hundred and fifty blood samples were collected from 150 patients who were scheduled for elective spinal surgery requiring blood salvage,and were equally and randomly divided into 5 groups (n =30 each) using a random number table:group N,group N1,group N2,group M1 and group M2.The blood reservoir was not prefilled before surgery in group N,while the blood reservoirs in N1,N2,M1 and M2 groups were prefilled with normal saline (NS) 100 ml,NS 200 ml,MAP solution 100 ml and MAP solution 200 ml,respectively.Blood sauples were obtained for erythrocyte osmotic fragility test after the salvaged blood was washed,and hemolysis rates in different concentrations of hypotonic NaCl solution were calculated.The concentration of free hemoglobin in the clear supernatant liquid (FHb) of washed blood placed for 0 h (T0),1 h (T1) and 2 h (T2) were detected.Results Compared with N and N1 groups,the hemolysis rate of washed erythrocytes under 0.48％ 0.68％ NaCl solutions was significantly decreased,the concentration of FHb at T1 was decreased,and no significant change was found in FHb at T2 in group M1.Compared with N and N2 groups,the haemolysis rates of washed erythrocytes under 0.48％-0.68％ NaCl solutions were significantly decreased,and the concentrations of FHb at T1,2 were decreased in group M2.The concentration of FHb was significantly lower at T2 in group M2 than in group M1.Conclusion Prefilling blood reservoir with MAP solution can mitigate the damage to erythrocytes in the intraoperative salvaged blood in patients,and the efficacy of prefilling of 200 ml is superior to that of prefilling of 100 ml.

Objective To study the expression of skin aspartic protease (SASPase) in lesions of cutaneous lupus erythematosus (CLE) and its role in the pathogenesis of CLE.Methods Skin samples were resected from the lesions and normal skin of 9 patients with CLE,including 3 cases of subacute cutaneous lupus erythematosus (SCLE),4 cases of discoid lupus erythematosus (DLE) and 2 cases of acute cutaneous lupus erythematosus (ACLE).Keratinocytes were isolated from the tissue samples and cultured in serum-free medium.Total proteins were extracted from the keratinocytes and separated by two-dimensional gel electrophoresis.ImageMaster 2D analysis software was used to assess differentially expressed proteins in keratinocytes between the lesional and normal skin,which were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS).The expression levels of SASPase were further determined by Western blot.The data were analyzed statistically by Student's t test.Results Keratinocytes were isolated from the tissue samples and successfully cultured in vitro.Two-dimensional electrophoresis profiles of proteins from the keratinocytes were obtained with high resolution and reproducibility,and the average matching protein spots were about 1200 with the matching rate higher than 80％.As Western blot showed,the relative expression level of SASPase was 0.463 ± 0.018 in keratinocytes from the lesional skin,and 0.145 ± 0.011 in those from the normal skin (P ＜ 0.05).The Western blot results were consistent with those of two-dimensional electrophoresis.Conclusion The initiation and progression of CLE seem to be associated with the abnormal activation and overexpression of SASPase.

Objective To analyze the risk factors for postoperative pulmonary complications (PPCs) in elderly patients with esophageal cancer aged 70 years and over. Methods 185 elderly patients aged 70 years and over after esophagectomy were retrospectively analyzed. Univariate and multivariate logistic regression analysis were used to examine the risk factors for PPCs and related mortality. Results In 185 elderly patients from 70 to 86 years of age with a median age of 72 years, PPCs occurred in 36 patients(19.5%) including pneumonia in 23(63.8%) cases, atelectasis in 3 (8.3%) cases, adult respiratory distress syndrome (ARDS) in 2(5.5%) cases, pulmonary embolism in 1(2.7%) case and respiratory failure in 7(19.4%) cases. The related mortality was 5.9% (11cases) and the causes of death were pneumonia (4 cases), ARDS (1 case), pulmonary embolism (1case) and respiratory failure (5 cases). There were 43 (23.2%) cases with the forced expiratory volume in one second (FEV1%)< 65% before operation. The bleeding volume during operation ranged from 200ml～2000 ml, with a mean volume of about 350ml, and was above 800ml in 8(4.3%) cases. Injury of recurrent laryngeal nerve during operation occurred in 13(7.0%) cases. Univariate and multivariate logistic regression analysis indicated that smoking, obesity, poor preoperative pulmonary function (FEV1 % < 65%), bleeding volume over 800ml during operation and injury of recurrent laryngeal nerve were the independent risk factors for PPCs in elderly patients with esophageal cancer aged 70 years and over. Poor preoperative pulmonary function (FEV1% < 65%)(OR=29.49, P=0.023), bleeding volume over 800ml during operation(OR=32.93, P=0.011) and injury of recurrent laryngeal nerve(OR= 10.14, P= 0.034) were also the independent risk factors for related mortality of PPCs. Conclusions The high risks of PPCs and related mortality in elderly patients with esophageal cancer are not only due to the physiological and pathological characteristics of elderly people, but also due to the operative manipulation.

Objective To evaluate the regulatory role of mTOR signaling in activation of renal interstitial fibroblasts and the potential effect on interstitial fibrosis. Methods 8-week old female C57BL/6 mice (n=30) underwent unilateral ureteral obstruction (UUO) to induce renal interstitial fibrosis. Animals were randomly divided into rapamycin (2 mg·kg-1· d-1) group and UUO group (vehicle-treated) (n=15 each group). Daily intraperitoneal injection of rapamycin or saline was applied to animals from day 1 before operation to the end of experiment.Three mice were sacrificed at day 1,3,7,14 respectively and kidneys were harvested for further analysis.NIH3T3 cells were stimulated by TGF-β for 12 hours with the presence or bsence of rapamycin (100 nmol/L). Results Immunofluorescent co-staining revealed that active fibroblasts highly expressed pS6K and α-SMA in kidney interstitium.Administation of rapamycin significantly inhibited activation of mTOR signaling in fibroblasts and ameliorated interstitial fibrosis of obstructed kidneys.Real-time PCR confirmed that rapamycin decreased the mRNA expression of FSP1,TGF-β,CTGF and Col4A1 in fibrotic kidneys. In vitro experiment revealed that TGF-β induced highly expression of pS6K and αSMA in cultured NIH3T3 cells,which could be markedly inhibited by rapamycin. Conclusions mTOR signaling highly activates in interstitial fibroblasts during kidney fibrosis.Inhibition of mTOR signaling by rapamycin decreases the activation of fibroblasts and ameliorates interstitial fibrosis.

Objective To study the wavelet entropy of intracranial electrode recording electroencephalogram (EEG) during the seizure onset,and explore the prospect of applying it for automatic detection of EEG.Methods Twenty-eight seizure events of 9 epilepsy patients whose outcome were Engel class Ⅰ were retrospective analyzed,by comparing the pre-ictal,initial ictal and ictal wavelet energy entropy variations of both seizure onset zone (SOZ) contacts and non-SOZ contacts.Results The wavelet energy entropy of SOZ contacts increased from pre-ictal (0.053 ± 0.047 ) to initial ictal (0.326 ± 0.250),while it declined during the ictal (0.138 ± 0.097,F =30.904,P =0.000).There was no obvious change of the wavelet energy entropy of non-SOZ contacts in different periods.By further applying time-window wavelet entropy to the detection of intracranial EEG,the results showed that the time-window wavelet energy entropy could be sensitive to reflect the seizure onset time and electrodes.Conclusion The wavelet energy entropy of contacts inside SOZ increased significantly at scizurc onset,and this conclusion can be used to assist in presurgical localization of epilepsy.

Objective To study the expression of Notch3 in pancreatic ductal adenocarcinoma (PDAC) and to find out its relationship with clinical features and overall survival in patients with pancreatic ductal adenocarcinoma.Methods PDAC and adjacent non-cancerous tissues from 80 patients who under went surgery for primary PDAC in the Affiliated Tumor Hospital of Zhengzhou University were collected between 2008 and 2015.The specimens were divided into two subgroups by immunohistochemical staining of Notch3:the low expression group (0-4 points) and the high expression group (5-12 points).Correlations between expression of Notch3 with clinical features and prognosis of patients with PDAC were analyzed.Results A high expression of Notch3 gene was significantly associated with tumor grade,metastasis,venous invasion and TNM staging.Univariate Cox regression analysis showed that metastasis,venous invasion,TNM stage and protein expression of Notch3 were strongly correlated with overall survival of patients.Multivariate analysis showed that metastasis,TNM stage and Notch3 were independent risk factors of overall survival in patients with PDAC.Kaplan-Meier survival curves indicated that a high expression of Notch3 was an important risk factor of poor survival.Conclusions A high expression of Notch3 was significantly associated with progression and poor prognosis of PDCA.Notch3 may serve as a new indicator of PDAC progression and patient survival outcomes.

Objective To study the clinicopathologic characteristics of sarcomatoid carcinoma of the lung.Methods Clinicopathologic characteristics and immunohistochemical results of 42 cases with sarcoma- toid carcinoma of the lung were analyzed.Results Forty-two cases were pathologically proved to be spindle cell carcinoma,1 cases;giant cell carcinoma,1 case;carcinosarcoma,4 cases;pleomorphic carcinoma,36 cases.The tumors were composed of both carcinomatous and sarcomatous elements.Immunohistochemistry showed that CK was positive in 24 of 24 cases,EMA was positive in 18 of 20 cases,Vim was positive in 25 of 25 cases.Eighteen cases were survival One-year survival rate was 61.2 %,with mean survival 13.3 months. Conclusion Diagnosis of sarcomatoid carcinoma of the lung depends on pathologic and immunohistochemical results.

Diethylstilbestrol ; therapeutic use ; Disease Progression ; Endocrine Disruptors ; therapeutic use ; Female ; Humans ; Urologic Diseases ; drug therapy ; pathology

Objective To investigate the frequency distribution of Val762Ala(T2444C)polymorphism among Han Chinese population in Gansu province,and to explore its relation to the suseeptibihty to gastric cancer. Methods A hospital-based,case-control study was performed involving 138 patients with gastric cancer and 110 healthy controls by PCR-RFLP method.Logistic regression and Chisquare analyses were used to assess OR and 95% CI. Results PARP-1762Ala allele was overexpressed in gastric cancer cases(11.5%)compared with controls(4.5%)(OR=3.012,95%CI 1.054-8.603,P=0.033).Statistic analysis showed increaged risk for gastric cancer patients with the 762Ala allele.Conclusion PARP-1 Val762Ala(T2444C)is related to the risk of gastric cancer,PARP-1762Ala allele could be used as a susceptibility marker for the development of gastric cancer.