Objective To investigate the expressions of epithelial cell adhesion molecule（EpCAM） and Ki-67 in primary lesion and metastatic lymph nodes of triple-negetive breast cancer（TNBC） and their clinical significance. Methods The expressions of EpCAM and Ki-67 were examined by SP immunohistochemical stain（IHC） in 81 cases of TNBC， 43 cases of metastatic lymph nodes and 20 cases of normal breast tissues. Results The overexpression rates of EpCAM and Ki-67 were 74.1％ and 61.7％，respectively. Moreover， the overexpression of EpCAM and Ki-67 in TNBC was significantly higher than that in normal breast tissues（P＜0.05）. The overexpression of EpCAM was correlated with differentiation grade and lymph node metastasis of TNBC（P＜0.05）. On the other hand， the high expression of Ki-67 was correlated with differentiation grade， lymph node metastasis and pTNM staging of TNBC（P＜0.05）. The overexpression of EpCAM in metastatic lymph nodes was as high as in primary lesion of TNBC， but the high expression of Ki-67 in lymph node metastasis was higher than that in primary lesion（P＜0.05）. Conclusion EpCAM and Ki-67 are expressed highly both in in primary lesion and metastatic lymph nodes of TNBC. The overexpression of EpCAM and Ki-67 can be closely related with the carcinogenesis and progression of TNBC.

Objective To investigate the relationship between the mutations of K-Ras and epidermal growth factor receptor（EGFR） gene and K-Ras gene and clinicopathological features in Chinese patients with non-small cell lung cancer（NSCLC）. Methods From July 2011 to August 2013， 381 cases of NSCLC patients with both EGFR and K-Ras mutations tested in the First Affiliated Hospital of Guangzhou Medical University were retrospectively enrolled in the study. All pathological specimens were tested for twenty-one mutations in EGFR 18-21 exon and six mutations in K-Ras 12，13 codon by amplification refractory mutation system（ARMS）. The clinicopathological features of patients were analyzed according to the mutation status of EGFR and K-Ras. Results Gene mutation of K-Ras was tested in 21 cases， including 20 cases 12 codon mutation and 1 case 13 codon mutation. Gene mutation of EGFR was tested in 146 cases， including 4 cases of 18 exon G719S mutation， 52 cases of 19 exon delection mutation， 3 cases of 20 exon delection mutation， 85 cases of 21 exon mutation （81 cases of L858R and 4 case of L861Q） and two dual gene mutation. K-Ras mutation was more frequently happened in male patients than in female patients （6.8％ vs. 2.5％， P=0.018）. EGFR mutations were related with gender, smoking history, TNM stage, systemic metastases and pathological type（P＜0.05）. Binary Logistic regression shown that pathological type and gender were closely related to EGFR mutation（P＜0.05）. Conclusion EGFR mutation was common in Chinese patients with NSCLC， and was related to adenocarcinoma. However， K-Ras mutation was rare and more commonly happened in male patients with NSCLC. More studies should be conducted to investigate the relationship between clinical features and EGFR and K-Ras mutation.

Objective To investigate the expression of matrix metalloproteinase-9（MMP-9） in gastric cancer and evaluate its relation ship with clinicopathological characteristics and prognosis of gastric cancer. Methods The expression of MMP-9 in 101 gastric cancer patients was determined by immunohistochemistry. The relationship between MMP-9 with clinicopathological characteristics and prognosis in gastric cancer was analyzed. The patients were followed up and recurrencefree survival （RFS） and overall survival （OS） were estimated using the KaplanMeier method, while factors influencing prognosis were tested by Cox proportional harzard model. Results Overexpression rate of MMP-9 was 54.5％ of gastric cancer samples, higher than 15.5% of adjacent normal tissue（P＜0.001）. The expression of MMP-9 was closely related to tumor size， tumor site， tumor invasion， lymph node metastasis and clinical stage in gastric cancer samples （P＜0.05）. The median RFS and OS of 101 patients were 28.0 and 35.0 months， respectively. Moreover， the patients with MMP-9 lower expression had better RFS and OS than those with MMP-9 overexpression （63.0 vs. 11.0 months， 65.0 vs. 17.0 months； P＜0.001）. The multivariate Cox proportional hazard regression analysis of prognostic factors for RFS and OS showed that the expression of MMP-9, tumor size, lymphnode metastasis were independent factors for prognosis of gastric cancer. Conclusion The expression of MMP-9 is correlated with tumor invasion and metastasis， and it can be a powerful molecular marker to predict the progrosis of gastric cancer.

Objective To explore the expressions of sodium coupled neutral amino acid transporter 1 （SNAT1） and epithelial membrane protein （EMP1） in gastric cancer tissue and cell lines， and analyze their relationship with clinicopathological features of gastric cancer. Methods The immunohistochemistry SP method was used to detect the expressions of SNAT1 and EMP1 in tissue sections from 82 gastric cancer and 67 paracancerous tissues from our hospital. The expression level was divided into low-level expression（＜5 points） and high-level expression（≥5 points） according to the two grade score. Then the relationships between expressions of SNAT1 and EMP1 and clinicopathological variables were analyzed. Meanwhile， the Western blotting method was employed to detect the protein level of SNAT1 and EMP1 in 20 paired cancer and paracancerous tissues as well as normal gastric mucosa cell （GES-1） and different cancer cell lines of various differentiation（BGC823， SGC7901， AGS and MKN28）. Results The high-level expression rate of SNAT1 in cancer tissues were 67.1％， higher than 34.3％ in paracancerous tissues （P＜0.05）， while the high-level expression rate of EMP1 was 40.2％ in cancer tissues， lower than 62.7％ in paracancerous tissues （P＜0.05）. The expression of SNAT1 was negatively correlated with EMP1 in cancer tissues （r=-0.272， P=0.014）. Both expressions were related with clinical stage and differentiation degree. In addition， the SNAT1 expression was related with age and lymph node metastasis， and the EMP1 expression was related with invasive depth （P＜0.05）. Compared with the paracancerous tissues and normal gastric mucosa cell，there existed higher protein level of SNAT1 but lower protein level of EMP1 in gastric cancer tissue and cell lines （P＜0.05）. Conclusion Both SNAT1 and EMP1 were related with clinical stage and differentiation degree， suggesting playing a important role in the development of gastric cancer. Both proteins can facilitate the diagnosis and evaluation of gastric cancer.

Objective To explore the influence of antiVEGF monoclonal antibody and antiEGFR monoclonal antibody on survival of patients with metastatic colorectal cancer（mCRC） under different administration patterns.
MethodsIn a retrospective study， the clinical characteristics， targeted therapy and followup data were analyzed among 135 mCRC patients ever treated with molecular targeted therapies. The medium overall survival（OS） was compared among different kinds of targeted drugs and different lines of chemotherapy plus targeted therapy. Results Among mCRC patients， the medium OS for patients receiving antiEGFR monoclonal antibody， bevacizumab or anti-EGFR monoclonal antibody plus bevacizumab were 20.7， 24.4 and 41.6 months， respectively. The medium OS was significantly longer in mCRC patients receiving anti-EGFR monoclonal antibody plus bevacizumab than anti-EGFR monoclonal antibody or bevacizumab alone（P＜0.05）. The medium OS for patients receiving chemotherapy alone as first-line treatment or firstline chemotherapy plus molecular targeted therapies were 30.8 and 21.5 months， respectively（P＞0.05）. The medium OS for patients receiving monoclonal antibody after second-line therapy was 37.0 months， higher than 13.7 months for patients receiving chemotherapy plus monoclonal antibody therapy for either firstline or second-line option with significant difference（P＜0.05）. Among patients ever treated with irinotecan， oxaliplatin， fluorouracil， anti-EGFR monoclonal antibody and bevacizumab， the medium OS for patients receiving chemotherapy plus monoclonal antibody used after thirdline therapy was 50.6 months， similar with the 41.6 months for patients receiving chemotherapy plus monoclonal antibody used before third-line therapy（P＞0.05）. Conclusion Patients ever receiving both bevacizumab and anti-EGFR monoclonal antibody therapies had better survival than those who received either bevacizumab or anti-EGFR monoclonal antibody therapy. Earlier introduction of monoclonal antibody might not associate with better survival. Patients with good tumor biological behavior might benefit from the treatment pattern of chemotherapy before monoclonal antibody.

Objective To analyze prognosis-related factors of the non-small lung cancer（NSCLC） patients with bone metastasis as an initial presentation.
Methods In the retrospective study， 46 NSCLC patients with bone metastasis as an initial presentation from Anhui Provincial Hospital Affiliated to Anhui Medical University and Anhui Provincial Cancer Hospital between February 2010 and February 2012 were investigated. The KaplanMeier method was employed to evaluate survival. Then the median overall survival（OS） was analyzed among different clinicopathological parameters， including age， sex， smoking， pathological type， the number of bone metastasis， bone related events， other parts of the transfer， ECOG score， alkaline phosphatase and carcinoembryonic antigen. The Cox multivariate analysis was used to evaluate the independent factors affecting survival of patients. Results The median OS of 46 NSCLC patients was 237 days. The univariate analysis showed that tumor subtype， number of bone metastasis and ECOG performance status were prognostic factors. Multivariate analysis showed that the independent predictors of OS were tumor subtype（OR=2.996， 95％CI： 1.070-8.389， P=0.037） and the number of bone metastasis（OR=3.263， 95％CI： 1.083-9.827， P=0.036）. Conclusion Tumor subtype and the number of bone metastasis of NSCLC patients with bone metastasis as an initial presentation may be independent prognosis predictors.

Objective To investigate the relationship between preoperative neutrophil to lymphocyte ratio （NLR） and clinicopathological characteristics， prognosis of patients with ovarian cancer. Methods The clinical data of 165 patients with newly diagnosed ovarian cancer in our hospital were obtained from January 2000 to December 2012. All patients underwent surgery after diagnosed ovarian cancer and followed up until the deadline. The patients were divided into two groups according to the preoperative NLR： low NLR（NLR≤3） and high NLR（NLR＞3）. The clinicopathological characteristics and survivals between the two groups were compared. The risk factors affecting overall survival （OS） and progression-free survival （PFS） in ovarian cancer were analyzed using multivariate Cox regression analysis. Results Compared to the low NLR group， the patients with high NLR had significant correlation with advanced tumor stage， suboptimal surgical， malignant ascites， low hemoglobin and lymphocyte counts， high neutrophil， white blood cell and platelet counts （P＜0.05）. Patients with preoperative NLR＞3 had significantly shorter median OS （28 months vs. 63 months） and PFS （10 months vs. 22 months） compared to those with NLR≤3 （P＜0.001）. The univariate analysis showed that the high risk factors affecting the survival of ovarian cancer including advanced tumor stage， malignant ascites， suboptimal surgical and increased levels of NLR （P＜0.05）. Cox's multivariate analysis showed that preoperative NLR was an independent prognostic factor of PFS （HR：1.130， 95％CI：1.053-1.213， P=0.001） and OS （HR：1.190， 95％CI：1.100-1.288， P＜0.001） in patients with ovarian cancer， along with tumor stage and surgical outcomes. conclusion Preoperative NLR may be an independent prognostic factor of survival in patients with ovarian cancer.

Objective To study the effects of thoracic epidural anesthesia（TEA） with bupivacaine on oxygenation， shunt fraction during one-lung ventilation（OLV）. Methods Sixty patients who had prolonged periods of OLV for elective thoracic surgery for esophageal cancer were randomized into two groups. Thirty patients （group A） were anesthetized with propofol／atracurium／epidural thoracic bupivacaine 0.5％. In another 30 patients （group B）， fentanyl／propofol／atracurium anesthesia was used. A double lumen endotracheal tube was inserted， and mechanical ventilation with 100％ oxygen was used during the entire study. Arterial and venous blood gases were recorded before surgery in a lateral position with twolung ventilation， 15 and 30 min after OLV （OLV+15 and OLV+30， respectively） in all patients. PaO2， venous central oxygen tension， arterial and central venous oxygen saturation， venous admixture percentage （Qs／Qt） were measured. Results The mean values for PaO2 during OLV in the group A after 15min with （219.3±48.2）mmHg and 30min with （174.7±37.6）mmHg were significantly lower compared with the group B （268.1±81.2mmHg and 221.6±87.0mmHg， respectively）. Furthermore， Qs／Qt was significantly increased in group A during OLV. And， blood pressure was significantly lower in group A during surgery. There were no significant differences. Conclusion We conclude that using the TEA regimen is associated with a lower PaO2 and a larger intrapulmonary shunt during OLV than with total anesthesia alone.

Objective To evaluate the analgesic efficacy of pregabalin combined with opioids in the treatment of malignant neuropathic pain （MNP）.
Methods Fifty-two patients with MNP of moderate to severe pain were enrolled and initially took 72 hours morphinepatient control intravenous analgesia（PCIA）， randomly assigned into 3 groups： group A （n=17）， receiving morphinePCIA； group B （n=18）， receiving morphinePCIA plus 75mg pregabalin （per 12h）； group C （n=17）， receiving morphinePCIA plus 150mg pregabalin （per 12h）. The oxycodone was calculated and substituted for morphine 72h after morphinePCIA for continuous 4 weeks. The 24h dosage of morphine was analyzed in 3 groups. The number of break-through pain， resting visual analogue scale （VAS） and VAS at activity during PCIA period and oral administration of oxycodone were recorded in 3 groups as well as the adverse reaction. Results Compared to group A， the dosage of every 24 hour morphine in 72h of group B and in 48， 72h of group C were low （P＜0.05）. The number of break-through pain and VAS at activity of group C were lower than group A （P＜0.05）. During the period of morphinePCIA， no serious adverse reaction were observed in 3 groups， and the common adverse reactions included nausea， vomiting， dizziness， drowsiness and constipation with not statistically significant difference among 3 groups （P＞0.05）. The dosages of oxycodone were （94.06±25.38）mg and （88.21±24.46）mg in group B and C， lower than （117.67±36.39）mg in group A with significant difference （P＜0.05）. The number of breakthrough pain of group B and C at day 7， 14， 28 were lower than group A （P＜0.05）， and the VAS at activity of group B at day 14 and group C at day 7， 14 were lower than group A （P＜0.05）. Conclusion MNP may be well controlled by pregabalin plus opioid， and the dosage of pregabalin may be needed more.

Objective To investigate the expression of deleted in malignant

brain tumor 1（DMBT1） in nasopharyngeal carcinoma， and analyze its

relationship with clinicopathological characteristics. Methods The DMBT1 protein expression in 69 cases of nasopharyngeal carcinoma tissues and 36 cases of normal nasopharyngeal tissue adjacent to carcinoma were determined by immunohistochemistry. The relationship between DMBT1 expression and clinicopathological characteristics and prognosis were analyzed. Results The positive rate of DMBT1 protein expression in nasopharyngeal carcinoma tissues was 33.3％（23／69）， significantly lower than 75.0％（27／36）in adjacent normal nasopharyngeal tissues（P＜0.05）. The level of DMBT1 protein expression was correlated with T stage， lymph node metastasis，clinical stage and histological grade（P＜0.05）. The median overall survival time in patients with DMBT1 positive and negative expression was 60.0 months and 47.0 months respectively（P＜0.05）. Cox regression analysis showed that DMBT1 negative expression was an independent risk factor for prognosis of patients with nasopharyngeal carcinoma（P＜0.05）. Conclusion DMBT1 plays an important role in the development of nasopharyngeal carcinoma， and can be used as a prognostic indicator of patients with nasopharyngeal carcinoma.

Objective To investigate the ultrasonic elastic strain rate of axillary lymph node benign and malignant diagnosis. Methods Retrospective analysis of 89 pathologically diagnosed breast cancer patients with 118 axillary lymph node elastic strain rate. Ultrasonic elastic strain rate of reactive hyperplasia and metastatic lymph nodes were compared，and ROC curve was drawn. Results In 118 axillary lymph nodes， 54 was metastatic lymph nodes， 64 was reactive hyperplasia. Sensitivity of ultrasonic elastic strain rate of axillary lymph node in breast cancer diagnosis of benign and malignant was 90.7％， specificity was 87.5％， and accuracy was 90.6％. By ROC curve analysis to obtain the most appropriate diagnostic threshold of 2.07. Conclusion Ultrasonic elastic strain rate is a method for identifying metastatic lymph nodes with reactive hyperplasia effective way.

Objective To analyze the clinical and pathological characteristics of cardiac angioma as to facilitate the diagnosis and treatment of cardiac angioma. Methods In the retrospective study， 10 cases of cardiac angiom （4 cases of capillary， 5 cases of cavernoma and 1 case of venous） were analyzed from Feburary 2003 to Feburary 2014. Results A smooth surface was observed in all tissues of cardiac angioma with honeycomblike cross section and full of thrombus in capsulas. Some of them had a pedicle. Vascular endothelial cell was the major component of cardiac angioma. Inflammatory cells could be seen in interstitium in some specimens. Three patients were lost contact. The other 7 patients were followed-up for 6 months to 3 years. They were recovered after operation， and no recurrence was observed. Conclusion Cardiac angioma is a rare disease. It could occur at any age with the absence of sex predominance. Generally， the tumor is located on visceral pericardial in adults and on tricuspid valve in children. It is hard to diagnose cardiac angioma before surgery and the resected specimen should be collected for pathological examination. The tumor would not recur after surgery with a good prognosis. Patients should be followed regularly after surgery.

MicroRNA （miRNA） is a kind of small endogenous non-coding single RNA containing 21-25 nucleotides， which regulates the expression of target genes through complementary binding to the 3’ untranslated region completely or incompletely. MiR-128， one of the subtypes of miRNA， expresses differently in a variety of diseases and normal tissues and plays an enormous role. Studies found that miR-128 played fundamental roles in various aspects of cellular function including differentiation， proliferation，migration and apoptosis in the development of several kinds of tumors including glioma， leukemia， stomach cancer， lung cancer and breast cancer. In this review， we will articulate the relationship between miR-128 and cancers， hoping to provide a new target for the treatment of tumor.

Anti-epidermal growth factor receptor（EGFR） monoclonal antibody is an important therapy for patients with metastatic colorectal cancer（mCRC）. However， due to the presence of intrinsic resistance and the development of acquired resistance， the response rate of antiEGFR monoclonal antibodies（anti-EGFR mAb） is not satisfied. According to the molecular alteration， this review elaborates with the molecular mechanisms of anti-EGFR mAb in mCRC， providing a reference for further studying on the resistance mechanisms of anti-EGFR mAb and a theoretical basis for individualized therapy in patients with mCRC.

MicroRNAs are a kind of small noncoding RNA molecules in eukaryotes， which regulate target gene expression in the posttranscription level. MicroRNAs play a significant role in development of malignant tumors. Epithelial to mesenchymal transformation occurred in cancer progression， which gets rid of the connection of the cells and acquires invasiveness and metastatic capability. This paper reviews the dysregulation of some MicroRNAs， which have diagnostic value of invasion， metastasis and prognosis of esophageal squamous carcinoma. Therefore， MicroRNAs will serve as new biological targets for the early diagnosis and gene therapy of esophageal squamous carcinoma.