The gastric cancer is closely related to the coagulation function.On the one hand,gastric cancer result in changes of coagulation mechanism such as blood coagulation,anticoagulation and fibrinolysis coagulation,which further result in hypercoagulable state and thrombosis related diseases.On the other hand,the abnormal of the coagulation function aggravate the progress of stomach cancer,and affect the prognosis of patients seriously.We review the domestic and international studies on the relationships between gastric cancer and coagulation function,and clinical doctors should pay attention to the abnormal of coagulation function and anticoagulaion treatment on gastric cancer.

Objective:To explore C-terminal tensin-like(CTEN) gene in breast cancer tissue and its significance. Methods:Explore the prevalence and clinical significance of CTEN expression in invasive breast cancer cases ( n = 1409 ) using immunohistochemistry and tissue microarray. Results: The staining pattern for CTEN in breast tumour cells was homogenous cytoplasmic staining. Moderate to strong cytoplasmic immunoreactivity for CTEN was observed in 90% of the studied cases(1268 cases) . CTEN expression was significantly associated with poor prognostic variables including larger tumour size(χ2=4. 254,P=0. 044), higher histological grade(χ2=7. 555,P=0. 019),axillary nodal involvement(χ2=5. 842,P=0. 035),poor Nottingham Prognostic Index (χ2=7. 578,P=0. 016),Local recurrence(χ2=5. 211,P=0. 039),Regional recurrence(χ2=4. 778,P=0. 042),Distant metastases (χ2=4. 780,P=0. 041) and Histological type(χ2=7. 634,P=0. 012). Significant associations were observed between increased CTEN expression and up-regulation of phosphorylated-Akt(P-Akt)(χ2=27. 23,P<0. 001),Phosphoinositide 3 kinase(PIK3)(χ2=37. 22,P<0. 001) and N-cadherin proteins(χ2=26. 91,P<0. 001). Kaplan-Meier survival analysis demonstrated that patients with high CTEN ex-pression had significantly shorter Breast Cancer Specific Survival(P=0. 004) and Metastasis-Free Survival(P=0. 041) than those with low-CTEN expression. Multivariate analysis showed that CTEN was not an independent prognostic marker in breast cancer. Conclusion:CTEN expression increase is a cancer gene,its association with poor prognostic parameters,and the expression of CTEN associated with poor prognosis of breast cancer parameters.

Objective Discussing reoperative reasons and selection of operation for congenital bile duct cysts.Method Retrospectively analyzing 15 reoperative patients for congenital bile duct cysts.Result Reoperative reasons include unresected cysts canceraztion (3 cases);unresected cysts calculogenesis (4 cases);anastomotic stoma between gut and cyst or bile duct stenosis (6 cases);reflux cholangitis(1 case);recurrence cholecystitis (6 cases).There are two kinds of operations,the first is interposed jejunal choledochoduodenostomy,the second is Rou-en-Y choledochojejunostomy.Conclusion Cysts and gallbladder must be resected totally,Roux-en-Y choledochojejunostomy can enhance effect of operation and prevent reflux cholangitis,this operation is very important for avoiding reoperation.

Objective To study the effects of deep hypothermia and L-arginine(NO precursor) pretreatment on cerebral protection after circulatory arrest and resuscitation in a canine model. Methods Ten healthy adult dogs of both sexes, weighing 14.45?2.3kg, were randomly divided into two groups(n=5): sham treatment group and L-arginine pretreatment group. Extracorporeal circulation was established routinely,circulatory arrest was induced when the nasopharyngeal temperature was reduced to 18℃, then the animals were resuscitated 90min later with extracorporeal circulation. SjvO2 was measured at 30min before circulatory arrest, 0min, 45min, 90min after circulatory arrest and at 60minutes after resuscitation. The ultrastructure changes in cerabral cortex were observed with transmission electron microscope (HITACHI 7500). The brain water content was also determined after the dogs were sacrificed. Results SjvO2 had decreased obviously after circulatory arrest, attaining the lowest level in CA 90min.After resuscitation it increased again in both groups. The levels of SjvO2 in dogs of L-arginine pretreatment group were markedly higher than that of control group at 45min and 90min after circulatory arrest (P

Objective To investigate whether the interleukin-10 (IL-10) gene therapy has the effect of anti liver fibrosis in mice and its mechanism.Methods Liver fibrosis was induced by long-term thioacetamide administration in mice.Human IL-10 expression plasmid was delivered via electroporation after liver fibrosis was established.The immunohistochemistry was used to study the expression of IL-10 in liver.Sircol collagen determination method was used to detect the contents of collagen in the liver.The reverse transcription polymerase chain reaction (RT-PCR) was used to detect the expressions of liver fibrosis-related genes,including transforming growth factor-β1 (TGF-β1),collagen α1,tumor necrosis factor-α (TNF-α),intercellular adhesion molecule-1 (ICAM-1),fibronectin,vascular cell adhesion molecule 1 (VCAM-1),and matrix metalloproteinase-inhibiting factor (TIMP-1,TIMP-2).Results Immunohistochemical results showed IL-10 gene therapy reversed hepatic fibrosis.Sircol collagen assay showed that IL-10 gene therapy reduced the content of collagen fibers(P ＜ 0.05).RT-PCR revealed IL-10 gene therapy reduced liver TGF-β1,TNF-α,collagen α1,cell adhesion molecule,and TIMPs mRNA upregulation.Conclusions Electroporative IL-10 gene therapy might be an effective therapeutic reagent for liver fibrosis with potential future clinical applications.

Objective We investigated the effect of rhIL-10 on reperfusion injury and acute rejection in rats after liver transplantation. Methods ACI (RTI a) rats and LEW (RTI 1) rats were used as donors and recipients. The dose of rhIL-10 was 0,2,10,and 50??g?kg -1?d -1. Results rhIL-10 at a dosage of 10??g?kg -1?d -1 significantly prolonged recipient′s survival time (13.1?1.0?d vs. 9.4?0.7d,P

BACKGROUND: BuCy2 composed of large-dose oral busulfanum and cyclophosphamide has been one of the main conditioning regimens before transplantation, but oral busulfanum can result in many side effects.OBJECTIVE: To evaluate the efficacy and safety of the conditioning regimen with intravenous busulfanum (Ⅳ Bu) in hematopoietic stem cell transplantation (HSCT) for malignant hematopathy.DESIGN: Case observation.SETTING: Department of Hematology, Union Hospital,Tongji Medical College, Huazhong University of Science and Technology.PARTICIPANTS: A total of 13 patients with chronic myelogenous leukemia (CML) and 6 patients with acute leukemia,who received allogeneic HSCT with the conditioning therapy of modified BuCy2, were enrolled at Institute of Hematopathy, Union Hospital, Huazhong University of Science and Technology from May to December 2006. There were 12 males and 7 females aged 14-50 years with an average of 33 years, and there were 9 cases of related transplantation and 10 cases of unrelated transplantation. Hematopoietic stem cells (HSCs) were harvested from peripheral blood of 18 subjects and bone marrow of 1 subject. All patients and their family members signed the informed consent.METHODS: All patients were treated with allogeneic HSCT with the conditioning therapy of intravenous BuCy2.All patients received the modified combination of busulfanum and cyclophosphamide that was commonly utilized currently.Hydroxycarbamide 40 mg/kg was orally taken ten days before transplantation. Arabinosylcytosin (Ara-C) 2 g/m2 was injected via vein nine days before transplantation. Busulfanum ampule 0.8 mg/kg (equal to 1 mg/kg oral administration)was given by central venous cannula eight, seven and six days before transplantation. The injection was performed over 2 hours controlled by infusion pump, once every 6 hours, totally 12 times. Busulfanum was diluted by saline or 5% glucose to about 0.5 g/L (about 10 times) before Ⅳ Bu. Cyclophosphamide 1.8 g/m2 was intravenously injected every day from five and four days before transplantation. Methyl-CCNU 250 mg/m2 was taken orally three days before transplantation. Occurrence of hepatic vano-occlusive disease (HVOD) and its side effects were determined. Follow-up was performed at month 6.5 after operation to observe disease recurrence and patient survival.MAIN OUTCOME MEASURES: Occurrence and side effects of HVOD 100 days after transplantation, and results of follow-up.RESULTS: Totally 19 patients were involved in the result analysis. In 13 days after transplantation, blood conversion,chromosome karyotype and DNA polymorphism tests verified that reconstruction of hematopoietic function was obtained and two patients got recurrence, of which one patient got complete remission after receiving fludarabine plus cytarabine plus granulocyte colony-stimulating factor (G-CSF) and HSCs from peripheral blood. DNA polymorhism test verified that re-engraftment was obtained. Another patient received chemotherapy. Other patients lived well.

BACKGROUND: Recently,the technique of isolation procedure of viable islets cell from large animals has been mature and used in clinical islet cell transplantation. Some study results indicate that low yields of pig islet cell isolations is probably not due to the presence of higher or more aggressive enzyme activities during the porcine isolation procedure. Therefore, the causative factors resulting in the inconsistent results should be sought for the intrinsic properties of the pancreatic islet and pancreas. The purpose of the study is to get more pancreatic islet cells for diabetic patients.OBJECTIVE: To investigate the effect of single enzymatic solution (SES)and multi-enzymatic solution(MES) on adult porcine pancreatic islet cell isolation,and to provide the theory base for diabetic patients rehabilitation.DESIGN: A completely randomized and controlled experiment based on animals.SETTING: General surgery and gerontology department in a university hospital.MATERIALS: The experiment was conducted in the Second Affiliated Hospital of Harbin Medical University from June 2003 to May 2004. Twenty consecutive random-bred adult pigs, 12 - 24 months old, weighing average 100 kg,were selected for experiment from Hada Slaughterhouse of Harbin.INTERVENTIONS: After slaughtering,the spleentic lobe of the pancreas was excised using sterile surgical gloves and surgical instruments. Each was immediately transported in 500 mL of sterile RPMI1640 solution at 4 ℃ to the laboratory for processing. After removal of fat peritoneum and superficial blood vessel,each pancreas was first immersed in 1:5 000 Liquor chlorhexidine for 3 minutes,then washed three times with cold RPMI1640, next mechanically minced into 1 mm×1 mm×1 mm fragments,weighed,and equally divided into two groups. Adult porcine islets were isolated with two different collagenase solutions(SES and MES).MAIN OUTCOME MEASURES: Islet count was performed with DTZ-staining. The viability was assessed by trypan-blue staining. Porcine islet insulin-secretory function was assessed by insulin content of cultured porcine islets and by insulin release. Islet morphological integrity was finally established by electron microscope examination.RESULTS: Overall islet cell content were statistically different between the two methods[(1 782 ±427) IE/g vs (1 293 ±451) IE/g,P<0.05]. No significant difference was found in viability,function or morphology of islet between MES and SES(P>0. 05).CONCLUSION: An average of isletisolated with MES method represents a uniquely massive yield in comparison with that by SES method. A good viability was also confirmed by static incubation and culture. The transplantation of those pancreatic islet cells can help to control the syndromes of diabetes.

Objective To analyze the Clavien-Dindo classification and risk factors of complications after pancreaticoduodenectomy and investigate the relationship between the major risk factors and Clavien-Dindo classification of complications.Methods The retrospective case-control study was adopted.The clinical data of 200 patients who underwent pancreaticoduodenectomy at the Third Affiliated Hospital of Inner Mongolia Medical University from January 2010 to June 2015 were collected.The patients underwent Whipple surgery or pylorospreserving pancreaticoduodenectomy according to the tumor location.Observation indicators included:(1)postoperative complications using Clavien-Dindo classification,(2) univariate and multivariate analyses:the basic conditions of patients,surgery-related factors,pancreas-related factors,(3) relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy.The univariate analysis and count data were done using the chi-square test.The comparison between groups was done using independent samples nonparametric test (Kolmogorov-Smirnov Z) and multivariate analysis was done using the Logistic regression model.Results (1) Postoperative complication situations:of 200 patients,122 underwent Whipple surgery and 78 underwent pylorus-preserving pancreatico-duodenectomy,including 6 combined with vascular reconstruction and 1 with radiofrequency ablation of liver tumors.Ninety-eight patients had postoperative complications,including 41 patients with 2 or above kinds of complications.Pancreatic fistula was detected in 80patients,including 42 with grade A,28 with grade B and 10 with grade C,wound infection in 29 patients,delayed gastric emptying in 24 patients,postoperative intra-abdominal infection in 16 patients,postoperative intraabdominal hemorrhage in 10 patients including 8 receiving interventional treatment,postoperative biliary leakage in 7 patients and unintended reoperation in 2 patients.Three patients were dead during hospitalization.The incidence of complications in grade Ⅰ,Ⅱ,Ⅲ (Ⅲ a and Ⅲ b),Ⅳ and V of Clavien-Dindo classification was 28.00％(56/200),13.00％ (26/200),5.00％ (10/200),1.50％ (3/200) and 1.50％ (3/200).(2) The univariate and multivariate analyses:the results of univariate analysis showed that body mass index (BMI) and texture of the pancreas were risk factors affecting complications after pancreatico-duodenectomy (x2=6.483,Z =-3.189,P ＜0.05).The results of multivariate analysis showed that BMI ＞ 23.9 kg/m2 and soft pancreas were independent risk factors affecting complications after pancreaticoduodenectomy (OR =2.044,1.649,95 ％ confidence interval:1.212-3.447,1.194-2.275).(3) The relationship between independent risk factors and Clavien-Dindo classification of complications after pancreaticoduodenectomy was analyzed,there were statistically significant differences between BMI or texture of the pancreas and Clavien-Dindo classification of complications after pancreaticoduodenectomy (x2 =13.897,27.077,P ＜ 0.05).Conclusions Clavien-Dindo classification of complications after pancreaticoduodenectomy is in favor of comprehensive comparisons and quality assessments among different studies,the primary classification is grade Ⅰ and Ⅱ.And decreasing BMI and good management of pancreatic stump may affect Clavien-Dindo classification of complications after pancreaticoduodenectomy.

Objective To explore the effects of bilirubin on myeloid differentiation factor 88 (MyD88)and interleukin-1 receptor associated kinase-4(IRAK-4).Methods Seven-day-old Sprague Daw-ley rats (clean grade),male or female,weighing 12.0 to 15.0 g,were randomly assigned to 6 groups.There were normal saline group(Ⅰ),lipopolysaccharide(LPS)control group (LPS,Ⅱ),15 mg /kg bilirubin con-trol (free-LPS)group (Ⅲ),15 mg /kg group (Ⅳa),30 mg /kg group (Ⅳb)and 50 mg /kg group (Ⅳc), and then subsequently divided into 2 h,5 h and 24 h subgroups in each groups.Some of the 200 newborn rats died amid the experiment.Finally a total of 144 were involved in the analysis of results,and 8 rats in each subgroups.Newborn Sprague Dawley rats were administered at various doses of bilirubin (15 mg /kg, 30 mg /kg and 50 mg /kg respectively)intravenously;1 h after injection,the rats were administered LPS intrap-eritoneally at a dose of 1 mg /kg;MyD88 and IRAK-4 were detected by immunohistochemistry at 2 h,5 h and 24 h after the injection of bilirubin.Results (1 )LPS could stimulate the expression of MyD88 and IRAK-4 in spleen cells (qMyD88 2 h =49.89,qMyD88 5 h =139.54,qIRAK-4 2 h =7.93,qIRAK-4 5 h =24.30,qIRAK-4 24 h =6.97 ,P <0.01 ).(2)Low concentration of bilirubin could promote the expression of MyD88 and inhibit the ex-pression of IRAK-4 (qMyD88 2 h =0.76,qMyD88 5 h =5.05,qIRAK-4 2 h =6.43,qIRAK-4 5 h =22.37,qIRAK-4 24 h =1.50, P <0.01 ).(3)LPS stimulation MyD88 affected by low concentration of bilirubin was not obvious (q2 h =1.48,q5 h =1.45,q24 h =0.10,P >0.05).Effects of medium and high concentration of bilirubin on LPS stim-ulation MyD88 were inhibitory(qⅣb 2 h =42.87,qⅣc 2 h =51.38,qⅣb 5 h =103.61 ,qⅣc 5 h =1 15.44,qⅣb 24 h =1.18,qⅣc 24 h =1 1.66,P <0.01 ).(4)Effects of low,medium and high concentration of bilirubin on LPS stimulation IRAK-4 were inhibitory(qⅣa 2 h =9.52,qⅣb 2 h =14.39,qⅣc 2 h =25.55,qⅣa 5 h =38.83,qⅣb 5 h =54.62,qⅣc 5 h =60.51 ,qⅣa 24 h =2.41 ,qⅣb 24 h =1.47,qⅣc 24 h =7.61 ,P <0.01 ).(5)The inhibition of biliru-bin to MyD88 and IRAK-4 was observed at 2 h,strengthened at 5 h,disappeared at 24 h in low-mid concen-trations of bilirubin(P <0.01 )while still visible at 24 h in high concentration of bilirubin.(6)There was neg-atively correlation between the expression level of MyD88,IRAK-4 and bilirubin concentration(rsMyD88 2 h =-0.86, rsMyD88 5 h =-0.92,rsMyD88 24 h =-0.53,rsIRAK-4 2 h =-0.82,rsIRAK-4 5 h =-0.86,rsIRAK-4 24 h =-0.57,P <0.01).(7) Under the effect of bilirubin and LPS,there were positively correlation between the expression levels of MyD88 and IRAK-4 of spleen cells(r2 h =0.77,r5 h =0.9,r24 h =0.67,P <0.01).Conclusion Bilirubin could inhibit the expression of MyD88 and IRAK-4.As the concentration of bilirubin increasing,its inhibition is more obvious and prolonged.The mechanism that bilirubin affects immune function of newborn rat may be related to regulation of expression of MyD88 and IRAK-4 at toll-like receptor 4 signal pathway.