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Cancer of unknown primary (CUP) is a heterogeneous tumor type that has been diagnosed as a metastatic tumor by pathological examination, but the primary tumor cannot be identified through comprehensive clinical examination. The incidence of CUP accounts for approximately 1%–2% of all tumors. CUP progresses rapidly and has a short course. The treatment and prognosis of patients with CUP are closely linked to the primary site. In clinical settings, identifying the primary tumor remains challenging. Scholars have focused on improving the detection rate. Novel technologies, such as gene expression profiling, high-throughput sequencing, epigenetics, and liquid biopsy, have been successively applied to identify the primary tumor of CUP accurately, sensitively and specifically. With the guidance of molecular diagnosis, targeted therapy, immunotherapy, and combination therapy will usher in the era of precision treatment for CUP, which may become a typical example for individualized therapy.
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Objective:To explore the changes in activity of indoleamine 2, 3-dioxygenase(IDO)before and after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer(NSCLC) and its relationship with survival.Methods:The retrospective study was to assess IDO activity by serum kynurenine (Kyn) and Kyn to tryptophan (Trp) ratio before and after SBRT of early stage NSCLC.Thirty early stage NSCLC patients who received SBRT in the Cancer Hospital of the University of Chinese Academy of Sciences were enrolled, from December 2014 to July 2017. High-performance liquid chromatography and mass spectrometry were used to detect serum Kyn and Trp before and after SBRT. The ratios of Kyn after SBRT to Kyn before SBRT were divided into high and low group according to the median value. Similarly, the ratios of Kyn to Trp after SBRT were divided into high and low group.The correlation between overall survival (OS), progression-free survival (PFS) and IDO activity was evaluated. The factors influencing prognosis were analyzed.Results:In all patients, lower ratio of Kyn after SBRT to Kyn before SBRT significantly was correlated with better PFS (median PFS: not reached vs. 26.8 months, HR=0.31, 95% CI =0.11-0.90, P<0.05). The lower Kyn∶Trp ratio after SBRT had longer OS (median OS: not reached vs. 36.5 months, HR=0.27, 95% CI =0.079-0.95, P<0.05). In multivariate analysis, smoking <30 packs/year, higher BED, and lower ratio of Kyn after SBRT to Kyn before SBRT were associated with longer PFS. Lower Kyn∶Trp ratio after SBRT and higher BED were associated with longer OS. Conclusions:SBRT could alter IDO-mediated antitumor immune activity. IDO is a potentially valuable biomarker for monitoring immune status and predicting survival in early NSCLC patients after SBRT.
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Objective@#To investigate the clinical efficacy and adverse effects of stereotactic body radiotherapy (SBRT) in the treatment of T2N0M0 non-small cell lung cancer (NSCLC) patients.@*Methods@#By retrospectively analyzing the clinical data of 30 inoperable patients with stage T2N0M0 NSCLC treated by SBRT, the overall survival, progression-free survival, cancer-specific survival and adverse effects were determined.@*Results@#The median follow-up was 18.4 months. The 1-, 2-, and 3-year overall survival rates were 92.2%, 92.2% and 80.6%, respectively. The corresponding cause-specific survivals were 95.7%, 95.7% and 83.7%. The progression-free survivals were 70.2%, 54.1% and 40.6%. The local control rates were 100%, 94.4%, and 94.4%. The regional controls were 84.2%, 72.1%, and 54.1%; and distant controls were 84.6%, 72.4% and 64.3%, respectively. Twenty patients (66.7%) developed symptoms of grade 1 radiation-related toxicities: dyspnea, chest pain, fatigue, cough, esophagitis, or pneumonia. Among these, 5 patients suffered grade ≥2 radiation pneumonitis, and one patient experienced grade 4 radiation pneumonitis.@*Conclusions@#SBRT was efficient and safe for patients with inoperable T2N0M0 NSCLC, imposing tolerable toxicities.
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Objective To investigate the clinical efficacy and adverse effects of stereotactic body radiotherapy (SBRT) in the treatment of T2N0M0 non-small cell lung cancer (NSCLC) patients.Methods By retrospectively analyzing the clinical data of 30 inoperable patients with stage T2N0M0 NSCLC treated by SBRT,the overall survival,progression-free survival,cancer-specific survival and adverse effects were determined.Results The median follow-up was 18.4 months.The 1-,2-,and 3-year overall survival rates were 92.2％,92.2％ and 80.6％,respectively.The corresponding cause-specific survivals were 95.7％,95.7％ and 83.7％.The progression-free survivals were 70.2％,54.1％ and 40.6％.The local control rates were 100％,94.4％,and 94.4％.The regional controls were 84.2％,72.1％,and 54.1％;and distant controls were 84.6％,72.4％ and 64.3％,respectively.Twenty patients (66.7％) developed symptoms of grade 1 radiation-related toxicities:dyspnea,chest pain,fatigue,cough,esophagitis,or pneumonia.Among these,5 patients suffered grade ≥ 2 radiation pneumonitis,and one patient experienced grade 4 radiation pneumonitis.Conclusions SBRT was efficient and safe for patients with inoperable T2N0M0 NSCLC,imposing tolerable toxicities.
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Whether to select one-tailed test or two-tailed test,how to establish null hypothesis and alternative hypothesis,how to improve the test efficacy were elaborated,and the common problems encountered when hypothesis was applied in scientific papers were pointed out with examples.
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Background and purpose:Cancer of unknown primary (CUP) represents approximately 5%~10%of malignant neoplasms. For CUP patients, identiifcation of tumor origin allows for more speciifc therapeutic regimens and improves outcomes.Methods:By retrieving the gene expression data from ArrayExpress and Gene Expression Omnibus data repositories, we established a comprehensive gene expression database of 5 800 tumor samples encom-passing 22 main tumor types. The support vector machine-recursive feature elimination algorithm was used for feature selection and classiifcation modelling. We further optimized the RNA isolation and real-time quantitative polymerase chain reaction (RTQ-PCR) methods for candidate gene expression proifling and applied the RTQ-PCR assays to a set of formalin-fixed, paraffin-embedded tumor samples.Results:Based on the pan-cancer transcriptome database, we identiifed a list of 96-tumor speciifc genes, including common tumor markers, such as cadherin 1 (CDH1), kallikrein-re-lated peptidase 3 (KLK3), and epidermal growth factor receptor (EGFR). Furthermore, we successfully translated the microarray-based gene expression signature to the RTQ-PCR assays, which allowed an overall success rate of 88.4% (95%CI: 83.2%-92.4%) in classifying 22 different tumor types of 206 formalin-fixed, paraffin-embedded samples. Conclusion:The 96-gene RTQ-PCR assay represents a useful tool for accurately identifying tumor origins. The assay uses RTQ-PCR and routine formalin-ifxed, paraffn-embedded samples, making it suitable for rapid clinical adoption.
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@#The study aims to establish a human gastric cancer orthotopic transplantation model in nude mice and to use 7T MRI for detection. After poorly differentiated human gastric adenocarcinoma SGC-7901 cells were injected subcutaneosly into the right flanks of nude mice, the model of in nude mice was established with orthotopic transplanted cancer of gastric tumor by the Compont® gel pasted method. 7T MRI scan was conducted on the mice after operating model about 20 days later. Histopathological examinations were carried out on the stomach. Two of three mice on which 7T MRI scan were performed showed visible suspected stomach tumor and their presence was verified again by histopathological examinations; tumor formation rate in the nude mice gastric orthotopic transplantation model was 66. 7%. This study suggested that 7T MRI could be used in the live detection of in situ tumor and that MRI could be used for pre-clinical gastric cancer drug development and clinical gastric carcinoma diagnosis.
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Objective To investigate the role of hypoxia induced factor-1 α (HIF-1 α) signaling pathway in development of nonacoholic fatty liver disease (NAFLD) by using a rat model.Methods Forty SD rats were randomly divided into 5 groups (normal control group,4 weeks model group,8 weeks model group,12 weeks model group,and 16 weeks model group according to random number table).NAFLD model was induced by high fat diet.Serum biochemical parameters and liver histological examinations were observed.The HIF-1α,peroxisome proliferator-activated receptor α (PPARα),and nuclear factor-κB (NF-κB) mRNA transcriptions of liver tissue were detected with realtime PCR.Results Compared with the control group,a remarkable rise of serum alanine amiotransferase,triglyceride,cholesterol,and reduction of high density lipoprotein-cholesterol were observed in rats treated with high fat diet after 12 weeks and 16 weeks (P＜0.05).Compared with model group,steatosis,grade of inflammation,and degree of fibrosis in the liver were also significantly aggravated.Fed with high fat diet for 8 weeks,the expression of HIF-1α was significantly higher than that in the control group;the expression of PPARα in 4 weeks group was significantly higher than that in the control group.The expression of PPARα was again significantly elevated in 16 weeks group (P＜0.05);NF-κB expression was increased gradually with high fat diet (P＜0.05).The expression of HIF-1 α mRNA was related with PPARα (r =0.82,P＜0.05) and NF-κB (r =0.67,P＜0.05),and PPARα mRNA was related with NF-κB (r =0.78,P＜0.05).Conclusion HIF-1 α signaling may regulate PPARα/NF-κB and seems to be related with development of NAFLD.
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Objective To explore the efficacy of catheter-directed thrombolysis (CDT) for acute deep venous thrombosis (DVT) of lower limbs.Methods The clinical data of 36 patients with acute DVT of lower limbs treated by CDT form September 2009 to September 2013 were analyzed respectively.Efficacy were assessed through observation of the circumferences,venous patency score and venous patency rate before and after thrombolysis.Results After treated by CDT,the effect of only 1 case with left lower limb DVT associated with inferior vena cava thrombosis was not obvious.The effects of 22 cases were excellence,and 13 cases were good.The total efficiency was 97.2％(35/36).The venous patency scores before and after CDT were (11.85 ± 1.12),(3.6 ± 1.53) points,and there had significant difference (P ＜ 0.01).After CDT,the venous patency rate was (69.6 ± 14.8)％.Conclusion Multi-channel CDT with small saphenous vein for acute DVT of lower limbs is safe and effective,with less invasion and quicker recovery.It is worthy of promotion in clinic.
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<p><b>OBJECTIVE</b>To establish the ultrasonographic criteria for normal size of infrarenal aorta (IRA) and common iliac arteries (CIA) of young males in a Chinese school and to determine the associations between IRA diameter (IRAD) and CIA diameter (CIAD) and body habitus as well as traditional cardiovascular risk factors.</p><p><b>METHODS</b>Cross-sectional study was done of 203 Chinese young males enrolled from a technical school in Beijing Changping district from May to June 2013. The IRA and CIA scans were carried out using ultrasonography. Longitudinal scans were used to assess aortic morphology and tortuosity. The maximum internal anteroposterior IRAD and CIAD in any area of the arteries were measured during the cardiac cycle. Participants information on demographic, medical history, smoking history and alcohol consumption was obtained through unified questionnaire. Univariate and multivariate linear regression was used to determine the associations between arterial diameter and body habitus as well as other risk factors.</p><p><b>RESULTS</b>The median participants age was 21.5 (ranging from 18 to 28) years. The IRAD was (13.4±1.9) mm, and the CIAD was (9.4±1.6) mm. There was no significant difference between the left and right CIAD. Waist circumference was significantly associated with increasing IRAD (P=0.03), while alcohol had an inverse correlation (P=0.04). Age, hip circumference were significantly associated with increasing CIAD (P=0.00, 0.04), while the systolic pressure and alcohol had inverse correlations (P=0.01, 0.00). By dividing the entire group into equal four groups using quartile values for both age and waist/hip circumference, the older group and the larger waist/hip circumference had greater arterial diameter.</p><p><b>CONCLUSIONS</b>The enrolled Chinese young males have smaller IRAD and CIAD compared with foreign older population. Age, waist circumference, hip circumference, alcohol and systolic pressure have statistically significance but small effects on arterial diameter.</p>
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Adolescent , Adult , Humans , Male , Young Adult , Age Factors , Aorta, Abdominal , Diagnostic Imaging , Beijing , Epidemiology , Blood Pressure , Cardiovascular Diseases , Epidemiology , Cross-Sectional Studies , Iliac Artery , Diagnostic Imaging , Risk Factors , Ultrasonography , Waist CircumferenceABSTRACT
<p><b>OBJECTIVE</b>To assess the accuracy of ultrasound-guided 16G and 18G core needle biopsy for detecting ultrasound visible breast lesions with different sonographic features.</p><p><b>METHODS</b>A total of 955 sonographically detected breast lesions examined with ultrasound-guided core needle biopsy (US-CNB) and subsequently surgically excised from July 2005 to July 2012 were retrospectively reviewed. Histological findings of US-CNB and the surgical specimens were analyzed for agreements, sensitivities, false negative rates, and underestimate rates according to different sonographic features.</p><p><b>RESULTS</b>The pathological results of the US-CNB showed malignant lesions in 84.1%, high-risk lesions in 8.4%, and benign lesions in 7.5% of the samples. The overall agreement rates were 92.4% for 16G CNB and 92.8% for 18G CNB; their complete sensitivities and false negative rates were both 98.6% and 1.4%, respectively; the high-risk underestimate rates and DCIS underestimate rates were 48.0% and 46.2% for 16G CNB vs 53.3% and 41.2% for 18G CNB, showing no significant difference between the two groups (P>0.01). For both 16G and 18G CNB, the agreements were better for mass lesions than for non-mass lesions (P<0.01). For the mass lesions with a diameter no greater than 10 mm, the agreement rates were lower than the overall data (P<0.01). Calcification in the lesions did not affect the agreement rates (P>0.01).</p><p><b>CONCLUSION</b>Ultrasound-guided 16G and 18G CNB are both accurate methods for evaluating ultrasound visible breast mass lesions with a diameter larger than 10 mm.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Young Adult , Biopsy, Fine-Needle , Methods , Biopsy, Needle , Methods , Breast , Pathology , Sensitivity and Specificity , Ultrasonography, MammaryABSTRACT
Objective To study the clinical value of acoustic radiation force impulse imaging (ARFI) in patients with ischemic type biliary lesion (ITBL) after orthotopic liver transplantation. Methods Between July 2012 to January 2013, forty-one patients in General Hospital of the People′s Liberation Army were enrolled in this study who were admitted for post-transplantation follow-up. Among them, 15 patients were diagnosed as ITBL by ultrasonography. Besides conventional ultrasonography, ARFI was used to detect the shear wave velocity (SWV) of liver tissue at depth of 4 cm and 5 cm respectively. Simultaneously liver function test was performed. Independent-samples t test was performed to compare the difference of SWV between ITBL and non-ITBL group at the same depth. Paired-sample t test was performed to compare the difference of SWV for the same ITBL patient. Pearson correlation analysis was used in analyzing the relation between SWV and liver function. Results The average SWV in depth of 4 cm was (1.561±0.425) m/s and (1.121±0.160) m/s in ITBL and non-ITBL group, respectively. Signiifcant differences were found among the ITBL and non-ITBL groups (t=-3.173, P=0.01). The average SWV in depth of 5 cm was (1.608±0.545) m/s and (1.175±0.173) m/s in ITBL and non-ITBL group, respectively. Signiifcant differences were found among the ITBL and non-ITBL groups (t=-2.454, P=0.034). There was no signiifcant difference between SWV measurements at different depth for the same ITBL patient. For all patients, SWV at different depths were both strongly correlated with alkaline phosphatase (r=0.656, 0.667, respectively;both P=0.000) andγ-glutamyl transpeptidase (r=0.482, P=0.007;r=0.508, P=0.004). Conclusion The liver stiffness measurement is valuable for the clinical evaluation of post-transplantation ITBL.
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Objective To investigate the clinical value of acoustic radiation force impulse (ARFI) imaging in the evaluation of liver functional reserve in patients with hepatic focal lesions. Methods Eighty-six patients with hepatic focal lesions in General Hospital of the People′s Liberation Army from September 2011 to August 2012 were studied. According to Child-Pugh score, 54 of them were classified as grade A, 18 patients were classiifed as grade B, and 14 patients were classiifed as grade C. Seventy patients underwent surgery and 16 patients underwent non-surgical treatment. Shear wave velocity (SWV) values were measured using ARFI technique, and indocyanine green (ICG) clearance tests were also performed to achieve ICG clearance rate constant (ICGK) and ICG retention rate at 15 minutes (ICG15). Correlation between SWV and ICGK, SWV and ICG15 were studied using Pearson correlation, and correlation between SWV and Child-Pugh score were analyzed using Spearman rank correlation. Difference between SWV values of patients underwent surgery and those of patients underwent non-surgical treatment was compared using t-test for independent samples. Analyses of receiver operating characteristic (ROC) curve were performed to investigate the value of ARFI in the evaluation of surgical feasibility for patients with hepatic focal lesion, with the clinical decisions serving as the golden standard. Results There was correlations between SWV and ICGR15, SWV and ICGK, and SWV and Child-Pugh scores (r=0.764,P <0.001;r=-0.686,P=0.000;r=0.864,P=0.000). The SWV of patients who underwent surgery was (2.46±0.45) m/s, and the SWV of patients who underwent non-surgical treatment was (1.54±0.36) m/s, with a signiifcant difference (t=-0.80, P=0.000). The ROC curve analysis demonstrated a highest Youden′s index of 0.775 when the cut-off was 2.06m/s. The corresponding sensitivity was 87.5% and the specificity was 90.0% for ARFI in the diagnosis liver functional reserve deficiency. Conclusion ARFI can effectively evaluate the liver functional reserve in patients with hepatic focal lesions and thus could be beneifcial in the decision of clinical treatment.
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The mollusicidal effect and toxicity to fish with META-Li in field were tested in mountain areas in Zhejiang Province. The snail control test, which had 3 groups including a META-Li group, niclosamide group and control group, were performed by the spraying method. The adjusted mortalities of snails in the META-Li group on the 3rd, 7th and 15th day were 89.76% , 87.98% and 94.10% , respectively, in the niclosamide group were 89.70% , 83.22% and 94.72% , respectively .and there was no significant difference between the two groups ( P > 0.05), but they were decreased obviously compared with the control group, which were 9.24% , 9.50% and 15.21% , respectively(P <0.05). The toxicity test to fish with META-Li included 3 groups, namely a high concentration META-Li group, low concentration META-Li group and control group, and none fish was dead. It is suggested META-Li has low toxicity to fish, and is suitable to snail control in aquiculture areas.
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OBJECTIVE To explore the predictive value of human telomerase RNA gene component(hTERC) gene amplification and high-risk human papilomavirus(HR-HPV) testing in cervical intraepithelial neoplasia(CIN) as a marker for early diagnosis of cervix carcinoma.METHODS Fluorescence in situ hybridization(FISH) was used to detect the amplification of hTERC of cervical epithelial cells in 72 cases.By using hybrid capture 2(HC-2),two types of the HR-HPV DNA(HPV16/18) of each case were detected.Then,the results were compared with the pathologic diagnosis.The dual-color probe we used was GLP TERC/CSP 3.HeLa cells and lymphocytes from normal marrow were the positive control,while the cervical specimens from healthy outpatients were the negative control.RESULTS hTERC Gene amplification of specimens was tested in 72 cases,the positive amplification rate of hTERC gene in the cervicitis/CINⅠgroup and normal,compared to the cervical carcinomas(100%) and CIN Ⅱ/Ⅲ(68.75%),which showed a significant difference.The rates in CINⅡ and CINⅢ were 60.00% and 83.33%,respectively,which showed a significant difference compared with normal and CINⅠ/inflammation groups.hTERC gene amplification was positive in both HeLa cells and lymphocytes from normal marrow and HC-2 testing was positive in 32 cases of patients containing 11 cases of CINⅡ/Ⅲ,3 cases of cervical cancer,18 cases of cervicitis/CIN1 diagnosed.The positive predictive value(PPV) and specificity(Sp) of hTERC for the high-grade CIN was significantly higher than the PPV and Sp of HC-2 HR-HPV testing.CONCLUSIONS hTERC Gene involves in the progression and occurrence of cervical intraepithelial neoplasia and cervical squamous carcinoma.As a marker for early diagnosis of cervical intraepithelial neoplasia and cervical squamous carcinoma,the FISH method for hTERC gene is more reliable to differentiate the malignant diseases from the benign ones in cervixes than HC-2 HR-HPV DNA testing.The combined detection of HR-HPV and hTERC gene will provide more effective and suitable management to enhance the early diagnosis rate of cervical intraepithelial neoplasia and cervical squamous carcinoma.
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Objective To determinate the weights coefficient of the comprehensive evaluation indexes in medical waste management objectively and scientifically.Methods The analytic hierarchy process was used to define the weight coefficients in 9 synthetic evaluation indexes.Results The biggest weight coefficient(0.311 7)was handling medical waste standardly,the consistent ratio(CR)being 0.005 5
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<p><b>BACKGROUND</b>Pulmonary carcinosarcoma (PCS) is a rare pulmonary mixed malignant tumor. The aim of this study is to explore the clinical characteristics and prognosis of 48 patients with PCS.</p><p><b>METHODS</b>The data of 48 patients with PCS from 1986 to 2004 were analysed retrospectively. Then their prognostic factors were analysed statistically.</p><p><b>RESULTS</b>PCS occurred usually in males over 50 years old, often in the right lungs. The clinical and radiographic characteristics of PCS were similar to primary non-small cell lung cancer. Its diagnosis was mainly verified by postoperative pathologic findings and immunohistochemical staining. The 1-, 3- and 5-year survival rate was 77.1%, 49.5% and 22.7% respectively. The multivariate prognosis analysis and Chi-square test showed that TNM stage was an independent prognostic factor.</p><p><b>CONCLUSIONS</b>TNM stage is an independent prognostic factor for PCS, so it is necessary to operate surgically in early stage to prolong the survival time of patients.</p>
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Objective To investigate the efficacy of laparoscopic cholecystectomy(LC) followed by endoscopic retrograde cholangiopancreaticography(ERCP) for gallbladder and bile duct stones.Methods A total of 58 patients with both gallbladder and bile duct stones received endoscopic sphincterotomy(EST) in our hospital.After the stones were removed,LC was performed on the patients.Results Of the 58 patients,56 were successfully treated with EST and LC.Two cases were unsuccessful owing to difficulty in intubation during ERCP in one and failure to remove all the stones from the bile duct in the other.These two patients were then cured by LC combined with electronic choledochoscopy.Perioperative complications included bleeding during EST in 1,acute edematous pancreatitis in 2,and mild infection of the puncture site in 1.The overall complication rate was 7.1%(4/56).Retained common bile duct stone was observed in 1 patient,and was successfully removed by subsequent ERCP.Conclusions LC combined with ERCP is a safe and effective minimal invasive method for the treatment of concurrent gallstones and bile duct stones.
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OBJECTIVE: To study the regular pattern and characteristics of adverse drug reactions(ADR) in our hospital.METHDOS: 93 ADR cases collected from Jan.1,2006 to Dec.31,2006 in our hospital were analyzed statistically in respect of drug categories,Sex and age distribution,routes of administration,organs and systems involved and clinical manifestations etc.RESULTS: Of the 93 ADR cases,the patients aged above 60 showed the highest proportion(47.3%);31.2% were induced by anti-infective drugs;69.9% were induced through intravenous way;and damages of skin and its appendants were the most common manifestations(35.5%).CONCLUSION: Anti-infective drugs should be used rationally to avoid or reduce the occurrence of ADR.
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ObjectiveTo detect the content of vascular endothelial growth factor（VEGF）in aqueous humour and in vitreous of patients with proliferative diabetic retinopathy（PDR）．MethodsEnzyme linked immunosorbent assay（ELISA）was used，which is one of the basic methods of protein quantitative analysis．ResultsThe VEGF levels in aqueous humour of PDR（mean level 398．6 pg/ml）were higher than those of the controls（mean level 106.5 pg/mlP＜0.05）．The VEGF levels in vitreous of the four PDR（mean level 1395.2 pg/ml)were higher than those in aqueous humour of the four PDR(P＜0.05，Primer t test）．The increased VEGF level in vitreous was positively correlated with the level in aqueous humour．In the normal group，the mean value of VEGF in the vitreous was 64.6 pg/ml．In comparison with that of 1140.4 pg/ml in the PDR group，there was a significant difference between the two groups （P＜0.05，Primer t test）．ConclusionVEGF might play an important role in the pathogenesis of neovascularization of PDR．