Objective To study the effect of oral chemotherapy on patients of pancreatic carcinoma undergoing Whipple′s procedure. Methods48 cases undergoing radical pancreaticoduodenectomy with regional lymphadenectomy were divided into two groups. 24 cases received oral chemotherapy consisted of 5′ DFUR and calcium folinate for a course of 6 months. ResultsThe clinicopathological features were similar between the two groups. During the period of follow up,5 cases in chemotherapy group died including motality caused by liver metastasis in 2 cases whereas 7 cases died of liver metastasis in the control group( P

Objective To study the clinic characters of patients with latent autoimmune diabetes in adults (LADA). Methods We evaluated the prevalence of acute and chronic complications in the LADA patients with serum antibodies to glutamic acid decarboxylase (GADA) or to islet cell cytoplasmic antigens (ICA). The prevalence of acute and chronic complications were further compared with that in patients with acute onset type 1 or type 2 diabetes. Results The mean age, BMI, fasting and postprandial C peptide levels of the LADA patients were higher than those of type 1 diabetes and lower than those of type 2 diabetes. Of the LADA patients, 29.3% had ketosis. Although the frequency of repeated attack of ketosis in the LADA patients was similar to that in type 1 diabetes, the duration from diabetic onset to first ketosis in the LADA patients was much longer. The prevalence of retinopathy in the LADA patients was 19.5%, which was similar to that in type 1 diabetes. The prevalence of cataract in the LADA patients was 48.8%, which was similar to that in type 2 diabetes. Less LADA patients had microalbuminuria, compared with the other groups. There was no difference in the prevalence of overt nephropathy, neuropathy and hyperlipidemia among the three groups. The prevalence of coronary heart disease in the LADA patients was similar to that in type 2 diabetes. The prevalence of hypertension in the LADA patients was higher than that in type 1 but lower than that in type 2 diabetes. Conclusion The clinic characters as well as acute and chronic complications in LADA patients are different from those in type 1 and type 2 diabetes.

Objective To investigate the effects of cefoprazone/sulbactam(CPZ/Sul)and dexamethasone(DXM) on serum IL-8,IL-10 in SD rats with severe pneumonia due to Klebsiella pneumoniae.Methods A rat model of severe pneumonia was induced by intratra- cheal instillation of Klebsiella pneumoniae with a dose of 3.6×108CFU(0.3ml).60 male SD rats were random divided into control group,model group,cefoprazone/sulbactam(CF-L/Sul)group and cefoprazone/sulbactam plus dexamethasone(DXM+CPZ/Sul)group.15 rats in each group were then divided into three subgroups and 5rats in each subgroup were examined at the 6th,8th and 10th day,respectively.Arterial gas analysis.total WBC and PMN cell counts in BALF were examined.ELISA method was used to detect the level of IL-8 and IL-10 in serum.RESULTSIn model group,PaO2 were progressively decreased while total WBC and PMN cell counts in BALF were markedly increased.In CPZ/Sul group,all parameters were alleviated,but there were no significant difference of serum IL-8 and IL-10 between model group and CPZ/Sul group.In DXM+CPZ/SUl group,all parameters were significantly alleviated including serum IL-8 and IL-10.Conclu sions Severe pneumonia of rat due to Klebsiella pneumoniae was characterized by significant elevation of serum IL-8 and IL-10,which suggested the imbalance of inflammatory/anti-inflammatory mediators during the course of severe pneumonia.DXM codd markedly decrease the production of inflammatory mediators and slightly decrease the production of anti-inflammatory mediators,which could restore the balance and contribute to the relief of severe pneumonia.

A new dibenzocyclooctadiene lignan, renchangianin E (1) was isolated from the stems of Kadsura renchangiana. Its structure and stereochemistry were elucidated by spectroscopic methods, including 2D-NMR techniques.

Objective To observe hypoxia-induced pulmonary arterial endothelial-to-mesenchymal transition and investigate the role of transforming growth factor β1 (TGF-β1) in the process. Methods Pulmonary arterial cells improved by adherence method were cultured in normoxia (containing 21%O2,5%CO2 and 74%N2) or hypoxia (containing 1%O2,5%CO2 and 94%N2) for 1,4,or 7 days,respectively. Endothelial-to-mesenchymal transition was confirmed with morphological observation and expression of α-smooth muscle actin (α-SMA) by immunocytochemistry. Expression of TGF-β1 was evaluated by RT-PCR and Western blot,and α-SMA by Western blot. Results Hypoxia-induced paving-stone-like pulmonary arterial endothelial cells transdifferentiating to polygonal cells with high-expression of α-SMA. TGF-β1 expression was increased significantly after 7 days of hypoxia. TGF-β1 stimulating alone increasedα-SMA expression of pulmonary arterial en-dothelial cells;while,SD-208,inhibitor of TGF-β1,abolished the above effect. Conclusion Hypoxia can induce endothelial-to-mesenchymal transition. And TGF-β1 plays an important role in the process.

ObjectiveTo evaluate the diagnostic value of “taller-than-wide sign” of thyroid malignancy in transverse and longitudinal plane using ultrasound.Methods708 thyroid lesions including 302 benign nodules and 406 malignant nodules ( 390 papillary carcinomas,12 medullary carcinomas,4 follicular carcinomas) that were diagnosed at surgery were included in this study.The sensitivity and specificity of “taller-than-wide sign” in transverse (A/TC ≥ 1 ) and longitudinal plane (A/TL ≥ 1 ) were evaluated using ultrasound.All thyroid malignant lesions were divided into three groups according to size of the nodules:group A≤1 cm; group B≤2 cm,group C＞2 cm.The sensitivity of each group was also evaluated.ResultsThe constituent ratio of “taller-than-wide sign” between benign and malignant nodules was significantly different (P＜0.001 ).The differences of sensitivity of A/TL ≥ 1 and A/TC ≥ 1 among three groups were also found( P ＜0.001),and the sensitivity of A/Tc≥1 was higher than A/TL≥1.ConclusionsA/TC≥1 found by ultrasound contributes to differentiate the thyroid carcinoma from benign nodules.For a large thyroid lesion,other indicators are needed to diagnose thyroid carcinoma.

Objectives To investigate the role of lymphangiogenesis in the perineural micrometastasis of pancreatic adenocarcinoma. Methods The clinical data of 30 pancreatic adenocarcinoma patients who were admitted from Sep. 2005 to Oct. 2006 for extended radical surgery were collected. The samples including pancreatic cancer, adjacent tissue, lower bile duct, pancreatic tail, the structure surrounding the SMA (peripancreatic nerve plexus) and lymph nodes were collected during operation. They were subjected to conventional pathological examination. The lymphatic capillaries weredetected by double immunohistochemical staining and the lymphatic vessel density ( LVD) was measured. Results Intra-pancreatic and/or peripancreatic neural invasion was observed in 25 patients (83. 3% ) , of which 20 were found to have both the peri-pancreatic and intra-pancreatic neural invasion. The other 5 only had the intrapancreatic neural fiber invasion and there was no single patient with peri-pancreatic neural fiber invasion only. Peri-neural invasion was not significantly associated with patients' age, gender, lymph node metastasis, tumor size and the location (P > 0.05) , but was obviously associated with JPS clinical staging ( P < 0. 05 ). The mean intratumoral LVD was (4.2 ±3.4) per field, which was significantly lower than (11.3 ±6.9) per field of adjacent tissue and (10.8 ±4.4)per field of normal pancreatic tissue(P<0.01). The mean intratumoral LVD between adjacent tissue and normal pancreatic tissue was not statistically different. Lymphatic vessel invasion was observed in non-malignant tissues in 18 patients, and there was a distribution correlation between lymphatic vessel invasion and extra-pancreatic neural plexus invasion (P<0.05). Conclusions The incidence of peri-neural invasion was high, peri-neural invasion was associated with JPS clinical staging and lymphatic vessel invasion, which suggested the possibility of the cancer spreading by peritumoral lymphangiogenesis route into the peri-SMA neural plexuses.

Objective To construct a human endostatin adenovirus vector and investigate its inhibitory effect on pancreatic carcinoma in nude mice.Methods Animal model of pancreatic carcinoma bearing nude mice was established by subcutaneous injection of SW1990 cells.All mice were randomized into Ad-hEnd group,Ad-LacZ group and control group with 8 mice in each group.The endostatin gene recombinant adenovirus were intratumorally injected every two days for 4 times.The rate of tumor growth was observed.lmmunohistochemical staining was employed to investigate the expression of vascular endothelial growth factor (VEGF) and micro-vessel density (MVD).TUNEL in situ was used to examine tumor cell apoptosis.Results The tumor formation rate was 100%.4 weeks later,the volumes of the tumors were (921.9±279.7 )mm3,(2804.4±553.5 )mm3 and ( 3040.6±487.6 ) mm3 in Ad-hEnd group,Ad-LacZ group and control group,respectively;the weights of the tumors were (1.19±0.18 ) g,( 2.38±0.42 ) g and ( 2.41±0.47 ) g,respectively;the VEGF positive rates were (36.3±7.1 )%,(81.2±6.6)% and (79.4±6.2)%,respectively;the levels of MVD were 12±4,27±5 and 25±6,respectively;the apoptotic rates were (31.2 ±5.4) %,( 9.4±4.9 ) % and ( 8.5±3.7 ) %,respectively.Compared with Ad-LacZ group and control group,the parameters in Ad-hEnd group were statistically different (P ＜0.01 ).The difference betweon Ad-LacZ group and control group was not statistically different.Conclusions Human endostatin gene mediated by recombinant adenovirus could inhibit tumor growth,angiogenesis and promote cell apoptosis of pancreatic carcinoma and could be used as geue therapy for pancreatic carcinoma.

Objective To improve the prognosis and radical resection of the extended pancreaticoduodenectomy for patients with pancreatic cancer in the ucinate process involving mesentery mot. Methods From Jan. 2004 to Dec. 2007, a total of 23 ( 14 male and 9 female, aged between 30 and 72 years old) patients with pancreatic cancer in the ucinate process involving mesentery root were treated in our department. Curative resection was performed for all patients by the extended pancreaticoduodenectomy with superior mesenteric artery (SMA) isolation and mesentery root resection. The surgical procedure, the safety and prognosis were analyzed retrospectively. Results 12 patients underwent the procedure, among them 11 also underwent combined SMV partial resection and reconstruction. The operation time was (4.2 ± 1.1 ) hours, and the blood loss was ( 1 635 ± 1 362) ml with the blood transfusion of ( 1 609 ± 1 462 ) ml. There was no operation related death in this case series, and mild to severe diarrhea occurred in 6 cases. The post-operative stay ranged 9 to 30 days. The pathological examination showed that the tumor size was (5.3 ± 1.4) cm. 13 patients (57%) had one or more lymph nodes metastasis. 20 patients (87%) had nerve involvement. Among 11 patients with SMV partial resection and reconstruction, 10 patients had endangium involvement. 22 patients had negative surgical margins for all specimens. Rapid intra-operative frozen pathological examination showed negative surgical margins in one patient, however, post-operative paraffin section pathological examination revealed nerve involvement between SMA and celiac trunk. After a follow-up of 5 to 42 months, liver metastasis occurred in 4 patients, and local recurrence occurred in 3 patients. The 1-year and 2-year accumulated survival rates were 77.2% and 42.5%, respectively. Conclusions Isolation SMA and the mesentery resection in extended pancreaticodudenectomy were safe and useful. Using this modified technique, Radical operation resection could be achieved in the treatment of pancreatic cancer in uncinate process.

Objective To investigate clinicopathological features、diagnosis and surgical treatment of duodenal stromal tumors. Methods A retrospective clinical analysis was made in 23 cases of duodenal stromal tumors admitted from 1995 to 2004. Results Melena and abdominal pain was the most common presenting symptom. Complete resection was achieved in all cases, including pancreatoduodenectomy in 13 cases, by pylorus-preserving pancreatoduodenectomy in 3 cases, and tumor enucleation in 7 cases. The mean size of the tumor was 6. 6 cm (2 - 21 cm) , among them 10 cm in 6. Pathologically tumors less than 5 cm were all of potential malignancy, whereas those larger than 5 cm were malignant. Follow-up of 2 months to 9 years found all cases alive and healthy except for one who died of liver metastasis one year postoperatively. Conclusion Duodenal stromal tumors were low malignancy tumors. Aggressive surgery is the choice of treatment. Favorable prognosis is expected after complete surgical excision.