ObjectiveTo improve the diagnosis and treatment of primary duodenal carcinoma.MethodThe clinical data of 45 patients with primary carcinoma of the duodenum from 1987 to 2000 were analyzed retrospectively.ResultAccording to the site of cancer, tumors around, below and above the duodenal papilla accounted for 64%, 22% and 13% of all cases. The diagnosis rate of duodenoscopy was 71%(15/21). Pancreatoduodenectomy was performed in 22 cases, segmental duodenectomy in 2 cases, simple tumor resection in 3 cases, gastroenterostomy or choledochojejunostomy in 12 cases and simple laparotomy in 4 cases. In patients of curative resection, the postoperative 3 and 5 years′ survival rate was 41 4% and 23 6%. In those with gastroenterostomy or choledochojejunostomy, the average survival time was 6～15 months. All cases undergoing biopsy only died within six months.ConclusionPrimary duodenal carcinoma mainly occurs around duodenal papilla. The long time survival of Whipple′s procedure is favourable.

Objective To investigate the clinical significance of the change in content of glycosaminoglycan and its composition in pancreatic carcinoma. Methods The content of glycosaminoglycan and its complements in 30 cases of pancreatic carcinoma and 2 cases of normal pancreatic tissue were determinated with biochemistrical and immuohistological methods. Results The content of glycosaminoglycan in pancreatic carcinoma (3.05 mg?0.75 mg/g wet tissue) was much higher than that in normal pancreatic tissue(1.39 mg?0.01 mg/g wet tissue) (P

Objective Benzoquinone ansamycin antibiotic, geldanamycin (GA), is a new anticancer agent that could inhibit Hsp90 by occupying its NH2-terminal ATP-binding site. This study was to investigate the antitumor efficacy of GA on Her2/neu tyrosine kinase overexpressing human breast cancer cell line SKBr3. Methods The degradation of Her2/neu tyrosine kinase was analyzed by Western blotting, the proliferation index was determined by MTT assay,cell cycle distribution was detected by flow cytometry, Cyclin D1 mRNA transcription was measured by RT-PCR and real-time PCR, and cell motility was evaluated by the cell culture insert model. Results GA induced a dose- and a time-dependent degradation of the Her2/neu tyrosine kinase protein and concurrently, the inhibition of cancer cell proliferation. The antitumor effects mediated by GA included: GA treatment decreased the survival rates of cancer cells,and led to a dase-dependent G1 arrest. Furthermore, this antitumor effect was proved to be related to declined transcription of Cyclin D1. Concurrently, the motility of cancer cells was reduced by GA. Conclusion GA treatment could induce the degradation of Her2/neu tyrnsine kinase efficiently, inhibit cancer cell proliferation and reduce motility in Her2/nen tyrosine kinase overexpressed human breast cancer cell line SKBr3.

Objective To determine the effect of suppressing TrkA expression on pancreatic cancer chemosensitivity to gemcitabine and further disclose the role of PI3K/Akt signal transduction pathway in pancreatic cancer chemoresistance. Methods Human pancreatic cancer cell lines PANC-1, MIA-PaCa-2 and ASPC-1 were studied. The expression and kinase activity of TrkA were determined by Western blot analysis and in vitro kinase assay, respectively. RNA interference was used to suppress TrkA expression. Gemcitabine-induced cytotoxicity was determined by tetrazolium reduction assay and caspase profiling was performed. The effect of TrkA-specific siRNA on PI3K/Akt activity was also quantified. Results TrkA expression and kinase activity in cell lines were directly correlated with gemcitabine chemoresistance. TrkA-specific siRNA suppressed TrkA expression and kinase activity, and furthermore increased gemcitabine-induced, caspase-mediated apoptosis. PI3K/Akt activity was decreased by suppression of TrkA expression. Conclusion TrkA is a determinant of pancreatic adenocarcinoma chemoresistance and PI3K/Akt is a key signaling component by which NGF activation of the TrkA signal transduction pathway protects pancreatic cancer cells from chemotherapy-induced cell death.

Objective To evaluate the identification successful rate of sentinel lymph node (SLN) with breast cancer and the accuracy to predict axillary lymph node status in different vital blue dyes.Methods 94 patients with breast cancer were recruited for the study between Oct. 1999 and Apr. 2001, of whom 32 and 62, respectively, were injected 0.028mmol*L-1 Methylene blue and 0.018mmol*L-1 Patent blue violet in breast parenchyma surrounding the primary tumor to identify SLN.All 94 patients underwent the axillary lymph node dissection.Results For Methylene blue group and Patent blue violet group, SLN identification successful rates were 65.6% (21/32) and 88.7% (55/62) (P=0.012) and accuracy rate to predict axillary lymph node status were 90.5% (19/21) and 98.2% (54/55) (P=0.183), respectively.Conclusion In identifying SLN,Patent blue violet is more ideal vital blue dye than Methylene blue, whereas the accuracy rate to predict axillary lymph node status had no significant difference.

Objective To inquire the nutritional and immune status in patients with gallbladder carcinoma before and after radical cholecystectomy.Methods The nutritional and immune status in patients with gallbladder carcinoma were assessed in 1 week before surgery, and on 3rd day, 7th day, 14th day and 21st day after operation, respectively.Results All of the nutritional parameters but the serum level of iron, TIBC and transferrin recovered within 3 week after operation. Remarkable decrease of serum IgG, IgA, IgM and C3, C4 complement, IL-2, CD4, CD4/CD8 ratio, and the remarkable increase of serum SIL-2R and CD8(P＜0.01) on 3rd day after operation.Conclusion Adequate iron should be supplemented after the radical cholecystectomy for gallbladder carcinoma in the third postoperative week. Radical cholecystectomy with complete resection of the tumor and removal of lymph nodes played the important roles in the recovery of immune function.

Objective To explore the risk factors for clinical anastomotic leakage after resection of rectal cancer in China. Methods By meta-analysis we made a comprehensive analysis of the risk factors for clinical anastomotic leakage after resection of rectal cancer based on 19 articles published in China between January 1999 and January 2009. Results The anastomotic leakage rate was higher in the patients aged 60 years old and above than in those younger, with the combined odds ratio (OR) value being 0.50 (95% CI: 0.33-0.76) (P<0.01). The incidence rate was higher in the male patients than in the female ones, with the combined OR value being 2.17 (95% CI: 1.38-3.42) (P<0.01). The incidence rate in the patients with the distance of tumor from the lower margin to anal verge being 7cm and shorter was higher than that with longer distance, with the combined OR value being 1.79 (95% CI: 1.37-2.35) (P<0.01). The incidence rate in the patients who had received radiotherapy preoperatively was higher than that in those who had not, with the combined OR value of 3.66 (95% CI: 2.19-6.09) (P<0.01). The incidence rate in the patients who had received stapler anastomosis was higher than that in the patients who had received manual anastomosis, with the combined OR value being 0.70 (95% CI: 0.47-1.05), but there was no significant difference between them (P>0.05). The incidence rate was higher in the patients with diabetes mellitus than in the healthy ones, with the combined OR value being 3.16 (95% CI: 2.27-4.39) (P<0.01). The incidence rate was lower in the patients with Dukes A and B stages than in those with Dukes C and D stages, with the combined OR value being 0.61 (95% CI: 0.45-0.83) (P<0.01). The incidence rate in the patients with high malignance degree in clinicopathological types was higher than that with low malignance degree, with the combined OR value being 2.17 (95% CI: 1.38-3.42) (P<0.01). The incidence rate was lower in the patients who had received preventive colostomy than in those who had not, with the combined OR value being 0.39 (95% CI: 0.14-1.05), but there was no significant difference between them (P>0.05). The incidence rate was higher in the patients who had got selective operation than in those who had got emergency operation, with the combined OR value being 0.27 (95% CI: 0.13-0.56). Conclusion The risk factors of anastomotic leakage after resection of rectal cancer are as follows: 60 years old and above, male patients, diabetes mellitus, preoperative neo-adjuvant radiotherapy, the distance of tumor from the lower margin to the anal verge being shorter than 7cm, Dukes C and D stages, high malignance degree in clinicopathological types, and emergency operation.

Objective:To explore the rational mode of hospital management under the trusteeship mode through the case study of a county-level hospital entrusted by a large general public hospital.Methods:Based on the system construction,the complete sinking of quality medical resources,the cultivation of talents and cultural integration,this paper analyzed the current situation of medical technology and service quality in hospitals before and after trusteeship by a retrospective control study.Results:The medical technology,quality and patient satisfaction of the hospital were improved significantly after trusteeship.Conclusions:The effective measures in the process of trusteeship of county-level hospitals are conducive to improve the level of medical technology and service of county -level hospitals,which can ensure the quality and safety of medical treatment,provide valuable suggestions for decision-making,and promote the development of hierarchical diagnosis and treatment.

Objective To study the identification rate of sentinel lymph node (SLN) in patients with breast cancer (BC) and the accuracy in predicting axillary lymph node(ALN) metastasis using methylene blue (MB) and patent blue violet (PBV) injection. Methods From October, 1999 to April, 2001, 94 patients with BC were selected for this study. Of them, 32 patients were injected with 1% MB and 62 patients with 1% PBV to identify SLN. All 94 patients underwent the axillary lymph node dissection. Results In MB group and PBV group , the SLN identification rate were 65.6% (21/32), 88.7% (55/62); the accuracy rate to predict axillary lymph node status were 90.5% (19/21), 98.2% (54/55) respectively. Conclusion Compared with MB ,PVB is the more ideal vital blue dye in identification of SNB.

Objective To investigate ectopic expression of key elements of Wnt/?-catenin signaling pathway,including E-cadherin,?-catenin and Cyclin D1,as well as the relationship between ectopic expression of ?-catenin and overexpression of Her2 in human breast carcinoma tissues.Methods Immunohistochemical technique(Elivision) was used to detect the expression of Her2 and three elements of Wnt/?-catenin signaling pathway(?-catenin,E-cadherin,Cyclin D1) in 90 samples of human breast carcinoma.Results In E-cadherin normally-expressed group,the ectopic expression rate of ?-catenin(27.3%) was significantly lower than that(75.0%) in E-cadherin negative breast carcinoma;in ?-catenin ectopic expression group,overexpression rate of Cyclin D1(83.3%) was significantly higher than that(40.7%) in the other group.In Her2 overexpressed-breast carcinoma tissue,the ectopic expression rate of ?-catenin(73.5%) was significantly higher than that(19.6%) in Her2 negative breast carcinoma.Her2 overexpression could coexist with ectopic expression of Wnt/?-catenin in promoting axillary lymph node metastasis in human breast carcinoma.Conclusion Ectopic expression of Wnt/?-catenin signaling pathway does exist in some human breast carcinoma tissues,and the abnormal expression correlates with overexpression of Her2.Furthermore,the instantaneous activation of them could present synergism in promoting metastasis of axillary lymph nodes.