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The diagnosis of bone metastasis of prostate cancer (PC) is of great significance to the treatment and prognosis of patients with PC.Bone scan is the most commonly used in the early diagnosis of bone metastasis, but its specificity is low and there is a high false positive.In recent years, with the in-depth study of the application of CT, MRI, emission computed tomography (ECT), positron emission computed tomography/computed tomography (PET/CT) and deep learning algorithm-convolutional neural networks (CNN) in the diagnosis of bone metastasis, the combined application of various auxiliary parameters in the diagnosis of bone metastasis has significantly been improved. The therapeutic effect of PC patients with bone metastasis can also be evaluated, which is expected to achieve the treatment of bone metastasis as well as diagnosis. By systematically expounding the research progress of the above-mentioned techniques in the diagnosis of bone metastasis, it can provide clinicians with new methods for the diagnosis of bone metastasis and improve the diagnostic efficiency for bone metastasis.

Objective: To analyze the association of the clinical inflammatory indices with the severity of urinary sepsis., Methods: We reviewed the clinical data of 70 patients with urinary sepsis treated in our hospital between January, 2013 and April, 2018. All the patients were diagnosed in line with the Guidelines for Diagnosis and Treatment of Urological Diseases in China (2014 edition), including 22 patients with sepsis, 12 with hypotension and severe sepsis, 17 with septic shock, and 19 with critical septic shock. White blood cell count (WBC), neutrophil percentage (N%), platelets (PLT), fibrinogen (FIB), Ddimer, interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) were examined in all the cases and compared among the 4 groups. The correlations of these inflammatory markers with the severity of sepsis were analyzed using logistic regression analysis., Results: The 4 groups of patients showed significant differences in N%, PLT, D-dimer, and PCT ( P < 0.05) but not in CRP ( P >0.05). Kruskal-Wallis Pairwise comparisons showed that the N% and PCT in patients with sepsis differed significantly from those in the other 3 groups; platelets in patients with sepsis differed significantly from those in patients with septic shock and critical septic shock; D-dimer differed significantly between patients with sepsis and those with septic shock. Among the 4 groups, the median levels of PLT decreased and PCT and N% increased with the worsening of sepsis. Logistic regression analysis indicated that PCT ( r =0.186, P =0.000), N% ( r =0.047, P =0.035) and PLT ( r =-0.012, P =0.003) were significantly correlated with the severity of sepsis in these patients., Conclusions: PCT, PLT and N% are all significantly correlated with the severity of sepsis, and their combined detection can be informative for assessing the severity of sepsis to facilitate clinical decisions on treatment.

Objective: To investigate the evaluation value of preoperative peripheral blood lymphocyte-to-monocyte ratio (LMR) on the prognosis of patients with stage III colon cancer undergoing radical resection and postoperative adjuvant chemotherapy., Methods: Electronic medical record were retrospectively retrived for stage III colon cancer patients who underwent radical surgery at Sun Yat-sen University Cancer Center from December 2007 to December 2013. Inclusion criteria were pathologically comfirmed colon adenocarcinoma, complete clinicopathological data, and postoperative XELOX (oxaliplatin + capecitabine) chemotherapy with follow-up of at least 3 months. Patients with neoadjuvant anti-tumor therapy, infectious disease, other malignant tumors and death of non-tumor causes within 3 months after operation were excluded. A total of 258 patients were included in this retrospective cohort study, including 146 males and 112 females with median age of 55 (22 to 85) years. Tumors of 100(38.8%) patients were located in the right hemicolon, and of 158 (61.2%) in the left hemicolon. Tumors of 194(75.2%) patients were highly and moderately differentiated, and of 64 (24.8%) were poorly differentiated. According to the TNM tumor pathological stage of AJCC 7th edition, 196 (76.0%) patients were stage IIIA to IIIB, and 62(24.0%) patients were stage IIIC. The median preoperative CEA was 3.8 (0.3 to 287.5) μg /L and the median cycle of the adjuvant chemotherapy was 6 (1 to 8). The cut-off value of preoperative LMR in prediction of 3-year overall survival (OS) outcome was determined by receiver operating characteristic (ROC) curve analysis. All patients were divided into low LMR group and high LMR group according to the critical value. Clinicopathological characteristics between the two groups were compared by using chi-square test or Fisher's exact test as appropriate. The 3-year disease-free survival and overall survival rate were estimated with the Kaplan-Meier method, and differences between two groups were assessed with the log-rank test. Univariate and multivariate analyses were performed through Cox regression model., Results: ROC curve showed that the cut-off value of preoperative LMR in predicting 3-year overall survival was 4.29. Then 143 patients were divided into low LMR group (LMR<4.29) and 115 patients into high LMR group (LMR ≥ 4.29). Compared with high LMR group, the low LMR group presented higher proportions of male [62.2%(89/143) vs. 50.4%(58/115), χ²=4.167, P=0.041], right hemicolon cancer [44.8% (64/143) vs. 31.3% (36/115), χ²=4.858, P=0.028], and the largest tumor diameter>4 cm [60.1% (86/143) vs. 33.0% (38/115), χ²=18.748, P<0.001]. During a median follow-up of 46.0 (range, 3.0 to 74.0) months, 3-year disease-free survival rate was 83.8% in high LMR group and 78.9% in low LMR group, which was not significantly different (P=0.210). While 3-year overall survival rate in low LMR group was significant lower than that in high LMR group (86.6% vs. 97.2%, P=0.018). Univariate analysis revealed that preoperative low LMR (HR=2.841, 95%CI: 1.146 to 7.043, P=0.024), right hemicolon cancer (HR=2.865, 95%CI: 1.312 to 6.258, P=0.008) and postoperative adjuvant chemotherapy≥6 cycles (HR=0.420, 95%CI: 0.188 to 0.935, P=0.034) were the risk factors for poor overall survival. Multivariate analysis identified that preoperative low LMR (HR=2.550, 95%CI: 1.024 to 6.347, P=0.004) and right hemicolon cancer (HR=2.611, 95%CI: 1.191 to 5.723, P=0.017) were the independent risk factors for overall survival., Conclusions: Preoperative peripheral blood LMR level represents an effective prognostic predictor for patients with stage III colon cancer receiving radical therapy. Low LMR indicates the poor prognosis and such patients require aggressive postoperative treatment strategy.

Objective: To investigate the feasibility of endoscopic metallic stent as a bridge to elective laparoscopic surgery in patients with malignant colorectal obstruction., Methods: Clinical data of 63 patients with obstructive colorectal cancer who underwent endoscopic metallic stent insertion under radiologic monitoring at the Longyan First Hospital between June 2012 and August 2016 were analyzed retrospectively. After complete remission of the obstruction, all the patients received multi-disciplinary team (MDT) evaluation to make the further treatment strategy. The subsequent surgery included open and laparoscopic procedures, and the short-term efficacy of these two procedures was compared., Results: There were 30 male and 33 female patients with age of 30 to 90 (mean 67) years, including 3 cases of ascending colon cancer, 4 cases of transverse colon cancer, 12 cases of descending colon cancer, 26 cases of sigmoid cancer, and 19 cases of rectal cancer. Only one patient (1.6%) developed sigmoid perforation at 3 hours after stent placement, and underwent emergency laparotomy with Hartmann procedure. The remaining 62 patients had bowel movements. After MDT evaluation, 10 patients (16.1%) were treated with palliative chemotherapy because they were unfit for surgery or for diffuse distant metastases. A total of 52 patients underwent radical surgery after a mean interval from stent insertion of 10 days (7-20 days), including open (n=18, including two cases with conversion to open surgery) and laparoscopy (n=34). The baseline data between open and laparoscopy groups were similar (all P>0.05). Primary anastomosis was successfully performed in all the patients without preventive stoma. Compared to open group, laparoscopy group had faster bowel movement [(2.88±1.06) d vs. (4.05±2.43) d, P=0.022] and shorter postoperative hospital stay [(7.85±0.96) d vs. (9.82±4.41) d, P=0.002]. There were no statistically significant differences in operative time, intraoperative blood loss, number of harvested lymph node, and postoperative complication rate between two groups (all P>0.05)., Conclusions: Endoscopic metallic stent placement can effectively remove malignant colorectal obstruction, and thus enables surgeons to perform an elective radical surgery, avoiding emergency surgery with stoma and unnecessary surgery for patients with distant metastasis. In the era of enhanced recovery after surgery, the endoscopic metallic stent placement combined with laparoscopic procedures, as a less invasive alternative, is effective and safe.

Background: Appropriate immunohistochemistry (IHC) scoring criteria can guarantee the reliability of mutation detection results. Most current studies suggest that the "four-grade criterion" may be the best among all scoring systems. The aim of this study is to discuss the influence of different four-grade immunohistochemistry scoring criteria on the test results., Methods: Three different four-grade immunohistochemistry scoring criteria were respectively used to evaluate the EGFR status of 83 cases of non-small cell of lung cancer (NSCLC) samples. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), the agreement of each criterion compared with the gold standard, and whether statistical significance exists between each criterion were calculated., Results: No statistical difference was found among the three criteria in detecting EGFR mutations. All three criteria exhibit considerably better specificity than sensitivity. For samples with scores of "3+", PPV could reach up to 100%., Conclusions: No definite best criterion is among different four-grade scoring criteria. Regardless of the kind of criterion used, the specificity of IHC method in detecting EGFR mutations is markedly better than the sensitivity. For samples with scores of "3+", mutation status can be confirmed, and samples can receive EGFR-TKI therapy directly.

Background: Patients with non-small cell lung cancer (NSCLC) harboring mutations of the epidermal growth factor receptor (EGFR) respond well to EGFR-tyrosine kinase inhibitor therapy. Immunohistochemistry (IHC) is a simple and widely used technique in clinical pathology laboratories. IHC also features cost effectiveness and rapid detection of EGFR mutations compared with molecular methods. This study aims to determine the accuracy of IHC for EGFR mutation detection in NSCLC., Methods: Specimens (obtained from surgery or biopsy) from 97 NSCLC cases were stained through IHC with mutation-specific antibodies. The clinicopathological features of patients with positive immunostaining results were analyzed. Positive specimens were subjected to liquid chip technology to detect the actual EGFR status. Forty NSCLC specimens obtained from surgery and confirmed to have EGFR mutations through liquid chip technology were collected. These specimens were then subjected to IHC analyses with mutation-specific antibodies. The sensitivity of IHC in detecting EGFR mutations was calculated., Results: Seventeen of the 97 NSCLC specimens were stained positive, and positive results were mostly observed in females, patients with adenocarcinoma, and non-smokers. About 76.9% of specimens with positive IHC results harbored mutations. The sensitivity of IHC was 40% among the 40 cases identified as containing EGFR mutations through liquid chip technology., Conclusions: The strong positive immunostaining result is accurate, but the sensitivity of the method may not be optimal and significantly varies in different studies. The widespread application of IHC in clinics must be further investigated.

In recent years, it has been well known that non-small cell lung cancer (NSCLC) patients with mutations of epidermal growth factor receptor (EGFR) response better to EGFR-tyrosine kinase inhibitor treatment. Although DNA-based assays (e.g. DNA sequencing) are the most frequently used and a relatively reliable method to detect EGFR mutations, they are complex, time-consuming and relatively expensive for routine use in clinical laboratories, besides they require high quality tumor samples. In contrast, the immunohistochemistry (IHC) methods make up fully for the above shortcomings and can serve as screening tests for EGFR mutations. However, there are many factors that can influence the results of IHC methods, such as different staining procedures, different antigen retrieval solutions and different sets of criteria, etc. Thus the IHC methods for detecting EGFR mutations have not been widely used in clinic and only in the research stage. This article reviews the use of IHC methods by different researchers and further discusses how to make the IHC methods work best for the detection of EGFR mutations.