Effects of Bushen formulae on bone metabolism and ENaCα,NCC and ClC-3 expression in ovariectomized rats with high salt intake / 中国病理生理杂志

AIM:To investigate the effect of Bushen formulae(BHF)on bone metabolism and its possible mechanism in ovariectomized rats with high salt intake.METHODS:According to the random number table method,80 SPF-grade Sprague-Dawley rats were divided into sham group,ovariectomy(OVX)group,medium-high-salt diet(MSD)group,high-salt diet(HSD)group,BHF group,BHF with normal saline(BHF+NS)group,BHF+MSD group,and BHF+ HSD group,with 10 rats in each group.After modeling,different diets and BHF formula interventions were administered,and the concentrations of sodium chloride added to MSD group and HSD group were 2%(w/w)and 8%(w/w),respective-ly.The dose of BHF was 7.8 g·kg-1·d-1,once a day,and the treatment lasted for 12 weeks.Bone density,bone microar-chitecture,bone parameters,bone metabolism biomarkers,bone histopathological changes,the expression of epithelial sodium channel α(ENaCα),Na-Cl cotransporter(NCC),and voltage-gated chloride channel 3(ClC-3)proteins in bone tissue were detected in each group.RESULTS:Compared with sham group,the rats in OVX group had reduced bone density and destroyed bone microstructure.Compared with OVX group,the bone microstructure in MSD and HSD groups was more significantly damaged,while the levels of bone formation markers,bone glycoprotein(BGP)and type Ⅰ procolla-gen N-terminal peptide(PINP),were significantly increased in HSD group(P<0.05).Moreover,the levels of bone re-sorption markers,such as amino-terminal cross-linked telopeptides of type Ⅰ collagen(NTX),carboxy-terminal cross-linked telopeptides of type Ⅰ collagen(CTX)and tartrate-resistant acid phosphatase(TRACP),were significantly in-creased(P<0.05),indicating that bone metabolism was in high-conversion state.High-salt diet accelerated the structural destruction of bone trabeculae,and Western blot results showed that high-salt diet caused decreases in the protein expres-sion levels of ENaCα and ClC-3 and an increase in the protein expression level of NCC in femoral tissues(P<0.05).After BHF intervention,the expression of relevant ion channels caused by high salt could be regulated to different degrees.CONCLUSION:Bushen formulae could differentially regulate the expression of relevant ion channels ENaCα,ClC-3,and NCC induced by high salt to different degrees,which has certain ameliorative and therapeutic effects on the imbalance of bone metabolism.

Clinical efficacy of combined therapy in children with stage 4 neuroblastoma / 中国当代儿科杂志

OBJECTIVES@#To study the early clinical efficacy of combined therapy of stage 4 neuroblastoma.@*METHODS@#A retrospective analysis was performed on the medical data and follow-up data of 14 children with stage 4 neuroblastoma who were diagnosed in Hong Kong University-Shenzhen Hospital from January 2016 to June 2021.@*RESULTS@#The median age of onset was 3 years and 7.5 months in these 14 children. Among these children, 9 had positive results of bone marrow biopsy, 4 had N-Myc gene amplification, 13 had an increase in neuron-specific enolase, and 7 had an increase in vanilmandelic acid in urine. Based on the results of pathological examination, differentiated type was observed in 6 children, undifferentiated type in one child, mixed type, in one child and poorly differentiated type in 6 children. Of all the children, 10 received chemotherapy with the N7 regimen (including 2 children receiving arsenic trioxide in addition) and 4 received chemotherapy with the Rapid COJEC regimen. Thirteen children underwent surgery, 14 received hematopoietic stem cell transplantation, and 10 received radiotherapy. A total of 8 children received Ch14.18/CHO immunotherapy, among whom 1 child discontinued due to anaphylactic shock during immunotherapy, and the other 7 children completed Ch14.18/CHO treatment without serious adverse events, among whom 1 child was treated with Lu177 Dotatate 3 times after recurrence and is still undergoing chemotherapy at present. The median follow-up time was 45 months for all the 14 children. Four children experienced recurrence within 2 years, and the 2-year overall survival rate was 100%; 4 children experienced recurrence within 3 years, and 7 achieved disease-free survival within 3 years.@*CONCLUSIONS@#Multidisciplinary combined therapy is recommended for children with stage 4 neuroblastoma and can help them achieve better survival and prognosis.

[Quality evaluation of American ginseng using UPLC coupled with multivariate analysis].

An ultra performance liquid chromatography (UPLC)method combined with multivariate data analysis was developed to evaluate the quality of American ginseng by simultaneously determining the concentrations of six ginsenosides (Rg1, Re, Rb1, Rc, Ro and Rd)in the samples. For UPLC, acetonitrile with 0.01% formic acid and water with 0.01% formic acid were used as the mobile phase with gradient elution. Under the established chromatographic conditions, the six ginsenosides could be well separated and the results of linearity, stability, precision, repeatability, and recovery rate all reached the requirement of quantification analysis, respectively. The total contents of Rg1, Re, and Rb1 in 57 samples all reached the requirement of the 2015 edition of Chinese Pharmacopoeia. At the same time, the experimental data were analyzed by principle component analysis (PCA) and partial least squares discriminant analysis (PLS-DA). The crude drugs and the decoction pieces can be discriminated by a PCA method and the samples with different age can be distinguished by a PLS-DA method.

Association Analysis of Proteasome Subunits and Transporter Associated with Antigen Processing on Chinese Patients with Parkinson's Disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Proteasome subunits (PSMB) and transporter associated with antigen processing (TAP) loci are located in the human leukocyte antigen (HLA) Class II region play important roles in immune response and protein degradation in neurodegenerative diseases. This study aimed to explore the association between single nucleotide polymorphisms (SNPs) of PSMB and TAP and Parkinson's disease (PD).</p><p><b>METHODS</b>A case-control study was conducted by genotyping SNPs in PSMB8, PSMB9, TAP1, and TAP2 genes in the Chinese population. Subjects included 542 sporadic patients with PD and 674 healthy controls. Nine identified SNPs in PSMB8, PSMB9, TAP1, and TAP2 were genotyped through SNaPshot testing.</p><p><b>RESULTS</b>The stratified analysis of rs17587 was specially performed on gender. Data revealed that female patients carry a higher frequency of rs17587-G/G versus (A/A + G/A) compared with controls. But there was no significant difference with respect to the genotypic frequencies of the SNPs in PSMB8, TAP1, and TAP2 loci in PD patients.</p><p><b>CONCLUSION</b>Chinese females carrying the rs17587-G/G genotype in PSMB9 may increase a higher risk for PD, but no linkage was found between other SNPs in HLA Class II region and PD.</p>

Quality evaluation of American ginseng using UPLC coupled with multivariate analysis / 中国中药杂志

An ultra performance liquid chromatography (UPLC)method combined with multivariate data analysis was developed to evaluate the quality of American ginseng by simultaneously determining the concentrations of six ginsenosides (Rg₁, Re, Rb₁, Rc, Ro and Rd)in the samples. For UPLC, acetonitrile with 0.01% formic acid and water with 0.01% formic acid were used as the mobile phase with gradient elution. Under the established chromatographic conditions, the six ginsenosides could be well separated and the results of linearity, stability, precision, repeatability, and recovery rate all reached the requirement of quantification analysis, respectively. The total contents of Rg₁, Re, and Rb₁ in 57 samples all reached the requirement of the 2015 edition of Chinese Pharmacopoeia. At the same time, the experimental data were analyzed by principle component analysis (PCA) and partial least squares discriminant analysis (PLS-DA). The crude drugs and the decoction pieces can be discriminated by a PCA method and the samples with different age can be distinguished by a PLS-DA method.

Dopamine Agonists Exert Nurr1-inducing Effect in Peripheral Blood Mononuclear Cells of Patients with Parkinson's Disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Nurr1 plays an essential role in the development, survival, and function maintenance of midbrain dopaminergic (DA) neurons, and it is a potential target for Parkinson's disease (PD). Nurr1 mRNA can be detected in peripheral blood mononuclear cells (PBMCs), but whether there is any association of altered Nurr1 expression in PBMC with the disease and DA drug treatments remains elusive. This study aimed to measure the Nurr1 mRNA level in PBMC and evaluate the effect of Nurr1 expression by DA agents in vivo and in vitro.</p><p><b>METHODS</b>The mRNA levels of Nurr1 in PBMC of four subgroups of 362 PD patients and 193 healthy controls (HCs) using real-time polymerase chain reaction were measured. The nonparametric Mann-Whitney U-test and Kruskal-Wallis test were performed to evaluate the differences between PD and HC, as well as the subgroups of PD. Multivariate linear regression analysis was used to evaluate the independent association of Nurr1 expression with Hoehn and Yahr scale, age, and drug treatments. Besides, the Nurr1 expression in cultured PBMC was measured to determine whether DA agonist pramipexole affects its mRNA level.</p><p><b>RESULTS</b>The relative Nurr1 mRNA levels in DA agonists treated subgroup were significant higher than those in recent-onset cases without any anti-PD treatments (de novo) (P < 0.001) and HC groups (P < 0.010), respectively. Furthermore, the increase in Nurr1 mRNA expression was seen in DA agonist and L-dopa group. Multivariate linear regression showed DA agonists, L-dopa, and DA agonists were independent predictors correlated with Nurr1 mRNA expression level in PBMC. In vitro, in the cultured PBMC treated with 10 μmol/L pramipexole, the Nurr1 mRNA levels were significantly increased by 99.61%, 71.75%, 73.16% in 2, 4, and 8 h, respectively (P < 0.001).</p><p><b>CONCLUSIONS</b>DA agonists can induce Nurr1 expression in PBMC, and such effect may contribute to DA agonists-mediated neuroprotection on DA neurons.</p>

Progress of mesoporous silica nanoparticles in targeting drug delivery system of antitumor drug / 中国中药杂志

Currently, chemotherapy is one of the main therapy for cancer. But the traditional antitumor drugs are systemic distribution in vivo, they are difficult to achieve an effective drug concentration in the tumor tissue and don't have the ability to distinguish normal cells and tumor cells by themselves, that cause systemic toxicity easily and can not meet the clinical needs. With the research on mesoporous silica nanoparticles (MSNs) deepening, more and more attention in the drug delivery system have been payed to in recent years, because of its unique physicochemical structure characteristics, it has the effect on specific targets, directly inhibits the tumor cell growth, reduces the side effects to normal cells, tissues and organs and can be long-term medication, etc. It is expected to be excellent carriers of antitumor drugs. MSNs application in the field of cancer treatment has now become a hot research field of medicine. In this paper, the latest research about MSNs in antitumor drugs targeting delivery system from 2008 to 2015 is summarized, including the application of MSNs separately in antitumor drug targeting, passive targeting, active targeting, physical or chemical conditions response targeting and other compound targeting drug delivery system. We expect it to provide a reference to the toxicity reducing and efficacy enhancing and further development of chemical medicine, natural medicine and monomeric compound of chinese herbal medicine.

[Determination of Ginsenosides Amount and Geographical Origins of Ginseng by NIR Spectroscopy].

In the study, 74 samples of ginseng were harvested from three provinces located in the northeast of China. Method for the quantification of total amount of ginsenosides Rg1, Rb1, and Re in samples with near infrared (NIR) spectroscopy was developed with the application of partial least squares regression (PLSR). The reference analysis was performed using a UPLC method. Different pretreatments like multiplicative scatter correction (MSC), Norris-Derivative were applied on the spectra to optimize the calibration and the spectral regions from 6001 to 4007 cm(-1) and from 10,000 to 8786 cm(-1) were selected for the calculation of the PLSR model. The root mean square error of cross-validation (RMSECV) and root mean square error of prediction (RMSEP) were 0.115 and 0.167, respectively, and the correlation coefficients were 0.9477 and 0.9153, respectively. At the same time, the spectral region from 8531 to 7559 cm(-1) was chosen to establish a model for identification the geographical origins of ginseng samples. MSC and Savitzky-Golay smoothing were utilized on the spectral preprocessing. According to the result, 74 samples were separated into three clusters, corresponding to the three geographical origins, i.e., Jilin, Liaoning and Heilongjiang Province. The cross-validation ability and the prediction ability were 96% and 90%, respectively. In Chinese Pharmacopeia, the total amount of ginsenosides Rg1, Rb1, and Re is used as one of the indexes to evaluate the quality of ginseng, the established quantification method herein is rapid and accurate, it can be applied as an alternative method for quality control of ginseng sample.

Comparison of the effect of Angelica polysaccharide, platelet-derived growth factor and thrombopoietin on megakaryocytopoiesis / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Angelica polysaccharide (APS), platelet-derived growth factor (PDGF) and thrombopoietin (TPO) on the proliferation and apoptosis of human megakaryocytic cell line M-07e.</p><p><b>METHODS</b>Cell count and the viability testing of M-07e cells (trypan blue exclusion assay) were performed at 24 hours, 48 hours and 72 hours after treatment with APS, PDGF or TPO. Three apoptosis related flow cytometric assays including Annexin V, Caspase-3 and JC-1 were performed to determine apoptotic rate of each group at 72 hours after the treatment.</p><p><b>RESULTS</b>After the incubation, the number of M-07e cells in the APS, PDGF and TPO group increased and the viabilities of the three groups were significantly higher than the control group (P < 0.05). The dead cells in the APS, PDGF and TPO group were (19.41 +/- 7.59)%, (21.38 +/- 7.25)% and (18.77 +/- 8.00)%, respectively by flow cytometry using Annexin V method, which were significantly lower compared to the control group (34.33 +/- 5.46)%. The expression of the activated caspase-3 in the group of APS, PDGF and TPO were (12.27 +/- 5.18)%, (12.39 +/- 6.26)% and (13.75 +/- 8.25)%, the APS and PDGF group decreased significantly compared to the control group (18.92 +/- 6.09)%. The ratio of total cell deaths in the APS, PDGF and TPO group were (23.64 +/- 6.69)%, (28.00 +/- 10.05)% and (27.99 +/- 8.99)%, the ratio in APS group decreased significantly compared to the control group (39.48 +/- 11.86)% by JC-1 method. Differences between APS and PDGF groups and between APS and TPO groups were not statistically significant.</p><p><b>CONCLUSION</b>APS, PDGF and TPO have similar effect in stimulating proliferation and inhibiting serum-free-culture induced apoptosis of M-07e cells.</p>

Effect of fibronectin-thrombopoietin gene modification on human bone marrow mesenchymal stem cells / 中华血液学杂志

<p><b>OBJECTIVE</b>To observe the effect of Fn-TPO gene modification on human bone marrow mesenchymal stem cells (MSCs).</p><p><b>METHODS</b>Retroviral vector containing Fn-TPO gene was constructed and bone marrow MSCs was modified by this vector. The transcription of Fn-TPO gene in MSCs was observed. The proliferation capacities, hematopoietic cells adhering capacities and TPO secretion capacities of gene modified MSCs were assayed respectively. Cord blood CD34 cells were seeded on the gene modified MSCs layers and several essential growth factors were added. After co-culturing in vitro for 7 days, the number of CD34 cells and their colony forming capacities were assayed by flow cytometry and semisolid culture assay.</p><p><b>RESULTS</b>Retroviral vector containing Fn-TPO gene was successfully constructed and bone marrow MSCs were modified by this vector. Fn-TPO gene was expressed by bone marrow MSCs after gene modification. The viability of MSCs had no significant difference between pre- and post-gene-modification [(7.18 +/- 0.89) 10(4)/ml vs. (6.92 +/- 0.77) 10(4)/ml, P > 0.05]. The hematopoietic cells adhering ability of gene modified bone marrow MSCs was reinforced(0. 188 +/- 0.018 vs. 0.167 +/- 0.017, P < 0.01). The concentration of TPO in the MSCs culture supernatant raised from (5.58 +/- 0.37) ng/ml to (7.46 +/- 0.59) ng/ml (P < 0.01) and did not significantly decline in a short-time period, but influenced by the growth status of MSCs. After co-culturing with gene modified MSCs for 7 days, the absolute number of nucleated cells, the percentage of CD34+ cells and the colony numbers of BFU-E, CFU-GM, CFU-GEMM were (29.9 +/- 2.7) x 10(4), (33.3 +/- 2.8)% , 109.3 +/- 4.1, 163.7 +/- 7.1, 13.3 +/- 1.5, respectively, being significantly higher than that co-cultured with non-modified MSCs.</p><p><b>CONCLUSIONS</b>Fn-TPO gene modification can improve the capacity of human bone marrow MSCs for hematopoietic cells adhering, TPO secretion and cord blood CD34 cells amplification.</p>

[Multidisciplinary therapy after radical surgery in stage I b1-II b cervical cancer patients with positive lymph nodes].

OBJECTIVE: To study the modality of multidisciplinary therapy and prognosis of cervical cancer patients with positive lymph nodes after radical surgery. METHODS: From January 1990 to June 2003, 215 patients with clinical stage I b1-II b node-positive cervical carcinoma who underwent radical hysterectomy and pelvic lymphadenectomy and were histologically confirmed to have lymph node involvement were analyzed. These patients were divided into four groups as chemoradiotherapy group (107 cases), radiotherapy group (45 cases), chemotherapy group (22 cases) and no adjuvant therapy group (41 cases). The prognosis and potential prognostic variables of the four groups were studied by survival analysis. RESULTS: The 3-year disease-free survival (DFS) rate of the chemoradiotherapy group, chemotherapy group, radiotherapy group and no adjuvant therapy group were 60.7%, 53.5%, 47.4% and 36.0% respectively. The 3-year DFS rate of the chemoradiotherapy group was significantly higher than that of the no adjuvant therapy group (P = 0.001). However, the 3-year DFS rate of the chemotherapy group, radiotherapy group were not significantly higher than that of the no adjuvant therapy group (P = 0.060 and 0.159). Among the four groups, the pelvic recurrent rate of the chemoradiotherapy group (7.5%) was much lower than those of the other three groups (22.7%, 26.7%, 34.1%, respectively; P < 0.01). However, the distant metastases rate did not decrease significantly (16.8%, 18.2%, 15.6%, 22.0%, respectively; P > 0.05), neither did the distant metastasis with pelvic recurrent rate (P > 0.05). COX proportional hazard model analysis showed that tumor size, histological type, the number of positive lymph node and postoperative adjuvant therapy were independent survival predictors of the patients with positive lymph node (P < 0.05). CONCLUSION: Chemoradiotherapy after radical surgery significantly improves the 3-year DFS, and decreases the pelvic recurrence in the cervical cancer patients with positive lymph node.

Recurrent ovarian carcinoma of low malignant potential: the role of secondary surgical cytoreduction and the prognosis in Chinese patients.

BACKGROUND AND OBJECTIVES: The study of pathology and prognosis for patients with ovarian tumors of low malignant potential (LMP) has been well documented. The treatment, particularly the secondary surgery, for recurrent disease is less documented. This study was conducted to investigate the role of secondary surgical cytoreduction for recurrent ovarian carcinoma of LMP. METHODS: Patients with ovarian carcinoma of LMP at advanced stages experiencing disease recurrence and treated by secondary surgical cytoreduction at Fudan University Cancer Hospital were retrospectively reviewed. RESULTS: Sixteen patients with recurrent serous and mucinous ovarian LMP tumors who underwent secondary surgical cytoreduction were entered in this study. The median age was 46.5 years. The 5-year survival in those with residual disease < or =1 cm after secondary surgical cytoreduction was 83%, compared to 26% in those with residual disease >1 cm (P = 0.01). Multivariate analysis suggested that extent of recurrent disease (solitary vs. multiple, relative risk [RR] =2.69, P < 0.01), and residual disease after secondary surgical cytoreduction (< or =1 cm vs. >1 cm, RR = 2.56, P < 0.01) were determinants of survival. CONCLUSIONS: For recurrent ovarian carcinomas of low malignant potential, prolonged survival was observed in patients with solitary recurrent disease and optimal secondary surgical outcome.

[Transposed ovarian function conservation in cervical cancer patients with radiotherapy].

OBJECTIVE: To evaluate the transposed ovarian function and complications in cervical cancer patients with postoperative pelvic radiotherapy. METHODS: Sixty-two women with stage I-IIa cervical cancer were treated with radical hysterectomy and pelvic lymphadenectomy and transposition of both ovaries to paracolic gutters from 1997 to 2003 at the Cancer Hospital of Fudan University. Menopausal symptoms, levels of follicle-stimulating hormone (FSH) and E2 were evaluated to assess ovarian function. RESULTS: Of 31 patients with stage IIa or poorly differentiated tumor or tumor > or = 2 cm in diameter, preoperative vaginal radiation was employed to deliver a dose of 15 Gy at point A. Postoperative pelvic radiation was performed in 15 patients. Totally 20% (6/30) of patients undergoing ovaries transposition without any radiation experienced ovarian failure within a mean of 15.7 months. In 35% (6/17) of patients with preoperative vaginal radiation, ovarian failure occurred within a mean of 12.0 months. When patients receiving postoperative pelvic radiation and ovaries transposition were considered together, 64% (9/14) experienced ovarian failure within a mean of 9.2 months (P < 0.05). Only 2 (3%) patients had cysts in transposed ovaries not requiring further surgery. There was no metastasis of the ovaries. CONCLUSIONS: Lateral ovarian transposition is safe to patients with early stage cervical cancer. Both pre- and post-operative radiation significantly damages the ovarian function. Even ovaries transposition procedure also reduces the effectiveness.

[Multidisciplinary treatment of recurrent epithelial ovarian carcinoma and prognostic analysis].

OBJECTIVE: To investigate individualized and multi-phase management of recurrent epithelial ovarian carcinoma in order to improve survival of the patients. METHODS: From 1998 to 2002, 70 patients with recurrent epithelial ovarian carcinoma were enrolled in the present study. The treatments were divided into: (1) Induction of tumor remission: platinum sensitive patients were treated with paclitaxol + cisplatin (TP) or carboplatin + cyclophosphamide (CP) regimen; platinum resistant patients used Taxol + mitomycin (TM) or etoposide + mitomycin (VM) regimen. Resection of tumors was done in an attempt to reduce the residual tumor with a diameter less than 1 cm. Local radiotherapy was performed for those with residual tumor and who achieved clinical response after chemotherapy or surgery. (2) Consolidation therapy: chemotherapy with lower doses was administrated after disease remission. Interferon was used as immunotherapy during chemotherapy and radiotherapy. Survival analysis was done. RESULTS: (1) The 1, 2, 3, 4, 5-year survival rates were 67%, 51%, 45%, 38%, 32%. Median survival was 38.57 months. (3) The 1, 2, 3-year progression-free survival rates of the research arm were 41%, 37%, 24%. Median progression-free survival was 12.00 months. (4) Multivariate analysis revealed that platinum-free interval (P < 0.05), Karnofsky performance scale (P < 0.01), residual disease (P < 0.01) and courses of second-line chemotherapy (P < 0.05) were independent prognostic factors. Residual disease (P < 0.05) and courses of second-line chemotherapy (P < 0.01) contributed to progression-free survival. CONCLUSIONS: Individualized and multi-phase treatment of recurrent epithelial ovarian carcinoma is efficacious. Optimal second cytoreduction and second-line chemotherapy are beneficial to improve the survival.

Secondary cytoreductive surgery for patients with relapsed epithelial ovarian carcinoma: who benefits?

BACKGROUND: This study was performed to address patient selection criteria and the role of secondary cytoreductive surgery (SCR) in patients with epithelial ovarian carcinoma (EOC) who had relapsed tumors after a progression-free interval > or = 3 months. METHODS: One hundred seventeen patients with relapsed EOC after a clinical complete remission duration > or = 3 months who underwent SCR were entered on this prospective trial. Survival curves were generated using the Kaplan-Meier method, and statistical comparisons were performed using log-rank tests, logistic stepwise regression analyses, and a Cox stepwise regression model. RESULTS: The median patient age at the time of relapse was 53 years (range, 20-78 years). The median survival was 22 months and the estimated 5-year survival rate for the entire cohort was 17.2%. Tumor was confined to a solitary site in 33 patients and to > or = 2 sites in 84 patients. After they underwent SCR, 11 patients were rendered macroscopically disease free, 61 patients had residual disease that measured < or = 1 cm in greatest dimension, and 45 patients had bulky intraabdominal residual disease. Survival was influenced by the extent of relapse disease (solitary site vs. multiple sites; P < 0.0001), the size of residual disease after SCR (0 cm vs. < or = 1 cm [P = 0.1211], < or = 1 cm vs. > 1 cm [P = 0.0002], and 0 cm vs. > 1 cm [P = 0.0011]), Eastern Cooperative Oncology Group performance status (0 vs. 1 [P = 0.134], 1 vs. 2 [P = 0.007], and 0 vs. 2 [P = 0.0012]), and the number of cycles of salvage chemotherapy (1-2 cycles vs. 3-5 cycles [P = 0.0144]; 1-2 cycles vs. > or = 6 cycles [P < 0.0001]; and 3-5 cycles vs. > or = 6 cycles [P = 0.0009]). The outcome of SCR was influenced by the extent of relapse disease (multiple sites [51.2%] vs. solitary sites [87.9%]; relative risk [RR] = 9.1237; P = 0.0002) and by the use of bowel resection (yes [60.9%] vs. no [37.5%]; RR = 0.3828; P = 0.0106). CONCLUSIONS: SCR was found to be safe for patients with relapsed EOC who achieved a clinical complete remission that lasted > or = 3 months, with resectability similar to that of primary debulking surgery. Optimal surgical outcomes were achieved easily in patients who apparently had solitary tumor sites, with bowel resection making it possible to remove bulky tumors that involved the intestine. A survival benefit was provided by optimal SCR, particularly when surgery was supported by multiple courses of salvage chemotherapy.

[Chondroblastoma occurring in atypical sites].

OBJECTIVE: To study the clinical, pathologic and radiologic features of chondroblastoma occurring in sites other than epiphysis and apophysis of long bones, and to investigate possible reasons for misdiagnosis. METHODS: The clinical, pathologic and radiologic data of 18 chondroblastoma cases occurring in atypical sites were collected from 5 major hospitals in Shanghai during the past 12 years. S-100 immunostaining was performed to confirm the cartilaginous differentiation of the tumor cells. RESULTS: Chondroblastoma occurred in small bones of feet in 10 of the 18 cases (55.6%) studied, being commonest in the talus and calcaneus bones. Mean age of the patients was 27.8 years, with 55.6% over 25 years of age. Radiologic examination revealed expansive, multilocular and well-demarcated radiolucent lesions in most cases. There was local cortical destruction in 5 cases (28%) and soft tissue infiltration in 1 case. In 10 cases (55.6%), the tumor was associated with aneurismal bone cyst or simple bone cyst formation. None of the cases studied was accurately diagnosed clinically before the operation. In 2 cases, the pathology was also misdiagnosed, often being diagnosed as aneurismal bone cyst or giant cell tumor. CONCLUSIONS: Chondroblastoma occurring in atypical sites are often associated with atypical age, radiologic features and pathologic findings at presentation. Thorough understanding of the potential pitfalls is essential in order to avoid misdiagnosis.

[Prognosis of patients with stage Ib-IIb node-positive cervical carcinoma].

BACKGROUND & OBJECTIVE: Pelvic lymph node metastasis was the important prognostic factor for the patients with cervical carcinoma. However, the relationship among the number of positive nodes, site of metastatic nodes, adjuvant therapy, and the prognosis were unknown. The purpose of this study was to investigate the variables that could predict the prognosis of the patients with stage Ib-IIb node-positive cervical carcinoma. METHODS: Sixty-six patients with stage Ib-IIb cervical carcinoma who underwent radical hysterectomy and pelvic lymphadenectomy were analyzed retrospectively. Potential prognostic variables were studied by Cox proportional hazard model. RESULTS: The 5-year survival rate of the patients with pelvic lymph node metastasis was 40.7%. Cox proportional hazard model analysis showed cellular differentiation, number of positive nodes, and adjuvant therapy were the important prognostic factors (P< 0.05). The 5-year survival rate of patients with one positive node (56.5%) was higher than that (36.4%) of those with two or more positive nodes (P< 0.05). The former's distant metastatic rate (5.9%) was lower than the latter's (32.7%) (P=0.05). However, there was no difference of pelvic recurrence between them (P >0.05). The 5-year survival rate of the patients who had no adjuvant therapy (12.6%) was much lower than that (53.7%) of those with adjuvant therapy (P< 0.05). However, the differences of the effects among adjuvant radiotherapy, chemotherapy, and chemoradiotherapy were not obvious (P >0.05). CONCLUSION: The prognosis of patients with stage Ib-IIb node-positive cervical carcinoma who underwent radical surgery was poor. Adjuvant therapy can improve the survival rate, decrease the pelvic recurrence and distant metastasis.

Treatment of late recurrent vaginal malignancy after initial radiotherapy for carcinoma of the cervix: an analysis of 73 cases.

PURPOSE: To evaluate the reirradiation therapy in late recurrent vaginal malignancy after initial radiotherapy for carcinoma of the cervix. METHODS: From July 1972 to July 1992, 73 cases of late recurrent (over 5 years) vaginal malignancy after initial radiotherapy for cervical cancer were treated in our hospital. Both the original and recurrent cancers were biopsy-proven squamous cell carcinoma. All of these patients received reirradiation therapy; chemotherapy or operation was combined when necessary. The reirradiation was planned according to the site and volume of the recurrent tumor, previous radiation dose, and radiation side effects. Brachytherapy was mainly used. Before 1981, radium therapy was delivered at 30-40 Gy in 3-5 fractions to tumor base within 3-4 weeks. High-dose-rate (100 cGy/min) cobalt-60 afterloading therapy (Ralstron therapy) has been used instead of radium since 1981; the dose to the tumor base was 20-35 Gy/3-5 fractions/3-4 weeks. Then, vaginal mold was supplemented with a dose to a point 0.5 cm below the surface of the vaginal mucosa at 20-30 Gy/4-6 fractions/2-3 weeks. When the vulva or groin was involved, cobalt-60 or high-energy electron beam radiation was added with a dose at 30-40 Gy. Among these, 61 patients received irradiation therapy alone. Eleven patients received irradiation combined with chemotherapy. One patient received hysterectomy after reirradiation. RESULTS: The 2-, 3-, and 5-year survival rates in this series were 54.7% (40/73), 46. 6% (28/60), and 40.3% (21/52), respectively. The 5-year survival rates for upper, upper-middle, and upper-lower vaginal tumor were 81. 8% (9/11), 33.3% (5/15), and 25.0% (3/12), respectively. The effect for upper vaginal recurrent malignancy was remarkably better than that for the upper-lower rate (P < 0.05). The local control rates for tumor >4 and <4 cm were 26.6% (4/15) and 86.5% (32/37), respectively (P < 0.01). The side effects of reirradiation in this series were serious: both moderate and severe radiation reactions were rectum 13.6% (10/73), hematuria 12.3% (9/73), vesicovaginal fistula 1.4% (1/73), and rectum-vaginal fistula 11.0% (8/73). CONCLUSIONS: We conclude that reirradiation for late recurrence in the vagina after previous radiotherapy for cervical cancer is valuable. Early detection and treatment could achieve better results. The smaller the recurrent tumor volume, the better the treatment effects. Reirradiation therapy should be carefully managed in order to reduce the complications as much as possible.