Objective To evaluate the clinical diagnosis,treatment and prognostic factors of kidney clear cell renal carcinoma(KIRC)in international sample database.Methods From 1998 to 2012,consecutive patients with KIRC who diagnosed and treated in TCGA organizations were enrolled.Clinical characteristics,objective response and survival time were evaluated,and correlation analysis with lncRNA urothelial cancer associated 1 (UCA1)gene was performed.Results 512 patients with KIRC were enrolled.35.4% of patients were female,59.6% of stage Ⅰ -Ⅱ, 90.0% of white and 45.1% of grade 1 -2.Comprehensive treatment was consistent with the clinical guidelines. Significant correlation was found between UCA1 expression and 4 mRNA subtype,30 genes mRNA expression, mir -101 -1 expression and PBRM1 mutation.And patients with UCA1 overexpression could achieve poor prognosis. Conclusion Diagnosis and treatment of the international TCGA -KIRC research meets clinical guidelines.UCA1 overexpression is an important poor prognostic factor.Combined with the clinical relevance of other important driver genes,UCA1 may be significantly valuable for further study.

Objective To summarize the experience of double layered anastomosis in thoracoscopic and laparoscopic esophagectomy,and to explore its impact on the postoperative anastomotic complications.Methods Patients with thoracoscopic and laparoscopic esophagectomy from September 2014 to Auguest 2015 were retrospectively included.The cervical anastomosis were conducted by hand-sewn double layered anastomosis on the posterior wall of the gastric remnant,with the anastomotic configuration of end-to-side.The patients' general information and postoperative complications were recorded and analyzed.Results 45 patients with esophageal squamous cell carcinoma were included.The major postoperative complications were gastric dilatation(6/45,13.3％),hoarseness(5/45,11.1％),anastomotic leak/gastric necrosis(2/45,4.4％),anastomotic stricture(0/45,0).All patients were discharged from hospital with no perioperative death.Conclusion Hand-sewn double layered anastomotic technique could be safely used in thoracoscopic and laparoscopic esophagectomy,which could assure the security of the anastomosis.The anastomotic complication rates for this technique are rare enough to be recommended,as compared with other anastomotic methods reported in the literatures.

Objective To investigate the expressions of Sema4D and HER-2 in breast cancers and their relationship with microlymphtic vessel density (MLVD).Methods MLVD and expressions of Sema4D and HER-2 were detected in 110 cases of breast cancer tissues by immunohistochemistry.The relationship of Sema4D and HER-2 expressions with clinicopathologic parameters was analyzed.Results The positive expression rate of Sema4D and HER-2 was 71.82％ (79/110) and 33.64％ (37/110),respectively,with a statistically significant differences compared to those in the control group ( P ＜0.01 ).The positive expression rates of Sema4D and MLVD in cases with lymphatic metastasis were higher than that without lymphatic metastasis ( P ＜ 0.01 ).The expressions of Sema4D and HER-2 were closely correlated with the histological grade,TNM stage,lymph node metastasis,and expression of ER of breast cancers ( P ＜0.05),but were not related to tumor size and expression of PR (P ＞ 0.05 ).On univariate analysis,the disease-free survival rate of patients with Sema4D positive expression was better than those with its negative expression ( P ＜ 0.05).Sema4D expression was positively correlated with the HER-2 expression ( r =0.535,P ＜ 0.01 ).Conclusions Sema4D may play important roles in the carcinogenesis and development of a breast cancer.

BACKGROUND:Poly-D,L-lactic-co-glycolic acid (PLGA) that was characterized as absorbable,weak cytotoxicity,and adjustable hardness was ideal to be synthetized artificial spinal dura mater.Because of lacking of functional group at the surface of PLGA,it should be modified to fit the demand of satisfied biocompatibility.OBJECTIVE:To study the biocompatibility of PLGA membrane modified by type-Ⅰ collagen and chitosan.DESIGN,TIME AND SETTING:Contrast observation study,which was carded out in the Biochemistry and Molecular Biology Laboratory Shanghai University of Traditional Chinese Medicine from May to December 2007.MATERIALS:Porous PLGA membrane was provided by Jinan Banzheng Biology-Technology Co.,Ltd.,type-Ⅰ collagen by Sigma Company,USA,chitosan by Shanghai Qisheng Biological Agent Medical Apparatus and Instrument Company,and L929 L cell by Cellular Institute of Shanghai Academy of Life Science,Chinese Academy of Science.METHODS:PLGA membrane (P membrane),PLGA/type-Ⅰ collagen composite membrane (PG membrane),PLGA/type-Ⅰ collagen/chitosan (9:1) composite membrane (PGC 9:1 membrane) and PLGA/type-Ⅰ collagen/chitosan (5:5) composite membrane (PGC 5:5 membrane) were produced through a certain process.MAIN OUTCOME MEASURES:Contact angle,absorption rate and cytotoxicity were tested.Morphological changes of L929 L cell cultured for 1,3,and 7 days were observed under fiberscope.RESULTS:Contact angle was shown as PG membrane＜PGC 9:1 membrane＜PGC 5:5 membrane＜P membrane (P＜0.01 );absorption rate was shown as P membrane＜PGC 5:5 membrane＜PGC 9:1 membrane＜PG membrane (P＜0.01).L929 L cell was characterized as well distribution,expansion and appearance after inoculation of PG membrane,PGC 9:1 membrane and PGC 5:5 membrane.Cytotoxic experiment (MTT methods) showed that,on the 1st day,there was no significant difference in absorbency among groups (P＞0.05).On the 3rd and 7th days,there were significant differences between P membrane and PG membrane or PGC 9:1 membrane,and between PGC 9:1 membrane and PCK2 5:5 membrane (P＜0.05).PGC 9:1 membrane could further improve cell adhesion and proliferation,and PGC 5:5 membrane could inhibit cell proliferation and differentiation.CONCLUSION:Type-Ⅰ collagen and chitosan appended to the exterior of PLGA can enhance the biocompatibility of membrane.In terms of biocompatibility,PLGA/type-Ⅰ collagen/chitosan (9:1) composite membrane can be fit to the qualification as a type of material of artificial spinal dura mater.

Objective To explore establishment of indicator system to evaluate basic capacities of trainers of training for community general practitioners (GPs) to standardize their capacity building and management.Methods Questionnaire survey was conducted among 190 trainers of training for community health managers and GPs who were involved in community health-care and health-care service management in 12 districts of Shanghai to investigate what basic capacities the trainers should have.Delphi expert consultation method was used to construct an evaluation indicator system.Firstly, an evaluation form was formulated based on the preceding questionnaire.Then, two rounds of expert consultation were carried out with 28 experts specialized in general practice, training for GPs, public health and health management.The last step was to set up an evaluation indicator system based on experts' opinions with statistical analysis.Results The newly-established system consisted of five first-grade indicators including comprehensive performance, capacities and personal willingness, background of education and career, personal potential for professional development, capacity in general practice and capacity in training for GPs, and 57 second-grade indicators.Activity coefficient of the experts was all 100%, authority coefficients of the experts were 0.85,and harmonious coefficient of importance of the evaluation was 0.190 and 0.225 ( all P ＜ 0.01 ),respectively, in two rounds of Delphi consultation.Conclusions The preliminarily established indicator system to evaluate capacities of trainers of training for community GPs in diverse aspects can be used as reference for quality critria in selection of trainers of training for community GPs.

ObjectiveTo evaluate effect of periarticular osteotomy in the treatment of asymmetrical ankle arthritis.MethodsSixty-five patients with asymmetrical ankle arthritis were treated with periarticular osteotomy between February 2005 and May 2011,including 43 females and 22 males,aged from 35 to 74 years (mean,55.5 years).According to the Takakura classification of ankle arthritis,there were 29 patients in grade 2,32 in grade 3 and 4 in grade 4.Supramalleolar tibial osteotomy were performed in 20 patients,supramalleolar tibial and fibular osteotomy in 12,supramalleolar osteotomy combined with calcaneal osteotomy in 30 patients,and supramalleolar tibial and fibular osteotomy combined with calcaneal osteotomy in 3patients.Forty three patients underwent ligament reconstruction procedures.Based on radiographs,the tibial anterior surface angle (TAS) and tibial lateral surface angle (TLS) were compared before and after operation.AOFAS-AH score was used to evaluate the function of the ankle.ResultsFifty-nine patients were followed up for an average of 35.7 months (range,7 to 94 months).Bone healing was observed in all patients,and the average healing time was 7 to 8 weeks.The average AOFAS-AH score was improved from 49.7 points preoperatively to 78.6 points 12 months postoperatively.Tbe average TAS and TLS was improved from 86.1° and 70.0° preoperatively to 93.9° and 81.5° 6 months postoperatively,respectively.Delayed wound healing occurred in 5 patients,which was resovled after nursing care.Forty-two patients felt excellent about results,15 felt good and 2 fell fair.ConclusionPerarticular osteotomy is a sound method in the treatment of asymmetrical ankle arthritis,based on chosing proper patients.The procedure can decrease the contact pressures on the degenerated cartilage and prolong the life span of the ankle.

Objective To report the clinical observation and nursing points for recurrent or refractory and aggressive non-Hodgkin's lymphoma treated with MINE regimen. Methods Patients (46 cases) with recurrent or refractory and aggressive non-Hodgkin's lymphoma were given mental nursing,preparation and evaluation of the condition of patients before chemotherapy. Complications especially extravasation of infusion fluid should be prevented during chemotherapy and myelosuppression and long-term complications should be prevented after treatment. Results No patient died after treatment but several complications such as infection(14 cases), nausea and vomiting (grade Ⅰ～Ⅱ, 22 cases, grade Ⅲ,2 cases), alopecia (grade Ⅰ～Ⅱ, 27 cases), mucositis (grade Ⅰ～Ⅱ, 4 cases), liver function lesion (grade Ⅱ, 1 case) were found and improved after proper treatment. No nephrotoxicity and hemorrhagic cystitis were found. Conclusions Selective mental nursing,proper chemotherapy preparation,evaluation of patients' condidtion and positively prevention of chemotherapy-related complications could increase the chemotherapy effect of patients with recurrent or refractory and aggressive non-Hodgkin's lymphoma.

Objective To evaluate the diagnostic value of MR cholangiopancreatography(MRCP) using three-dimensional fast recovery fast spin-echo(3D FRFSE) in differentiating benign from malignant causes of biliary and pancreatic duct dilatation.Methods 106 cases suspected biliary and pancreatic duct dilatation underwent 3D FRFSE MRCP.The images were prospectively analysed by two skilled radiologists,and the results were compared with that of surgery,biopsy or follow-up.Results MRCP was successful performed at one time in all cases.On MRCP,the visual rate of intra-and extrahepatic bile duct was 100% and that of main pancreatic duct was 93.4%.80 patients had benign lesions: bile duct lithiasis(n=66),papillitis(n=6),descending part of duodenum diverticulitis(n=2),duodenal adenomatoid hyperplasia(n=1) and chronic pancreatitis(n=5).26 patients had malignant lesions: extrahepatic cholangiocarcinoma(n=9),ampullary carcinoma(n=5),gallbladder carcinoma(n=4) and pancreatic head carcinoma(n=8).The sensitivity,specificity and accuracy in differentiating benign from malignant causes of biliary dilatation were 92.3%,96.3% and 95.3%,respectively.Conclusion 3D FRFSE MRCP plays an important role in diagnosis of differentiating diagnosis of the causes of biliary dilatation in clinical practice.

Objective:To develop HMGA1-silencing SMMC-7721 cell and investigate its impacts on apoptosis and cell cycle in tumor cells.Methods:Constructing HMGA1-silencing SMMC-7721 cell through G418 selection of RNAi plasmid transfected cells;surveying the apoptosis,prliferation and cell cycle of the tumor cells by FACS and MTT.Results:Stable HMGA1-silencing cells were obtained successfully.The apoptosis percentage in RNAi group(29.46?3.04%) was significantly higher than that in the negative control (1.96?0.76%) or control (2.04?0.70%)within each P

Objective:To establish a mouse fibroblastic cell line stably transfected with HMGA1 gene,and to use the cell line to investigate the role of HMGA1 in tumor development and progression.Methods:Eukaryotic expression vector pcDNA3.0-HMGA1 was transfected into NIH3T3 by lipofectamine-mediation.Stable transfectants were selected by G418.The expression of extraneous HMGA1 gene was analyzed by RT-PCR and DNA sequencing.Cell growth was measured through MTT and the cell cycle by FCM.Soft agar colony formation was employed to analyze the ability of anchorage-independent growth.The expression of the immune inhibition factors of VEGF and FasL mRNA was detected by RT-PCR.Results:NIH3T3 cell lines stably expressing HMGA1 gene were successfully established.Comparing with controls,the HMGA1 gene-transfected cells grew faster,acquired the ability of anchorage-independent growth and expressed the immune inhibition factors of VEGF and FasL mRNA.Conclusion:Extraneous expression of HMGA1 gene can induce malignant transformation of NIH3T3 and modulate mRNA expression of immune inhibition factors.HMGA1 gene plays a key role in tumor development,progression and immune escape.