High-grade papillary urothelial carcinoma of the urinary tract: a clinicopathologic analysis of a post-World Health Organization/International Society of Urological Pathology classification cohort from a single academic center

About one half of all bladder neoplasms are noninvasive, and in those, the histologic grade is a crucial prognosticator. Few single-center studies have assessed the recurrence, progression, and cancer-related mortality rates of noninvasive high-grade papillary urothelial carcinomas. With this aim, we evaluated the clinicopathologic and outcome features of 85 patients with high-grade papillary urothelial carcinoma. Median age was 68 years, and 80.5% were men. Tumor size ranged from 0.3 to 13.0 cm (median, 1.6 cm). Recurrence was found in 36.5% of the patients, whereas tumor progression, defined as invasion of lamina propria or beyond, was identified in 40% of all cases. When present, lesion reappearance involved mostly 1 to 2 episodes. Metastasis appeared in 20% of the patients, and 15% died of disseminated bladder cancer. All cancer-related deaths occurred in the group of patients with progression, whereas patients with recurrence showed similar outcomes to those with no recurrence. For patients with tumor progression, clinical stage was significantly associated with outcome (P = .002). As for prognosis, tumor size was strongly associated with progression (P < .01). In conclusion, recurrence, progression, and cancer-specific mortality rates were 36.5%, 40%, and 15%, respectively. All the patients who died of cancer had a history of tumor progression. Patients with recurrences showed similar outcomes to those with no recurrence. Tumor size was strongly associated with tumor progression and cancer-specific survival, whereas clinical stage was significantly associated with outcome in the progression group. In light of the high recurrence and progression rates of high-grade papillary urothelial carcinoma, strict clinical surveillance aimed to detect early recurrent lesions, especially in patients with larger tumors, is warranted.     

社区老年男性下尿路症状的病情演进规律随访研究

目的探究社区老年男性下尿路症状(lower urinary tract symptoms,LUTS)的病情演进规律。方法从深圳光华、长龙社区选择5 995例年龄>65岁的老年男性为研究对象,2009年3月采用问卷对其进行调查,并采用美国泌尿协会制定的症状指数(AUA-SI)来评估其LUTS的严重程度,然后进行2年的随访。随访结束时再次进行问卷调查和LUTS程度评估。根据第1次调查时AUA-SI分值将所有研究对象分为≤7分组和≥8分组,如果研究对象最初AUA-SI≤7分而第2次调查时≥8分,则认为其发生了LUTS;如果研究对象最初AUA-SI≥8分而第2次调查时上升4分以上(不包括4分),则认为其病情有演进。分别统计两组LUTS发生率及演进率。结果第1次调查AUA-SI≤7分者3 092例,其中有883例第2次调查时AUA-SI≥8分,28.6%(883/3 092)的被调查者2年后发生了LUTS。第1次调查AUA-SI≥8分者2 605例,其中622例第2次调查时AUA-SI分值增长>4分,即23.9%(622/2 605)的被调查者2年后病情发生了演进。第1次调查AUA-SI≤7分且在随访前从未经过良性前列腺增生(BPH)和LUTS治疗者2 200例,其中94%的被调查者在随访结束时依然未采取治疗,2%在随访期间接受过BPH外科治疗,另有4%采用了药物治疗。结论在无或仅有轻度LUTS的老年人群中,28.6%在2年内发展为明显的LUTS;在有中重度LUTS的老年人群中,有23.9%在2年内病情发生了演进。本研究结果将有助于了解社区老年人群中LUTS的演进规律,并为该病的防治提供依据。     

氧化苦参碱的含量测定及提取工艺研究进展

目的：探讨氧化苦参碱的含量测定及提取工艺研究进展,为工艺改进及含量测定提供参考。方法：查阅资料,分析整理。结果：氧化苦参碱的含量测定方法取得了重要的进展,提取纯化研究仍比较薄弱。结论：氧化苦参碱的提取纯化工艺有待进一步改进。     

Frontal lobe volumes in schizophrenia: effects of stage and duration of illness

While the changes in the volume of the temporal lobe and its sub-regions over the course of illness have been studied in patients with schizophrenia, few studies have examined changes in the frontal lobe between the first episode and the chronic stage. In this study, we focussed on the effect of illness stage and duration of illness on the volume of frontal lobe regions, though we also examined several other regions to establish the specificity of any effects, if observed, in this region. We compared the volumes of brain regions among 34 first-episode schizophrenia patients, 49 chronic schizophrenia patients, 18 healthy controls matched, on average, to the first-episode patients and 21 healthy controls matched, on average, to the chronic patients. Logarithmic regression analyses examined the relationships between the duration of illness and the brain regional volumes in the patient group. The results showed that chronic patients had smaller prefrontal cortical grey matter volumes, but larger premotor cortical and putamen volumes compared to first-episode patients and matched healthy controls. Although there were significant patient-by-control group interactions in the cerebellum and sensori-motor cortical grey matter volumes, these did not survive correction for multiple comparisons. There was a significant exponential relation between the duration of illness and the volumes of prefrontal cortex, parieto-occipital cortex grey matter, thalamus and putamen, suggesting that these regions are susceptible to change as the disorder persists. The enlargement of the premotor cortex and putamen are likely to be a result of antipsychotic medication.     

Adrenomedullin expression in epithelial ovarian cancers and promotes HO8910 cell migration associated with upregulating integrin α5β1 and phosphorylating FAK and paxillin

Background

Epithelial ovarian cancer (EOC) is one of the leading causes of cancer deaths in women worldwide. Adrenomedullin (AM) is a multifunctional peptide which presents in various kinds of tumors.

Methods

In this study, we characterized the expression and function of AM in epithelial ovarian cancer using immunohistochemistry staining. Exogenous AM and small interfering RNA (siRNA) specific for AM receptor CRLR were treated to EOC cell line HO8910. Wound healing assay and flow cytometry were used to measure the migration ability and expression of integrin α5 of HO8910 cells after above treatments. Western blot was used to examine the phosphorylation of FAK and paxillin.

Results

We found that patients with high AM expression showed a higher incidence of metastasis, larger residual size of tumors after cytoreduction and shorter disease-free and overall survival time. Exogenous AM induced ovarian cancer cell migration in time- and dose- dependent manners. AM upregulated the expression of integrin α5 and phosphorylation of FAK, paxillin as well.

Conclusions

Our results suggested that AM contributed to the progression of EOC and had additional roles in EOC cell migration by activating the integrin α5β1 signaling pathway. Therefore, we presumed that AM could be a potential molecular therapeutic target for ovarian carcinoma.     

Overcoming resistance to antiangiogenic therapies

The concept of targeting new blood vessel formation, or angiogenesis, in tumors is an important advancement in cancer therapy, resulting, in part, from the development of such biologic agents as bevacizumab, a monoclonal antibody directed against vascular endothelial growth factor (VEGF)-A. The rationale for antiangiogenic therapy is based on the hypothesis that if tumors are limited in their capacity to obtain a new blood supply, so too is their capacity for growth and metastasis. Additional evidence suggests that pruning and/or "normalization" of irregular tumor vasculature and reduction of hypoxia may facilitate greater access of cytotoxic chemotherapy (CT) to the tumor. Indeed, for metastatic colorectal cancer, bevacizumab in combination with established CT regimens has efficacy superior to that of CT alone. Despite ～2-month longer progression-free and overall survival times than with CT alone, patients still progress, possibly because of alternative angiogenic "escape" pathways that emerge independent of VEGF-A, or are driven by hypoxic stress on the tumor. Other VEGF family members may contribute to resistance, and many factors that contribute to the regulation of tumor angiogenesis function as part of a complex network, existing in different concentrations and spatiotemporal gradients and producing a wide range of biologic responses. Integrating these concepts into the design and evaluation of new antiangiogenic therapies may help overcome resistance mechanisms and allow for greater efficacy over longer treatment periods.     

现代术中放疗的进展

文章回顾了现代术中放射治疗的历史进程,总结了术中放疗设备的进展和特点,对术中放疗理论基础、临床适应症的变化和拓展、主要并发症以及和其他治疗方法的联合应用进行了归纳。     

Embedding the assistant practitioner role within the clinical department: A qualitative study

Aim

To evaluate the Assistant Practitioner (AP) role in terms of service delivery and gain insight into the improvements that could be made in embedding this role effectively. This evaluation was timely as the role had been established in radiography for several years and there was limited research which explored its success in practice.

Method

A qualitative approach was used to examine the perceptions of radiology managers using a regional focus group (n = 10) and follow up interviews (n = 4). These were designed to gain an understanding of the managers’ views. Focus groups and interviews were audio recorded and transcribed. Data were analysed using a framework analysis approach to reveal salient issues.

Results

Three main themes representing the perceptions of the role were uncovered and these related to organisational issues, the educational perspective and the individual perspective. This paper is restricted to in depth reporting and analyses of the organisational and individual perspectives only. Analysis revealed several factors facilitated the role in practice but equally other factors inhibited its effectiveness.

Conclusions

There is potential for the AP role to support the work of radiographers and more importantly enhance the care of patients. However, certain individual views should be addressed and the identified changes in departmental organisation attended to, if the role is to develop successfully and become firmly embedded in the radiography service structure.