Tumor-stroma ratio is the ratio of tumor cells and stromal tissue. It can be evaluated through HE-stained sections. Usually a 50% cut-off value is taken. TSR is stratified as stroma rich(TSR < 50% )and stroma poor(TSR≥50% ). The different prognosis between the two groups can be assessed. Several previous studies show that TSR is an independent prognostic factor for colon carcinoma,breast cancer,esophageal squa-mous cell carcinoma,cervical carcinoma and non-small cell lung cancer;patients with stroma-rich tumor suffer worse prognosis. The cause might be that tumor cells could activate stroma cells while activated stroma cells could promote the growth,infiltration and metastasis of tumors. And tumor stroma should be recognized as an indispensible participant in progression and invasion of carcinoma.

Objective To study the chemical constituents from Vernonia chunii of Hainan Province.Methods The constituents were isolated and purified by repeated column chromatography.Their structures were identified on the basis of physiochemical properties and spectral data.Results Four compounds were isolated and identified as:lupenyl propionate(Ⅰ),lupenyl(Ⅱ),oleanolic acid(Ⅲ),and daucosterol(Ⅳ).Conclusion Compound Ⅰ is a new compound,the others are isolated from this plant for the first time.

Objective:To study the use of left renal vein as a graft vessel in reconstruction after portal vein/superior mesenteric vein (PV-SMV) resection in pancreaticoduodenectomy.Methods:A retrospective study was conducted on 5 of these patients who underwent surgery from July 2008 to December 2017 at Chinese PLA General Hospital. The operative, complication and follow-up data were analysed.Results:There were 4 males and 1 female, with an average age of 57 (33-72) years. The mean operative time was 6.8 (5.4-9.1) h and the mean tumor size was 3.8 (2.8-4.8) cm. The average length of the PV-SMV defect left after resection was 3.8 (3.2-4.6) cm. The average length of the left renal vein used was 3.4 (3.0-4.1) cm. The operations were carried out in 3 patients with pancreatic cancer and in 2 patients with colon cancer pancreatic metastasis. The average postoperative hospital stay was 12 (10-25) days. Perioperative complications included 1 patient each with ascites, diarrhea and delayed gastric emptying. The creatinine levels ranged from 70-98 μmol/L preoperatively, with a transient creatinine rise to 80-156 μmol/L after operation and became 62-107 μmol/L upon discharge from hospital. The follow-up time was 4.3-17.8 months. Two patients died of recurrence/metastasis at 14.2 and 17.8 months after surgery.Conclusions:The left renal vein has the appropriate diameter and rich collateral branches. It has a sufficient length and it is conveniently located in the surgical field. This study showed that there was a minimal effect on renal function after its excision, and it can be used as a graft vessel for reconstruction in pancreaticoduodenectomy after PV-SMV resection.

Objective To investigate the value of combined therapy for hand post-burn scars.Methods We retrospectively analyzed 78 hands post-burn scars in 46 cases from 2007 to 2011.A mong them,scar contracture releasing,scar excision,free skin grafting and fixation with Kirschner's pins were performed in 38 hands,scar excision and regional flat transfer were performed in 18 hands,scar excision and skin grafting were performed in 18 hands,abdominal expanded flap transplantation and scar excision were performed in 4 hands.All patients received elastic sleeve pressure therapy,sili cone gel for external application and function training.Within six months after the operation,52 hands received drug delivery by wax therapy,16 hands incision with scar proliferation received drug injection into scar.We followed up all patients from half a year to three years after the treatment to observe the recovery of the appearance and function of the hands.Results We mainly chose surgery,elastic sleeve pressure therapy,silicone gel for external application,drug injection into scar,wax therapy,function training and so on treating the hand post-burn scars and found that the joins deformities caused by scar contracture were largely or totally corrected.The function and appearance were satisfying.Conclusions It is a good method to treat hand scars by surgery and post-surgery combined physical rehabilitation therapy,which deserves to popularization.

OBJECTIVETo investigate the effect of epidermal stem cells from human hypertrophic scar (HS-ESCs) on the skin wound healing in nude mice.

METHODS40 mice were randomly divided into two groups as experimental group (n = 20) and control group (n = 20). Wounds, 1 cm in diameters, were made on every mouse back. The wounds were treated with HS-ESCs and erythromycin ointment in experimental group, or only with erythromycin ointment in control group. The wound healing was observed during the following 14 days. The expression of collagen-I, collagen-III, epidermal growth factor (EGF), fibroblast growth factor (FGF2) , transforming growth factor (TGFbeta1, and TGFbeta2) were studied.

RESULTSThe wound healing time in the experimental group was (20.8 +/- 0.84) d, which was (25.6 +/- 0.89) d in the control group. HE staining revealed that the extent of vascularization in the experimental group was 11.60 +/- 0.55, while it was 8.04 +/- 0.33 in the control group. Immunochemistry analysis showed the expression of collagen-I, collagen-III, EGF, FGF2, TGFbeta1, and TGFbeta2 in the experimental group were significantly higher, compared with those in control group (P < 0.05).

CONCLUSIONHS-ESCs may promote wound healing through enhancement of the vascularization of the wound tissue and the expression of growth factors.

Animals ; Cicatrix, Hypertrophic ; pathology ; Epidermis ; cytology ; Female ; Humans ; Male ; Mice ; Mice, Nude ; Skin ; injuries ; Stem Cell Transplantation ; Stem Cells ; Wound Healing

Objective To lay a foundation for the clinical application and tissue engineering research of hypertrophic scar (HS)-derived DMSCs by comparing the biological characteristics of dermis mesenchymal stem cells (DMSCs) from human maturing-phase HS and normal skin.Methods Twenty maturing-phase HS specimens (scar group) and 20 normal skin specimens (control group) were selected to extract and sort DMSCs by two-step enzyme digestion.When cells in both groups were subcultured to 3rd generation,cell morphology and growth curve were observed; expressions of cell surface proteins CD29,CD49 and vimentin were tested by immunocytochemistry; cells with positively expressed surface proteins CD34,CD73,CD90,and CD105 were examined by flow cytometry; expressions of genes Oct4 and Nanog were tested by RT-PCR; cell potential to differentiate into lipoblasts,osteoblasts,and chondroblasts was assayed in inductive medium.Results DMSCs in both groups showed similar shape and growth curve.Cell markers CD29,CD49 and vimentin expressed positively.Of scar and control groups,expressions of CD34,CD73,CD90,and CD105 were (0.60±0.03)％ vs (0.61 ±0.02)％,(98.90±0.80)％vs (99.00±0.70)％,(98.30±0.30)％vs (98.20±0.40)％,and (93.10± 0.40) ％ vs (93.00 ± 0.20) ％ respectively (P ＞ 0.05) ; expressions of genes Oct4 and Nanog were 0.506±0.024 vs0.512±0.024 and 0.496 ±0.018 vs 0.494 ±0.023 (P＞0.05).Both types of DMSCs were able to differentiate in vitro into lipoblasts,osteoblasts,and chondroblasts in invitro conductive medium.Conclusion DMSCs exist in maturing-phase HS and present biomechanical characteristics basically similar with those of normal human skin.

Objective: To identify the special biomarkers and the differentially expressed proteins in keloid tissue and to explore the pathogenesis characteristics of familial keloid by comparing the protein expression differences among familial keloid(FK), sporadic keloid(SK), hypertrophy scar (HS), normal scar (NS). Methods: The tissue specimens of FK, SK, HS and NS(6 specimens in each group), were digested, taged and analysed using quantitative proteomic isobaric tags for relative and absolute quantitation (iTRAQ) labeling technology. A difference greater than 1.2 folds and P<0.05 were selection criteria for differencial expression proteins. Then bioinformatics analysis was applied.The expressions of 2 differential proteins were validated using Western Blot analysis. Results: A total of 2 450 differentially expressed proteins were identified. Compared with NS, 250 up-regulated and 281 down-regulated proteins were identified in FK; 281 up-regulated and 232 down-regulated proteins were identified in SK; 199 up-regulated and 233 down-regulated proteins were identified in HS.Compared with SK, 64 up-regulated and 164 down-regulated proteins were identified in FK; 79 up-regulated and 169 down-regulated proteins were identified in HS.Compared with HS, 124 up-regulated and 115 down-regulated proteins were identified in FK.These different proteins were concentrated in several vital signal pathways such as the extracellular matrix protein, cell adhesion and biological metabolism pathways. The variation trend of 2 differentially expressed proteins (P3H1 and RCN-3) were validated by Western Blot. Conclusions Proteomic analysis can identify the proteins with variance of keloid, hypertrophy scar and normal skin. Further investigations of these differential proteins may reveal the pathogenesis of keloid and provide new treatments for it.

Objective: To investigate the characteristics of spectrum and drug resistance of pathogens causing sepsis in patients with severe acute pancreatitis(SAP). Methods: The clinical data of 63 SAP patients with sepsis admitted in Department of Hepatobiliary, People′s Liberation Army General Hospital from January 2014 to December 2015 were retrospectively studied. There were 47 males and 16 females, aged from 22 to 73 years, with an average age of (52±11)years. Samples were collected mainly from: (1)pancreatic and peripancreatic necrosis and abdominal drainage; (2)bile; (3) blood or deep venous catheter; (4) sputum and tracheal catheter and thoracic drainage; (5) urine. Strain identification and drug-resistance test were preformed on positive specimens. Results: Of 244 pathogenic isolates, mainly derived from abdominal cavity(36.0%), blood stream (14.0%), central venous catheter(11.8%), necrotic tissue(9.1%) and sputum(8.1%); 154(63.1%) were gram-negative bacteria, 68 cases(27.9%) were gram-positive bacteria and 22 cases(9.0%) were fungi respectively. The top six common pathogens isolated were E. coli(16.0%), E.faecium and faecalis(15.2%), P.aeruginosa(10.7%), K.pneumonia(9.8%), Acinetobacter baumanni(8.2%), Stenotrophomonas maltophilia(5.3%)respectively. The detection rate of E. coli and K. pneumonia extended-spectrum β-lactamases(ESBL) was 84.6%(33/39) and 70.8%(17/24), the resistance rate to imipeniem was 12.8% and 25.0%, to cefperazone-sulbactam was 28.2% and 29.2%. As to P. aeruginosa and Acinetobacter bacillus, the resistance rate to imipeniem was 50.0% and 75.0%, to cefperazone-sulbactam was 42.3% and 70.0%; Stenotrophomonas maltophilia was completely resistant to cefperazone-sulbactam, but sensitive to minocycline, SMZ-TMP with the resistance rate less than 40.0%. Gram-positive bacterium strains mainly included E. faecium(38.2%, 26/68), E.faecalis(16.2%, 11/68) and Staphylococcus(35.3%, 24/68) which maintained high sensitivity to vancomycin, teicoplanin and linezolid, there was only one isolate resistant to vancomycin. Candida were the sole pathogens of fungal infections, sensitive to common antifungal drugs overall. Conclusions The gram-negative bacteria are the predominant pathogens mainly including ESBL-producing isolates(E.coli and K. pneumonia) and non-fermentation bacteria(P.aeruginosa and Acinetobacter bacillus) causing sepsis in SAP. The infection rate and drug-resistance rate of these two kinds of pathogens are relatively higher.

Objective Surgical resection is the primary form of curative treatment for hepatocellular carcinoma.Recent reports suggested that when compared to non-anatomical resection,anatomical liver resection improved prognosis of HCC patients.Whether anatomical liver resection should be the preferred routine procedure remains controversial.Methods The data of 236 HCC patients who underwent curative hepatectomy at the PLA General Hospital from January 2008 to July 2013 were reviewed.The data included basic information,procedure,tumor related information and follow-up data.Factors influencing overall survival and tumor-free survival rates were analyzed by multivariate analysis.Multivariate analysis and stratification analysis were also used to evaluate the long-term efficacy of the different procedures.Results The 5-year survival rate of anatomical liver resection was 75％,which was significantly better than that of non-anatomical resection (65 ％) (P ＜ 0.05).The tumor-free survival rate was 51％,which was significantly better than that of non-anatomical resection (34％) P ＜ 0.05).Antiviral therapy prolonged survival time and tumor-free survival time of HbsAg-positive patients.Surgical procedure,tumor diameter,tumor staging,antiviral therapy were influencing factors of overall survival.Surgical procedure,tumor staging,antiviral therapy were influencing factors of tumor-free survival.Anatomical resection improved the tumor-free survival for patients with tumor diameters less than 5 cm (P =0.098),improved tumor-free survival for patients with TNM stage T1 and T2 (P =0.059),and significantly improved the overall survival and tumor-free survivals for patients with T3,T4 (P ＜ 0.05).Conclusion Anatomical resection is recommended for treatment of patients with hepatocellular carcinoma.

Objective:To study the use of trans gastric sinus stent placement and drainage in management of persistent external pancreatic fistula.Methods:The clinical data of 12 patients who developed persistent external pancreatic fistulae after severe acute pancreatitis, pancreatic trauma or pancreatic surgery who were treated at the First Medical Center of Chinese PLA General Hospital from August 2018 to December 2020 were retrospectively analyzed. There were 10 males and 2 females, aged 30 to 65 years, median 43.5 years. These patients underwent trans gastric sinus stent placement and drainage, and were followed-up to study persistence of pancreatic fistula, new pancreatic fluid accumulation, complications and death.Results:In this study, there were 9 patients who developed persistent external pancreatic fistulae after severe acute pancreatitis, 2 patients after pancreatic trauma, and 1 patient after pancreatic surgery. The median operation time was 47 min (range 38-54 min). The technical success rate was 100.0% (12/12). The median follow-up was 22.5 months (range 2-29 months). Seven days after stenting, the percutaneous drainage tubes (urinary catheters) of all the patients were removed. One patient (8.3%) developed recurrence of pancreatic fistula 17 days after treatment. The same procedure of placing another stent was done and the patient recovered. Six months after treatment, 2 patients (16.7%) lost their stents, and 1 patient developed a pseudocyst (recurrence of pancreatic fistula). The maximum diameter of this pseudocyst increased gradually to 7cm after 9 months. A double pigtail drainage tube was placed under endoscopy in this patient, and the patients recovered. All the other patients did not develop recurrence of pancreatic fistula or pseudocyst. During the follow-up period, no patient developed any new complications including pancreatic fluid accumulation, fever, bleeding, infection and organ dysfunction, and no patients died.Conclusion:It was safe and efficacious to use trans gastric sinus stent placement for treatment of persistent external pancreatic fistula. However, the long-term outcomes require further studies.