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2010 Vol. 1, No. 1

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2010, 1(1): Ⅳ-Ⅳ.
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2010, 1(1): 1-2.
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2010, 1(1): 3-6.
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2010, 1(1): 7-10.
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2010, 1(1): 11-13.
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2010, 1(1): 14-15.
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2010, 1(1): 16-17.
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2010, 1(1): 17-17.
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2010, 1(1): 18-21.
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2010, 1(1): 22-24.
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2010, 1(1): 25-26.
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2010, 1(1): 27-28.
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2010, 1(1): 29-33.
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2010, 1(1): 34-39.
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2010, 1(1): 39-39.
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2010, 1(1): 40-43.
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2010, 1(1): 43-43.
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2010, 1(1): 44-48.
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2010, 1(1): 49-52.
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2010, 1(1): 59-59.
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Ultrasound Diagnosis of Phyllodes Tumors
Shan-shan YOU, Yu-xin JIANG, He LIU, Qing-li ZHU, Jing ZHANG, Qing DAI, Qiang SUN, Meng-su XIAO
2010, 1(1): 66-71.
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  Objective  To investigate the value of color Doppler sonography in the diagnosis of phyllodes tumors with different pathologic types and in the differential diagnosis of phyllodes tumor and fibroadenoma.  Methods  The sonographic characteristics of 87 breast phyllodes tumors confirmed by histopathology from Janurary 2005 to December 2009 were retrospectively studied. In addition, 120 breast fibroadenoma confirmed by histopathology between June 2008 and August 2008 were set as the control group. The pathologic results were regarded as the gold standard.  Results  The patients with phyllodes tumors were older than the patients with fibroadenoma[(39.86±9.68) years vs. (34.23±12.33) years; P < 0.05]. The diameter of phyllodes tumor was larger than that of fibroadenoma[(3.70±2.26) cm vs. (1.92±1.13) cm; P < 0.05]. As shown by color Doppler sonography, the shape of the tumor, retrotumor acoustic phenomenon, and cystic area were significantly different between phyllodes tumor and fibroadenoma (P < 0.05). The tumor size and Color Doppler flow grade were independent risk factors of phyllodes tumors (OR=1.36 and 1.82, respectively; both P < 0.05). Benign, borderline, and malignant phyllodes tumors displayed no significantly different sonographic findings.  Conclusions  There is a substantial overlap in the sonographic characteristics between phyllodes tumors and fibroadenoma. If lobulation, posterior acoustic shadowing, and cystic area are observed under color Doppler sonography, a diagnosis of phyllodes tumor can be considered. Sonography can not distinguish benign, borderline, or malignant phyllodes tumors.
2010, 1(1): 71-71.
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Laparoscopic Surgery for Adrenal Pheochromocytoma and Paraganglioma:Report of 211 Cases
Han-zhong LI, Jin WEN, Zhi-gang JI, He XIAO, Wei-gang YAN, Wei-feng XU, Zheng-pei ZENG, Yu-guang HUANG, Da-wei LIU
2010, 1(1): 72-76.
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  Objective  To explore the effectiveness and safety of laparoscopic surgery in treating adrenal pheochromocytomas and paragangliomas.  Methods  The clinical data of 211 patients with pathologically confirmed adrenal pheochromocytomas (n=170) or paragangliomas (n=41) (ranges 2-16 cm in diameter) treated with laparoscopic surgery in our center from 2003 to 2010 were retrospectively reviewed. Endocrine examinations, ultrasound, CT, MRI, and 131I MIBG were performed before surgery. Patients also received α-receptor blocker for 2-4 weeks preoperatively.  Results  All the operations were successfully performed, with a mean operating time of (97±29) min (60-170 min) and a mean estimated blood loss of (84.6±56.3) ml (15-250 ml). The mean hospital stay after operation was (4.9±1.6) days (3-7 days). No major intraoperative complication was noted. Patients were followed up for 3-84 months, and 12 experienced recurrences, which were further diagnosed as malignant tumors.  Conclusions  Surgery is required once a diagnosis of adrenal pheochromocytoma or paraganglioma is confirmed. Laparoscopic surgery is a safe and minimally invasive procedure for adrenal pheochromocytomas and paragangliomas.
2010, 1(1): 76-76.
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Imaging Diagnosis and Transcatheter Arterial Embolization for Massive Hemorrhage Due to Pseudoaneurysms Complicating Pancreatitis
Xiao-guang LI, Xiao-bo ZHANG, Hai-feng SHI, Jie PAN, Kang ZHOU, Zhi-wei WANG, Zheng-yu JIN
2010, 1(1): 77-81.
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  Objective  To discuss the imaging diagnosis of massive hemorrhage due to pseudoaneurysms complicating pancreatitis and evaluate the safety and effectiveness of transcatheter arterial embolization (TAE) in treating this disease.  Methods  For 6 patients with massive hemorrhage due to pseudoaneurysms complicating pancreatitis, the clinical manifestations, imaging findings, TAE procedures, complications, and follow-up were retrospectively analyzed.  Results  The locations of these 6 pseudoaneurysms included splenic artery (n=3), gastroduodenal artery (n=1), right gastroepiploic artery (n=1), and inferior pancreatioduodenal artery (n=1). Four pseudoaneurysms were detected by contrast-enhanced computed tomography (CT) and all were showed in digital subtraction angiography (DSA). TAE was performed as the first-choice management and the hemorrhage was controlled in all cases. Both the technical and clinical success rates reached 100% and no major complications occurred.  Conclusions  For pseudoaneurysms complicating pancreatitis, contrast-enhanced CT and DSA are ideal imaging methods. TAE is safe and effective and should be the treatment of choice for this disease.
Fertility Sparing Therapy in Patients with Intermediate Trophoblastic Tumors
Xiao-yan SHEN, Yang XIANG, Li-na GUO, Feng-zhi FENG, Xi-run WAN, Yu XIAO, Jun ZHAO
2010, 1(1): 82-86.
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  Objective  To investigate the methodologies of fertility sparing therapy in treating intermediate trophoblastic tumors (ITTs) and analyze their outcomes.  Methods  The clinical data of 6 patients with ITTs who underwent fertility sparing therapy in our department from January 1999 to March 2010 were retrospectively analyzed.  Results  Serum β-hCG of two patients returned normal after treated by dilation and curettage. Serum β-hCG of two patients returned normal after two courses of combined chemotherapy. Three patients were cured after open uterine tumor resection and combined chemotherapy. The gross pathology of three ITTS were polypoid, which were controlled by combined chemotherapy following dilation and curettage. Two of three patients with nodular masses type were cured by a multi-modality treatments that combined dilation and curettage with chemotherapy, followed by open uterine tumor resection (the other one did not undergo dilation and curettage). The average follow-up time was 35 months. All patients experienced complete remission (CR). Menstruation returned normal in all patients. No recurrence was noted during follow-up. No one had been pregnant.  Conclusions  Fertility sparing therapy is safe and feasible for ITTs patients under the following conditions:younger than 35 years and having a strong wish to get pregnant in future; the tumor is localized in uterus; and multifocal disease (the diffuse infiltrative type) has been excluded.
Pathogens and Antibiotic Resistance of Isolates from Patients with Urinary Tract Infections in Peking Union Medical College Hospital, 1990-2009
Xiao-Jiang ZHANG, Xiu-li XIE, Hong-li SUN, Qi-wen YANG, Hui WANG, Ying-chun XU
2010, 1(1): 87-90.
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  Objective  To identify the common pathogens of urinary tract infections and the potential existence of drug resistance.  Methods  A total of 4565 clinical isolates from patients with urinary tract infections were collected in Peking Union Medical College Hospital from 1990 to 2009. Antimicrobial susceptibility was detected by disk diffusion method.  Results  The most common pathogen identified was E. coli (33%), followed by Enterococcus faecalis (12%), Enterococcus faecium (8%), coagulase negative staphylococcus (7%), Pseudomonas aeruginosa (6%), and Klebsiella pneumoniae (6%). Extended-spectrum beta-lactamases (ESBLs)-producing strains in E. coli isolate was 60% from 2006 to 2009. Strains of E. coli and K. pneumoniae were still highly susceptible to imipenem, meropenem, and ertapenem. The resistance rates of E. coli strains to ciprofloxacin and levofloxacin were 77.7% and 76.4%, respectively. The resistance rates of E. faecalis to nitrofurantoin and fosfomycin were lower than 10%.  Conclusion  E. coli is the main cause of urinary tract infection. Bacterial resistance remains a major concern and more efforts should be made in the monitoring of drug resistance.
Retroperitoneal Laparoscopic Surgery: Clinical Analysis of 2621 Cases
Yu-shi ZHANG, Han-zhong LI
2010, 1(1): 91-94.
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  Objective  To summarize the clinical experiences of 2621 patients treated with retroperitoneal laparoscopic surgery.  Methods  Totally 2621 patients[1271 males and 1350 females; aged 8-86 years (mean 48.9 years)] were treated with retroperitoneal laparoscopic surgery from 2002 to 2009 in the Urology Department of Peking Union Medical College Hospital. The demographic and clinical data of these patients were retrospectively analyzed.  Results  Among these patients, 1410 patients (53.79%) underwent adrenal surgery, 1041 (39.72%) underwent renal surgery, and 170 (6.49%) underwent renal pelvis and ureter surgery, with an operating time of 20-120 minutes (mean:60.5 minutes) and a intra-operative bleeding volume of 10-1500 ml (mean:85.2 ml). The overall hospital stay was 3-97 days (mean:20.6 days) and the postoperative hospital stay was 2-35 days (mean:6.5 days). Complicatons were noted in 191 patients and were well managed.  Conclusions  The retroperitoneal laparoscopic surgical technique has been widely used in urology department. It has been proven to be safe and effective.
2010, 1(1): 95-97.
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2010, 1(1): 98-102.
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2010, 1(1): 103-107.
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2010, 1(1): 108-112.
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2010, 1(1): 112-112.
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2010, 1(1): 113-116.
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2010, 1(1): 117-118.
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2010, 1(1): 118-118.
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Original Contributions
Relationship between the Mutations of Epidermal Growth Factor Receptor Gene and k-ras Gene and the Clinicopathological Features of Non-small Cell Lung Cancers
Jing ZHANG, Zhi-yong LIANG, Jie GAO, Tong-hua LIU
2010, 1(1): 53-59.
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  Objective  To investigate the relationship between the mutations of epidermal growth factor receptor(EGFR)gene, k-ras gene and clinicopathological characteristics in Chinese patients with non-small cell lung cancers (NSCLC).  Methods  Tumor cells were collected by microdissection from paraffin embedded tumor specimens obtained from 170 patients with NSCLC. The genomic DNA was extracted.Mutations of EGFR gene (exons 18, 19, 20, and 21) and k-ras gene (codons 12 and 13) were detected by scorpions amplification refractory mutation system (Scorpions ARMS).  Results  Somatic mutations were identified involving the tyrosine kinase domain of the EGFR gene in 84 patients (49.4%), which included in-frame deletions of exon 19 (n=39), point mutation of exon 21L858R (n=34), point mutation of exon 21L861Q (n=3), insertions mutations (n=4) and point mutation in exon 20 (n=2), and co-existence of T790M point mutation in exon 20 and L858R point mutations in exon 21 (n=2). k-ras mutations were identified in 14 patients (8.2%), among whom a single-amino-acid substitution in codon 12 were noted in all of them including 8 for 12CYS, 3 for 12ASP, and 3 for 12VAL. Simultaneously harbored EGFR and k-ras gene mutations were not observed in any single NSCLC specimen. Compared adenocarcinoma with non-adenocarcinoma, EGFR mutation rate was statistically significant (P < 0.001) and the former had higher mutation rate. Also, the relationship between EGFR mutations and various clinicopathological factors suggested that the EGFR mutations usually occurred in the female, non-smokers, smaller tumors (≤ 3 cm), and better differentiation. However, there was no association among age, gender, smoking, tumor size, histological types, differentiation grades, lymph node metastasis, pTNM stages and k-ras mutations (P > 0.05).  Conclusions  The detection rate of EGFR mutation is remarkably higher in China than other countries, especially in non-smoking female patients with adenocarcinoma. The detection rate of k-ras mutation is very low, which is not associated with the clinical features such as gender and age. The efficacy and drug resistance of gefitinib is associated with the mutations of EGFR and k-ras gene. k-ras mutations does not coexist with EGFR mutations. Scorpions ARMS method is a rapid, sensitive, and accurate technology in detecting the mutations of EGFR gene and k-ras gene and can therefore provide useful information for clinical decision-making.
Immune Response of Peripheral Blood Mononuclear Cells to Lipopolysaccharide in vitro in Patients with Primary Biliary Cirrhosis
Wei-duan ZHONG, Li WANG, Jie CUI, Feng-chun ZHANG
2010, 1(1): 60-65.
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  Objective  To explore the roles of lipopolysaccharide (LPS) and cytokines in the pathogenesis of primary biliary cirrhosis (PBC).  Methods  The peripheral blood mononuclear cells (PBMCs) were collected from PBC patients, patients with primary Sjögren's syndrome (pSS), and healthy controls and then cultured in vitro in RPMI 1640 medium with or without LPS. The immune responses of PBMCs to 0.01mg/ml LPS in vitro were investigated by measuring the levels of cytokines(IL-1β, IL-2, IL-6, IL-10, TNF-α, IFN-γ) in supernates using enzyme-linked immunosorbent assay (ELISA).  Results  The response of freshly extracted PBMCs to LPS were remarkably different from that of the resuscitated PBMCs. In the supernates of PBMCs cultured without LPS for 24 hours in vitro, the level of IL-2 was significantly higher in PBC patients than in healthy controls (P < 0.05). In the supernates of PBMCs cultured with 0.01mg/ml LPS for 24 hours in vitro, the levels of IL-1β, IL-2, and TNF-α were significantly higher in PBC patients than in healthy controls (P < 0.05). After the stimulation of LPS, the elevation rate of IL-1β and decrease rate of IL-2 in PBC patients were significantly higher than those in healthy controls (P < 0.05). Compared with the pSS patients, the levels of cytokines in PBC patients showed no difference in culture media without LPS, while IL-6 level was significantly increased in the supernates cultured with LPS in PBC patients. IFN-γ were seldomly detected in the the supernates of PBMCs from PBC patients, even after the LPS concentrations were increased to 0.1 and 1.0 mg/ml.  Conclusions  The occurence of PBC is related to bacterial infections, in which LPS may play an important role. Many cytokines are involved in the pathogenesis of PBC, especially Th1 subtype.
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