2014年 · 第127卷第04期

Abstract：Background Obsessive-compulsive disorder (OCD) is a highly prevalent and devastating psychiatric condition.Repetitive transcranial magnetic stimulation (rTMS) is a potential and non-invasive treatment for OCD.Diverse efficacies of rTMS have been reported in different locations or frequencies of the stimulation.The main objective of this study was to assess the treatment effect for OCD with alpha electroencephalogram (αEEG)-guided TMS over dorsal Iateral prefrontal cortex bilaterally.Methods There were 25 OCD patients in the αTMS treatment group and 21 OCD patients in the sham control group.Each subject received 10 daily treatment sessions (5 days a week).The αTMS group had significant reduction in scores of Yale-Brown Obsessive Compulsive Scale and Hamilton Rating Scale for Anxiety (HAMA) compared with the control group at the end of 2-week treatment and 1-week follow-up.Analysis of variance with repeated measures was used to test the effects between the two groups.Results Significant difference in scores of obsession and HAMA were found between the two groups after treatment.No significant difference in scores of Hamilton Rating Scale for Depression was found between the two groups after the treatment,but statistical significance was shown at the end of 1-week follow-up.Conclusions αEEG-guided TMS may be an effective treatment for OCD and related anxiety.Delayed response to αTMS in depression suggests that it might be secondary to the improvement of primary response in OCD and anxiety。

Abstract：Background Integrated positron emission tomography and computed tomography (PET/CT) is increasingly used for the preoperative nodal staging of non-smail cell lung cancer (NSCLC).The aim of this study was to evaluate the accuracy of PET/CT in comparison with CT in detection of nodal metastasis and preoperative nodal staging in patients with NSCLC,and to analyze the causes of the PET/CT false-negative and false-positive results.Methods Consecutive patients with pathologically proven NSCLC who underwent staging using PET/CT from July 2008 to February 2012 were evaluated retrospectively.Nodal staging was pathologically confirmed on tissue specimens obtained at thoracotomy.The accuracy of PET/CT and CT in the assessment of intrathoracic nodal involvement was determined using histological results as the reference standard.Logistic regression was used to define the causes of the false-negative and false-positive results.Results A total of 528 lymph node stations were evaluated in 101 patients.Lymph nodes were positive for malignancy in 43 out of 101 patients (42.6％),and 101 out of 528 nodal stations (19.2％).PET/CT was significantly more accurate for nodal staging than CT.The sensitivity,specificity,positive and negative predictive values,and accuracy of PET/CT for detecting nodal metastasis were 51.5％,95.8％,74.3％,89.3％,and 87.3％ and the corresponding data by CT were 45.5％,87.1％,45.5％,87.1％,and 79.2％,respectively.PET/CT confers significantly higher specificity,positive predictive value,and accuracy than CT in detecting nodal metastasis.False-negative results by PET/CT are significantly associated with smaller lymph node size,whereas false-positive results are related to a combination of inflammatory disorders and larger lymph node size.Conclusion PET/CT confers significantly higher accuracy than CT in nodal staging,and is more specific and accurate than CT in detecting nodal metastasis but has a low sensitivity and high false-negative rate。

Abstract：Background Coronary artery bypass graft (CABG) has been developed over many years.Recently,an increasing number of patients need a second surgery for relapse of symptoms.In consideration of the high surgical risk,accurate preoperative evaluation is needed.The aim of the study was to assess the predictive value of three different risk scoring system for early postoperative mortality rate in patients with redo-CABG.Methods Seventy-seven patients who underwent redo-CABG in Fu Wai Hospital from January 1997 to June 2013 were enrolled.All patients were retrospectively scored for early postoperative mortality rate using EuroSCORE,STS score and SinoSCORE.Overall expected mortality rates were compared with observed mortality rates.Discrimination was evaluated using receiver operating characteristic (ROC) curves and area under a ROC curve (AUC).Results Four patients died after a redo-CABG 5％.The mortality rates predicted by EuroSCORE,STS score and SinoSCORE were 5.0％,2.2％ and 1.4％,respectively.The AUC of the three kinds of score were 0.465,0.543 and 0.528,respectively,indicating a poor correlation between the observed and predicted mortality rates.Conclusion The predictive value of EuroSCORE,STS score and SinoSCORE is poor for early postoperative mortality rate in patients with redo-CABG。

Abstract：Background Patients with atherosclerotic renal artery stenosis (ARAS) are in substantial risk of cardiovascular adverse events.We investigated whether myocardial infarction patients with ARAS are in additional risk of cardiovascular events.Methods In this retrospective study,257 patients with type 1 myocardial infarction were enrolled.Median follow-up was 42 months.Composite endpoint events are analyzed by definitions of ARAS as ≥50％ or ≥70％ diameter stenosis.Results Defining ARAS as ≥70％ diameter stenosis,ARAS was a significant predictor for composite endpoint events including death,non-fatal myocardial infarction,ischaemic stroke and intracranial haemorrhage,rehospitalisation for cardiac failure (HR:4.381; 95％ Cl:1.770-10.842) by Cox regression analysis,but not for death.Diabetes mellitus was also a significant predictor for composite endpoint events (HR:2.756; 95％ Cl:1.295-5.863).However,defining ARAS ≥50％ diameter stenosis,ARAS was no longer a significant predictor for composite endpoint events or death.Conclusions Although not associated with mortality,ARAS ≥70％ is associated with major adverse cardiac events after acute myocardial infarction.For prognosis,≥70％ diameter stenosis is a more appropriate criteria for ARAS definition than ≥50％ diameter stenosis。

Abstract：Background Radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) has developed rapidly,and is a commonly performed ablation in many major hospitals throughout the world,due to its satisfactory results.The aim of this study was to detect the effect of RFCA on C-reactive protein (CRP),brain natriuretic peptide (BNP),and echocardiograph in patients with persistent and permanent AF.Methods A total of 120 patients (71 males,mean age (50.8±12.0) years) with persistent and permanent AF undergoing RFCA under guidance of the Carto merge technique were studied.Left atrial diameter (LAD),right atrial diameter (RAD),left ventricular ejection fraction (LVEF),CRP,and BNP were observed 3,6 and 12 months after RFCA and compared with results before RFCA.The recurrence of atrial arrhythmias was observed 3 and 12 months after the procedure.Results Compared with that before RFCA,LAD and RAD decreased and LVEF increased significantly after RFCA.Meanwhile,the levels of CRP and BNP were reduced significantly at 3,6,and 12 months after RFCA (P＜0.05).In the non-recurrent patients,LVEF was increased significantly compared with the recurrent patients at 3,6,and 12 months after RFCA (P＜0.05).CRP and BNP levels were decreased significantly in the non-recurrent patients compared with the recurrent patients at 3,6,and 12 months after RFCA (P＜0.05).After one or two applications of RFCA,during a follow-up of 12 months,12 patients (10.0％) had AF,10 patients (8.3％) had atrial flutter,and 5 patients had atrial tachycardia (4.2％).Conclusions Conversion of AF to sinus rhythm by RFCA,has been shown to reduce LA size and improve LVEF.It can also significantly decrease the levels of CRP and BNP in patients with persistent and permanent AF and reduce the risk of inflammation and developing heart failure。

To the editor:The neck,shoulder and back pain problems are common already among school children.Students experience that problems due to school tables and chairs.School furniture tbrces the students to poor sitting postures.Many factors can contribute to poor lung function,including smoking habits,surgical history,asthma,allergies,chronic obstructive pulmonary disease,and obesity.Additionally,the cormection between posture and lung performance has proved significant。

Abstract：Backround N-terminal pro-brain natriuretic peptide (NT-proBNP) is a reliable predictor in acute coronary artery disease (CAD).Little is known about patients with stable CAD,especially Chinese patients with CAD.The aim of the present study was to investigate the association of NT-proBNP levels with the severity of CAD in patients with normal left ventricular ejection fraction.Methods A total of 658 consecutive patients were divided into two groups based on angiograms:CAD group (n=484) and angiographic normal control group (n=174).The severity of CAD was evaluated by modified Gensini score,and its relationship with NT-proBNP was analyzed.Results The prevalence of risk factors such as age,male gender,diabetes mellitus (DM),dyslipidemia,smoking,and family history of CAD in the CAD group were higher than that in the control group.In multivariate regression model analysis,age,gender,and DM were determinants of the presence of CAD.NT-pro BNP was found to be an independent predictor for CAD (OR:1.66 (95％ Cl:1.06-2.61),P ＜0.05).In a receiver operating characteristic (ROC) curve analysis,an NT-proBNP value of 641.15 pmol/L was identified as a cut-off value in the diagnosis or exclusion of CAD (area under curve (AUC)=0.56,95％ Cl:0.51-0.61).Furthermore,NT-proBNP was positively correlated with Gensini score (r=0.14,P ＜0.001) in patients with CAD.Conelusion NT-proBNP was an independent predictor for Chinese patients with CAD,suggesting that the NT-proBNP level might be associated with the presence and the severity of CAD。

Abstract：Background Intra-cerebral hemorrhage (ICH) is a devastating complication that can result from superficial temporal artery-middle cerebral artery (STA-MCA) bypass in patients undergoing treatment for steno-occlusive cerebrovascular disease (CVD).There is a clinical need to find the possible risk factors to prevent ICH,as it is a significant cause of mortality and morbidity.The aim of the study was to investigate the factors associated with delayed ICH after STA-MCA bypass in patients with steno-occlusive CVDs.Methods We retrospectively analyzed the records of 163 patients seen from 2002 to 2011 with STA-MCA bypass for steno-occlusive cerebrovascular diseases at the Department of Neurosurgery,Xuan Wu Hospital,Beijing.Demographic and clinical data,including age,gender,vascular risk factors,preoperative syndrome,preoperative National Institutes of Health Stroke Scale (NIHSS),ipsilateral ischemic lesions,classification of steno-occlusive CVDs,donor branches of STA,graft patency,postoperative hypertension,and postoperative-increased MCA velocity were recorded and analyzed.Binary Logistic regression served to identify factors associated with delayed ICH after STA-MCA bypass.Results We identified 8 (4.9％) patients with delayed ICH after STA-MCA bypass.Patients with hypertension,preoperative stroke,ipsilateral ischemic lesions,postoperative hypertension and postoperative-increased MCA velocity were significantly more prone to experiencing delayed ICH after STA-MCA bypass.Logistic regression analysis shows ipsilateral ischemic lesions,postoperative hypertension,and postoperative-increased MCA velocity remained independent predictors for delayed ICH after STA-MCA bypass.Conclusion Despite the varied associated factors in patients with steno-occlusive CVDs,ipsilateral ischemic lesions,postoperative hypertension,and postoperative-increased MCA velocity could be associated with delayed ICH after STAMCA bypass。

Abstract：Background N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) are excellent biomarkers for detecting heart failure and subclinical myocardial injury.However,it remains unclear whether subclinical myocardial injury is associated with NT-proBNP elevation in a community based population.Methods In a community based study,levels of hs-cTnT and of NT-proBNP were determined in 1 497 participants older than 45 years.The lower detection limit of the hs-cTnT assay used in the present study was 0.003 ng/ml.The association of hs-cTnT levels and NT-proBNP levels was analyzed.Results When the subjects with undetectable (＜0.003 ng/ml),intermediate (0.003-0.014 ng/ml),and elevated (≥0.014 ng/ml) levels of hs-cTnT were compared (r=0.175,P ＜0.001),a strong association between the hs-cTnT levels and NT-proBNP levels was observed (β=-0.206,P ＜0.001; β=-0.118,P ＜0.001,respectively).In multivariable analyses,older age and hs-cTnT were positively and independently associated with NT-proBNP levels (β=0.341,P ＜0.001; β=0.143,P ＜0.001,respectively),and male gender and the levels of eGFR were inversely and independently associated with NT-proBNP levels.When the subjects with normal or elevated NT-proBNP were analyzed separately,the hs-cTnT level was not an independent predictor for the NT-proBNP level in the normal NT-proBNP group,whereas the hs-cTnT level was the only independent predictor for NT-proBNP level in the elevated NT-proBNP group (β=0.399,P ＜0.01).Conclusions In this community based population,NT-proBNP elevation was common.In addition to female gender and older age,subclinical myocardial injury indicated by the hs-cTnT level was another important factor in NT-proBNP elevation。

Abstract：Background Intensive insulin therapy has been found to lessen the progress of diabetic retinopathy (DR) to some extent,while it has also been implicated to be responsible for decrease of DR.We investigated visual function and morphological changes in the macular area in short-term follow-up of patients with type 2 diabetes mellitus after intensive insulin therapy.Methods This was a prospective clinical study of nonproliferative DR patients (102 eyes,120 patients) undergoing intensive insulin therapy.The Contrast Glare Tester (Takagi CGT-1000) was used to examine contrast sensitivity (CS) and Heidelberg Retina Tomograph (HRT) Ⅱ and Stratus Model 3000 OCT were used to observe the changes of morphology in the macular area.Follow-up times were pre-intensive therapy,3 and 6 months post-intensive therapy.Results CS at low and middle frequencies was higher at 3 and 6 months post-therapy compared with pre-therapy (P ＜0.05).Significant differences in CS at low frequency were found between 6 and 3 months post-therapy (P ＜0.05).Macular edema index was lower in the first,second,and third rings of the macular area after intensive therapy compared with pre-therapy (P ＜0.05).Compared with 3 months post-therapy,the macular edema index was lower in the first,second,and third rings of the macular area at 6 months post-therapy (P ＞0.05).No significant differences in the thickness of the first,second,and third rings of the macular area were detected between 3 and 6 months post-therapy and pre-therapy (P＞0.05).Conclusion CS and macular edema indexes were significantly improved in nonproliferative diabetic retinopathy patients after intensive insulin therapy,but thickness of the macular area was unchanged。

Abstract：Background The World Health Organization and European Organization for Research and Treatment of Cancer (WHOEORTC) classification in 2005 promoted the comparisons of primary cutaneous lymphoma (PCL) subtypes between different countries.The relative frequency of PCL varied according to geography.The study aimed to analyze the relative frequency and survival of PCLs in China and to compare the data with the published results from other countries.Methods We analyzed 98 patients with PCLs over a 6-year period and reclassified them according to the most recent WHO-EORTC classification (2005).Disease-specific survival rate and curves according to specific subtypes such as mycosis fungoides,lymphomatoid papulosis,and primary cutaneous peripheral T-cell lymphoma,unspecified was also calculated.Results The relative rate of PCL in China was distinct from those in Western countries.Our study showed a higher frequency of cutaneous T-and NK-cell lymphomas (CTCLs) (94％),and a lower frequency of cutaneous B-cell lymphomas (CBCLs) (6％).The 5-year survival rate of the total PCLs was 82％.There was no significant difference in the 5-year survival rate (P ＞0.05 by Log-rank test) between CTCL (80％) and CBCL (100％).Conclusions The higher percentage of CTCL in China may provide a clue to further study the etiological factors of PCLs.Racial variations in factors such as HLA determinants may play a role in the development of CTCL。

Abstract：Background Vascular endothelial growth factor (VEGF) is a major mediator of angiogenesis,and plays a key role in the pathogenesis of diabetic retinopathy (DR).This study was designed to identify the possible role of VEGF gene polymorphisms in the development of DR in type 2 diabetic patients in Chinese and clarify the relationship between VEGF serum levels and the risk of DR.Methods This cross-sectional study included 1 040 Chinese subjects with type 2 diabetes mellitus.There were 372 patients diagnosed with DR in the case group and 668 patients without DR in the control group.DNA from each patient was analyzed for VEGF polymorphisms of-2578A/C (rs699947),-1154G/A (rs1570360),-460C/T (rs833061),+405C/G (rs2010963),and +936C/T (rs3025039) using MassARRAY compact analyzer.The VEGF serum levels were quantified by enzyme-linked immunosorbent assay (ELISA).Results No evidence of association was observed between-2578 A/C (rs699947),+405C/G (rs2010963),+936C/T (rs3025039),and DR risk under stringent Bonferroni's correction.However,VEGF serum levels were significantly higher in DR patients than those of control group.The genetic variation of VEGF polymorphisms influenced VEGF serum levels; subjects carrying the VEGF-2578 C/C (rs699947) genotype had greater VEGF serum levels than those carrying the C/A genotype and VEGF serum levels were significantly higher in CC genotype of the +405C/G (rs2010963) compared with those of the other genotypes.Conclusions The data did not suggest significant association between the VEGF polymorphisms and DR risk under stringent Bonferroni's correction.However,our study indicated that DR patients have higher VEGF levels than diabetic patients without retinopathy,and-2578A/C (rs699947) and +405C/G (rs2010963) may be important factors in determining serum VEGF levels。

Abstract：Background Pulmonary lipiodol embolism after transarterial chemoembolization (TACE) was rare and life-threatening,occasionally reported in previous literatures.We aimed to review the records of 11 patients with pulmonary oily embolism and analyze their characteristics of radiographic findings and risk factors.Methods Records of 478 consecutive patients who underwent 1 026 percutaneous TACE procedures were retrospectively analyzed.Eleven cases with respiratory symptoms were identified as having symptomatic pulmonary lipiodol embolism after TACE.Data of these patients,including clinical presentation,techniques of TACE,imaging features of tumor and chest imaging findings,were assessed.Results Eleven (2.3％) of 478 consecutive patients who underwent percutaneous TACE procedures had a pulmonary oily embolism after procedures.The mean size of target tumors embolized was (13.6±2.0) cm.All were hyper-vascular.The mean volume of lipiodol was (21.8±8.2) ml.Pulmonary oily embolisms were revealed within 12-48 hours after TACE.The most severe respiratory symptoms and imaging abnormalities of the eight patients who survived presented between 2 and 5 days after TACE,becoming normal between 12 and 35 days after TACE.Three patients died.Chest CT revealed retention of radiopaque lipiodol in lungs.Conclusions Pulmonary lipiodol embolism occurs easily in patients who have large hyper-vascular hepatic malignant tumor.The high-density lipiodol deposition in the lung field can be used as diagnostic feature。

Abstract：Background Rat renal transplantation is an essential experimental model and requires greater microsurgical skills.Thus,training novices to perform quick and reliable microvascular anastomosis is of vital importance for rat renal transplantation.In this study,we developed and evaluated a staged microvascular anastomosis training program for novices,harvesting and transplanting both kidneys from one rat donor.Methods Five trainees without any prior microsurgical experience underwent a training program in which the goals were staged according to difficulty.Each trainee had to achieve satisfactory results as evaluated by a mentor before entering the next stage.Rat renal transplantation was accomplished by end-to-end technique with a bladder patch.In the intensive rat renal transplantation stage,the trainees required an average of 20 independent attempts at isotransplantation as final training assessment.Results After 2 months of intensive practice,all trainees had achieved stable and reproducible rat renal transplantation,with a satisfactory survival rate of 85.9％ at postoperative Day 7.The total mean operative time was 78.0 minutes and the mean hot ischemia time was 26.2 minutes.With experience increasing,the operative time for each trainee showed a decreasing trend,from 90-100 minutes to 60-70 minutes.After 20 cases,the mean operative time of the trainees was not statistically significantly different from that of the mentor.Conclusion Harvesting and transplanting both kidneys from one rat donor after a staged microvascular anastomosis training program is feasible for novices without any prior microsurgical skills。

To the editor:Acute complete atrioventricular (AV) block might have a good chance to recover,and late recovery of surgicallyinduced AV block has been reported.1-3 Here we report a chronic complete AV block without prior surgery resolved 18 years later。

To the editor:In January 2013,a 58-year-old man presented to our department with an 11-month history of intermittent fever.He experienced recurrent low-grade fever and a non-productive cough without hemoptysis since February 2012.A chest CT showed diffuse ground-glass opacity and consolidation in both lungs.At that time,he was diagnosed as pneumonia and prescribed azithromycin and ciprofloxacin at a local hospital.The symptoms recurred after discontinuation of the antibiotics.He reported weakness of dominant muscles of his left leg in December 2012.Subsequently,loss of pain and temperature sensation was noted in his right leg,following a painless scalding,and he denied incontinence.Neurological examination revealed paraparesis below the T8 spinal cord segment.Muscle strength in the left and right legs was 0/5 and 4+/5,respectively.Deficits in pain and thermal sensations were detected in the right leg,while deep sensations were spared.Patellar and calcaneal tendon reflexes were brisk,and Babinski reflex was positive on both sides。

To the editor:Parathyroid carcinoma is an uncommon cause of parathyroid hormone (PTH)-dependent hypercalcemia and its timely diagnosis and treatment remains a clinical challenge.1 Here,we report a case in which extremely rare distinct metastatic foci of parathyroid carcinoma within the fourth lumbar vertebra was found.A 53-year-old man was admitted to a local hospital with persistent symptoms of generalized weakness,nausea,and vomiting on February 8,2012.Primary hyperparathyroidism and right sided parathyroid adenoma was diagnosed and right parathyroidectomy was performed.But,the patient's hypercalcemia remained and he underwent en bloc resection.Unfortunately,his calcium level still fluctuated between 3.08-4.60 (normal,2.08-2.60) mmol/L and the PTH level was 283.9 (normal,15-65) ng/L.The patient was transferred to our hospital on May 2 and he was found severely hypercalcemic upon admission (serum calcium:4.43 mmol/L;PTH:3 235 ng/L).10.3760/cma.j.issn.0366-6999.20132122。

Abstract：Background Currently,cystoscopy and urine cytology are standard modalities in therapy monitoring and follow-up of bladder carcinoma (BC).Cystoscopy is an invasive and uncomfortable procedure while cytology has a limited value because it is operator-dependent and has low sensitivity.This study was to assess the accuracy of ImmunoCyt in detecting BC by comparing it with cytology using systemic analyses of studies published in both English and Chinese.Methods Cochrane systematic evaluation was used to search through MEDLINE,EMBASE,Cochrane Library,CMCC,and CNKI for studies regarding ImmunoCyt and cytology for detection of BC.Data were extracted and analyzed by the software MetaDiSc 1.4.Results In total 42 relevant studies were searched,of which 15 were enrolled and 12 491 patients were included.Heterogeneity,except for threshold effects,was found within these studies.A meta-analysis was performed using the random effect model.Pooled accuracy indicators like sensitivity,specificity,and diagnostic odds ratio of ImmunoCytTM and cytology were 0.75 (0.73-0.77) vs.0.45 (0.43-0.48),0.73 (0.72-0.74) vs.0.97 (0.96-0.97),and 10.97 (7.53-15.99) vs.16.40 (10.57-25.46),respectively.The sensitivity of both was increased with the increase of tumor grade and stage.The area under summary receiver operating characteristics curve was 0.834 4 and 0.853 4 and the Q index 0.766 7 and 0.785 3 for ImmunoCyt and cytology,respectively.Combination of both can obviously improve the accuracy of diagnosis.Conclusions ImmunoCyt has a high sensitivity in detecting BC,but its specificity is low.As an important adjunct,ImmunoCytTM can not replace cytology,but combined with cytology it could improve sensitivity with high specificity in the detection and postoperative monitoring of BC。

Abstract：Background Numerous studies have investigated the association between adiponectin concentrations and diabetic retinopathy (DR) caused by type 2 diabetic mellitus.However,the results remain conflicting.We performed a metaanalysis to explore the relationship between adiponectin concentrations and risk of DR caused by type 2 diabetic mellitus from published articles.Methods A published literature search was performed through the PubMed,Cochrane Library,EMBASE,Science Citation Index Expanded database,Chinese CNKI,and Chinese Wan Fang databases for articles published in English and Chinese.Pooled standardized mean differences (SMDs) and 95％ confidence intervals (95％ Cls) were calculated using random or fixed effects model.Heterogeneity between studies was assessed using the Cochrane Q test and/2 statistics.Results Nineteen studies with a total of 1 545 cases and 1 502 controls were retrieved.The original meta-analysis found a significant difference in the adiponectin concentrations between the DR and non-DR (NDR) groups.After excluding the high heterogeneity studies,the second meta-analysis also demonstrated the significant association (SMD (95％ CI) =-0.62 (-0.80 to-0.44),P=0.0001).According to the available data,there was statistical significance in the adiponectin concentrations considering non-proliferative DR (NPDR) versus NDR,PDR versus NPDR in Chinese populations with high heterogeneity.Conclusion Adiponectin concentrations are correlated with DR; however,the relationship between adiponectin concentrations and DR needs more in-depth investigations with larger sample sizes。

Since the introduction of a series of reform and open policies in its economic system in 1976,China has been in a boom period of social and economic fields.Rapid development in economy and the consequent improvement in living conditions,nutrition,and health care help to decrease infant mortality and deaths from infectious diseases,and notably effected the patterns of mortality.For example,respiratory diseases,acute infectious diseases,and tuberculosis were the leading causes of death in 1957,while diseases of heart,cerebrovascular disease,and malignant neoplasm were the fifth,sixth,and seventh leading causes of death.1 Up to 1975,cerebrovascular diseases,diseases of heart,and malignant neoplasm were the top three death causes,followed by respiratory diseases,digestive diseases,and pulmonary tuberculosis.1 A prospective cohort study involving a representative sample of the adult Chinese population was conducted in 2005,which revealed that the five leading causes of death were malignant neoplasm,diseases of heart,cerebrovascular disease,accidents,and infectious diseases among men and diseases of heart,cerebrovascular disease,malignant neoplasm,pneumonia and influenza,and infectious diseases among women。

The current researches on natural history of small renal masses show that small renal tumors grow slowly,and few metastasize.1-4 As the length of follow-up is short in these studies (the longest mean follow-up time is 48 months),changes in tumor size in vivo cannot be observed enough.In addition,the growth model of tumor is linear,and the average growth rate is used to reflect tumor growth in these studies.However,most malignant tumor growth curves were not linear.It may not be correct to assess the growth of tumors by linear models。

Vulvar intraepithelial neoplasia (VIN) is a relatively uncommon disease that includes all of the precancerous lesions of vulvar malignancies with an incidence of approximately 2.5 per 100 000 women.In 2004,the International Society for the Study of Vulvovaginal Diseases (ISSVD) abolished the old VIN grading system and introduced a two-tier classification for squamous VIN:the usual type and the differentiated type;the term VIN applied only to histologically "high-grade" squamous lesions (old terms VIN 2 and VIN 3).1 The two types of VIN differ in etiology,morphology,biology,clinical features and malignant potential.The usual type VIN (uVIN),which is associated with HPV infection,is the most comrnon subtype,accounting for more than 80％ of all VIN cases.Currently,the old 3-grade system of the VIN terminology is still used in most of the hospitals in China.In this presentation,we categorized the patients with the ISSVD 2004 classification standard and attempted to describe the clinical features and the outcome of surgical treatment of uVIN using the retrospective data from three academic hospitals in China。