Objective:To investigate the long-term survival and safety in patients with muscle-invasive bladder cancer (MIBC) who experienced a noninvasive down-staging (≤pT 1)after transurethral resection of bladder tumor (TURBT) plus systemic chemotherapy and received bladder-sparing treatment. Methods:The records of patients with MIBC who underwent maximal TURBT plus systemic chemotherapy-guided bladder-sparing treatment were reviewed retrospectively from Dec 2013 to Dec 2020. Eventually, 22 patients who achieved noninvasive down-staging underwent conservative management. The total patient cohort contained 10 males and 12 females. A majority of patients had single lesion and stage T2 disease. The median age of the patients was 66 years and the median tumor size was 3.0 cm. All patients underwent maximal TURBT to resect all visible diseases and followed by 3-4 cycles platinum-based systemic chemotherapy. After achieving noninvasive down-staging, 14 patients received concurrent chemoradiotherapy, and the other 8 patients underwent surveillance. Overactive bladder symptom score (OABSS) was used to assess the bladder function after treatment.Results:Twelve patients achieved pT 0 and 10 patients were down-staged to cT a-T 1. At a median follow-up of 36.7 months, 90.9%(20/22) patients retained their bladder function successfully. Among the 14 patients who received concurrent chemoradiotherapy, 4 had grade 3 or 4 adverse events. Among the 8 patients who underwent surveillance, 3 had grade 3 or 4 adverse events after systemic chemotherapy.Nine patients experienced tumor recurrence in the bladder, and 2 patients died of bladder cancer. Seven (31.8%) patients experienced Ⅲ/Ⅳ grade complications. The 5-year recurrence-free survival (RFS) and overall survival (OS) in patients achieved pT0 were 66.7% and 100.0%, respectively. The 5-year RFS and OS in patients achieved cTa-T1 were 40% and 72%, respectively. The OABSS score of 20 patients who retained their bladder successfully was (1.00±1.03). Conclusions:MIBC patients who achieved noninvasive down-staging might be candidates for the bladder-sparing treatment with maximum TURBT followed by systemic chemotherapy.The patients who achieved pT 0 might have better prognosis with functional bladder.

Purpose: Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. Materials and Methods: Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. Results: Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. Conclusion After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.

Objective:To analyze the effects of blood collection fixture in arterial blood collection in the Respiratory Intensive Care Unit (RICU) and provide a basis for optimizing clinical nursing work.Methods:Totally 496 patients hospitalized in RICU between January and December 2018 were selected by convenient sampling and divided into the study group ( n=248) and the control group ( n=248) on the basis that their admission registration number is even or odd. Patients in the control group used traditional wrist cushion positioning and cotton swab presses to stop bleeding in performing radial puncture blood collection, while patients in the study group used home-made blood collection fixtures for blood collection. Puncture time, operation time of blood collection and the success rate of one-needle puncture were observed and compared between the two groups. The incidence rate of adverse puncture events such as blood extravasation, local ecchymosis at puncture sites and skin traction pain during the collection of arterial blood in RICU were observed and compared between the two groups. Results:Totally 2 110 blood samples were taken from the two groups, including 1 079 for the study group and 1 031 for the control group respectively. The puncture time and blood collection time in the study group were (2.46±0.38) min and (5.53±0.98) min respectively, both shorter than (4.02±0.43) min and (6.06±1.35) min in the control group, and the differences were statistically significant ( P<0.01) . The success rate of one-needle puncture in the study group was 95.74% (1 033/1 079) , which was higher than 82.93% (855/1 079) in the control group, and the difference was statistically significant ( P<0.01) . The incidences of blood extravasation, local ecchymosis at puncture sites and skin traction pain in the study group were 2.50% (27/1 079) , 4.45% (48/1 079) , and 7.32% (79/1 079) , which were lower than 17.26% (178/1 031) , 16.10% (166/1 031) , and 28.81% (297/1 031) in the control group, and the differences were statistically significant ( P<0.01) . Conclusions:The use of blood collection fixtures in radial artery blood collection operation in RICU can improve the success rate of puncture, shorten the puncture time, save the time of blood collection operation, and reduce the incidence of adverse puncture events.

Objective To reconstruct the original three-dimensional conformation of tumor resection tissue through the study of breast-conserving surgery excision specimens for part-mount sub-serial section and pathological three-dimensional (3D) reconstruction,to establish a new margin assessment model,and to guide tumor bed delineation individually for radiotherapy.Methods From February 2016 to February 2017,thirtythree eligible breast cancer patients underwent breast-conserving surgery in Breast Cancer Center of Shandong Cancer Hospital were recruited.The excision specimens were prepared with part-mount sub-serial section,and residual tumors were microscopically outlined,scanned and registered by Photoshop software.The 3D model of residual tumors was reconstructed with 3D-DOCTOR software to evaluate margin status and record pathological type,tumor length and 3D negative margin distance.The gross tumor volume (GTV) was delineated based on clips placed in the lumpectomy cavity.CTV1 and CTV2 were defined by adding uniform 1.00 cm and 1.50 cm margin based on GTV respectively.CTV3 and CTV4 were defined by adding 1.00 cm and 1.50 cm margin based on 3D boundary of excision tumor respectively,and compared the volume differences of CTV1 and CTV3,CTV2 and CTV4.Results Based on the marginal assessment results of 3D pathological reconstruction,the rates of false negatives during the intraoperative rapid pathological examination and postoperative routine pathological margin evaluation were 6.7％ (2/30) and 3.4％ (1/29) respectively.The pathological type of pathological large slice and routine pathological examination was consistent with rate of 93.9％ (31/33).The M(QR) tumor lengths of routine pathological and pathological 3D reconstruction were 1.90 (1.50-2.40) cm and 2.00 (1.60-2.70) cm respectively,with statistical difference between the two groups (Z =-2.438,P =0.015).The M(QR) volumes for CTV1,CTV2,CTV3,CTV4 were 70.76 (49.84-78.07)cm3,110.11 (83.38-126.17) cm3,23.85 (16.46-31.49)cm3 and 38.74 (30.47-50.58) cm3 respectively.There were statistical differences between CTV1 and CTV3,CTV2 and CTV4 (Z =-4.372,P ＜0.001;Z =-4.372,P ＜0.001).Conclusion The application of pathological 3D reconstruction technology can largely compensate for the shortcomings of the traditional margin assessment model,make the decisions of adjuvant treatment after breast-conserving surgery more accurate,and guide the tumor bed delineation individually for radiotherapy.

Objective To investigate the efficacy of percutaneous laser disc decompression(PLDD)combined with injection of collagenase through a target location for treatment of lumbar intervertebral disc protrusion.Methods Ninety patients with lumbar intervertebral disc protrusion scheduled for discolysis,aged 31-52 yr,weighing 58-70 kg,were randomly divided into 3 groups: PLDD group(group P,n = 29),collagenase injection group(group C,n = 31),PLDD combined with injection of collagenase through a target location group(group PC,n = 30).The puncture was performed under the guidance of CT.Group P was treated using PLDD.Group C was treated with collagenase injection.Group PC was treated with injection of collagenase after PLDD was completed.The therapeutic effect was assessed before operation and on day 7,30,60 and 90 after operation using M-JOA score.Results M-JOA grade was significantly higher at the each time point after operation in group P and PC,and on day 30,60 and 90 after operation in group C than that before operation(P ＜ 0.05).M-JOA grade was significantly lower on day 30 after operation in group P,while higher on day 30,60 and 90 after operation in group C and PC than that on day 7 after operation(P ＜ 0.05).M-JOA grade was significantly lower at the each time point after operation in group P and C than in group PC.Conclusion The therapeutic effect of PLDD combined with collagenase injection through a target location is stable for treatment of lumbar intervertebral disc herniation and better than that of PLDD or collagenase injection alone.

Objective To study the expression of signal transducer and activator of transcription 1 (STAT1) in human renal clear cell carcinoma (RCC) and the effect of STATI inhibition on the radiosensi-tivity of RCC. Methods The expression of STAT1 in 34 human RCC samples compared with 12 normal kid-ney tissues was examined by immunohistochemistry method. For in vitro experiments, a human RCC cell line, CRL-1932, was used. Western blotting was performed to evaluate the expression of total and phospory-lated STAT1. Fludarabine and siRNA were respectively used to inhibit the expression of STAT1 in CRL-1932 cells. Clonogenic assay and trypan blue staining assay were used to evaluate the radiosensitivity of CRL-1932 cells. Results The expression of both total and phospborylated STAT1 in human RCC samples was signifi-cantly higher when compared to normal kidney tissues. Similarly, the expression of STAT1 was higher in CRL-1932 cells when compared to fibroblast and Wilm's tumor cell lines. STAT1 expression was inhibited by both fludarabine and siRNA. Radiosensitivity of CRL-1932 cells was enhanced by both fludarabine and siRNA induced STAT1 inhibition. Conclusions STAT1 is over-expressed in both human RCC tissue and cell line. Inhibition of STAT1 can enhance the radiosensitivity of RCC cells.

Objective To compare the efficacy of liposuction and open surgery for patients with accessory breast.MethodsA total of 73 patients with accessory breast,who were treated in our hospital from June 2000 to December 2007,were enrolled in this study and divided into open surgery(June 2000 to June 2004,43 patients with accessory breast at 80 sides)and liposuction(April 2004 to December 2007,30 cases with accessory breast at 58 sides)groups.The outcomes of the patients,operation time,and intraoperative blood loss in the two groups were compared.Results The curative rate of the both groups were 100%.However,the open surgery group had more blood loss [(49.6?13.3)ml vs(28.9?6.9)ml,t=10.836,P=0.000] and longer operation time[(57.4?11.1)min vs(27.3?4.3)min,t=19.597,P=0.000].Conclusions Compared with open surgery,liposuction leads to quicker recovery and less trauma without leaving scars,and thus is more acceptable to the patients.

OBJECTIVE:To Evaluate the characteristics of national essential drugs on the view of pharmaceutics.METHODS:Referring to related literatures,the characteristics of national essential medicines were analyzed and summarized on the basis of pharmaceutics.The national essential drugs list was compared with that of WHO's.RESULTS:In the equipment part of primary healthy care institution national essential drugs list (2009 edition),chemical and biological medicines had 205 species which included 270 formulations,were classified as 21 kinds of dosage forms.Chinese traditional medicines had 102 species which included 188 formulations,were classified as 13 kinds of dosage forms.The ration of the amount of dosage forms to species is 1.49,a little higher than WHO(1.31) now.CONCLUSION:The dosage forms of national essential drugs were abundant and enable to meet the clinical requirement.But should optimize the breed and add in many species of dosage form to satisfy the needs of medicines useage from urban to rural.