BACKGROUND:With the in-depth study of cancer stem cels, increasing evidence has shown that cancer stem cels are the reason for cancer metastasis and recurrence, and therefore it is of great significance to isolate and identify cancer stem cels that can elucidate the pathogenesis of cancer and development of anticancer drugs.
OBJECTIVE: To isolate and culture gastric cancer stem cels and then to detect its biological characteristics.
METHODS: Cancer tissues from 16 patients with gastric cancer were cultured using adherent method and enzymic digestion methods to isolate gastric cancer stem cels. The cel morphology was observed under inverted microscope to drawn out growth curves. Osteogenic and adipogenic ability of cels were also detected.
RESULTS AND CONCLUSION: Gastric cancer stem cels were isolated successfuly by both two methods. Under the microscope, the cels were fusiform- or polygon-shaped. At confluence, the cels grew in a vortex or radial manner. The cel growth curve showed that 1-3 days were latent period, 4-9 days were logarithmic growth phase, and over 10 days were growth plateau phase. Flow cytometry results showed that passage 3 gastric cancer stem cels highly expressed CD90, CD29, CD44, but lowly expressed CD34, CD45 and HLA-DR. After osteogenic induction, calcified nodules were clearly visible in the gastric cancer stem cels at passage 3; after adipogenic induction, bright and tiny fat droplets were seen in the cytoplasm. These findings indicate that cancer stem cels exist in the gastric cancer tissues, and have similar morphology, biological property and multipotent differentiation ability to normal cels, which are probably involved in gastric cancer occurrence and development.

Pancreatic carcinoma is one of the malignancies of the gastrointestinal tract with the most dismal prognosis.As a consequence of its anatomic and biological behavior,the 5-year survival is only 10％- 20％ even after curative resection.There are many problems which need to be solved in the diagnosis and treatment of pancreatic cancer.This paper aims to discuss the preoperative assessment of resectability,histological diagnosis,radical surgery,multidisciplinary and multimodality treatment to help to raise the standard of diagnosis and treatment of pancreatic cancer in China.

Objective To study the clinical feature, diagnosis and surgical treatment of mixed hepatocellular and cholangiocellular carcinoma(MHC).Methods The clinical materials of 14 surgically treated patients with MHC were retrospectively analyzed.Results There were nine males and five females, with age ranging from 33 to 62 years (mean 50 years). Some patients had a history of hepatitis B(71%), and cirrhosis(64%). Elevation of serum alpha-fetaprotein(AFP) was observed in nine patients(64%). The resection rate was 86%(12/14), and postoperative overall 1-, 3-, 5-year survival rates were 71%(10/14)?43%(6/14)?and 29%(4/14), respectively. In the tumor-resected patients, the 1-, 3-, 5-year survival rates were 83%(10/12)?50%(6/12)?and 33%(4/12),respectively. Conclusions MHC patients lack typical clinical manifestations. Radical surgery is an effective treatment for this disease. The cholangiocellular carcinoma component appears to determine the prognosis.

objective: To study the properties of keepers treated with different methods. Methods: Eighteen Z 3 magnetic attachments were divided into three groups at random. Cobalt chromium alloy was used for root cap. The keepers in the first group were cast to the caps, those in the second group were welded to the caps by Nd:YAG laser welding apparatus. Keepers in the third group were untreated. Universal testing machine was adopted to measure the breakaway retention of the attachments. The roughness of keeper surfaces was measured by roughness tester. Results: No statistical difference was observed as to the breakaway retention between magnetic attachments and laser welded coping keeper or between those and cast coping keepers. But retention of the keepers in the two groups was slightly lower than that of untreated keepers. Defects of pits were found on the surfaces of the cast coping keepers. The surface smoothness of the cast coping keepers was inferior to that of the laser welded coping keepers. Conclusion: Laser welded keepers and cast coping keepers can meet clinical demands for the use of magnetic attachments.

Objective To study the methods for diagnosis and treatment of insulinoma.Methods The clinical data of 120 patients with insulinoma who had been admitted to our hospital in the last 40 years were retrospectively reviewed.Results Fasting blood glucose values were less than 2.75 mmol/L in all the patients.Fasting serum insulin values in 75 patients were higher than 25 ?U/mL,and the average was (65 ?6.0)?U/mL.Before operation,tumor was detected in 2 of 60 patients by ultrasound scan,and in 10 of 50 by CT. Among 18 patients who had intra-operative B-ultrasound examination, 16 positive cases were verified by intraoperative exploration; and one case the tumor was not palpable but was found by intraoperative B-ultrasound examination.The operations included enucleation of insulinoma(70 patients),insulinoma resection and distal resection of the pancreas(44),distal resection of the pancreas(4),and biopsy(2).The low blood glucose symptoms disappeared after the first operation in 111 of the 112 patients who had benign tumor.One case with benign tumor was cured by a second operation.Twenty patients developed pancreatic fistula after tumor enacleation, of them,14 healed uneventfully after drainage,5 were cured by operation,and 1 died of peritoneal infection.Conclusions Preoperative localization of insulinomas is difficult. Intraoperative exploration and ultrasound scan are the chief methods for the localization of insulinoma.Enucleation of insulinoma should be selected for benign tumor. Resections of the pancreatic body and tail is required for large,deep or multiple tumors.

Objective To investigate the risk factors of central lymph node metastasis and significance of prophylactic central lymph node dissection for clinical N0 (cN0) patients with papillary thyroid carcinoma (PTC).Methods The clinical data of 315 patients with cN0 PTC in Department of General surgery,the Second Affiliated Hospital of Dalian Medical University from Jan.2012 to Jan.2014 were analyzed retrospectively.Results (Iumor size,infiltration of thyroid capsule,and tumor number were associated with central lymph node metastasis in patients with cN0 PTC(P＜0.05),and the high risk factors of central lymph node metastasis were infiltration of thyroid capsule and multiple lesions (P＜0.05);()The overall complication rate was 3.17％ (10/315),the rate of transient recurrent laryngeal nerve paralysis was 0.63％ (2/315),and the rate of transient hypoparathyroidism was 2.54％ (8/315).All patients with complications recovered after treatment.No patient developed permanent recurrent laryngeal nerve paralysis or hypoparathyroidism;()The follow-up time was 6 to 30 months,and 2 cases were lost.No patient developed local tumor recurrence,distant metastasis,or death.Conclusions The high risk factors of central lymph node metastasis in patients with cN0 PTC were infiltration of thyroid capsule and multiple lesions.No patient developed local tumor recurrence,distant metastasis,or death.It is preferable and necessary to perform prophylactic central lymph node dissection in patients with cN0 PTC.

Objective To investigate the treatment of severe Budd-Chiari syndrome (BCS) . Methods The clinical data of 95 patients with severe BCS from November 1994 to June 1999 were retrospectively analyzed . Results Mesocaval C shunt with artificial graft was performed in 51 cases , splenojugular shunt with artificial graft in 23 cases ,mesojuglar shunt with artificial graft in l case , percutaneous transhepatic recanalization and dilation and/or stent placement of main hepatic vein (MHV) in 10 case, and combined PTA and stent placement of inferior vena cava (IVC) and mesocaval shunt in 10 cases . 5～60 months follow-up showed excellent result in 65 patients , good results in 25 and 5 cases dead. Conclusions Good results could be obtained by most of the severe BCS patients treated by different procedures according to the pathological changes of IVC and main hepatic vein.

Objective To explore rational surgical treatment for rectal villous adenoma with canceration. Methods Sixty-two cases of rectal villous adenoma with canceration undergoing different surgical procedures were analyzed retrospectively. Among them 28 underwent local excision including 20 with transanal resection and 8 with Kraske resection; Thirty-four underwent extended excision consisted of 11 Miles operation, 21 with Dixon operation and 2 with other procedures. Results Among 62 cases, 82%(51/62)were in early stage. 68%(42/62) and 26%(16/62) of the patients were of high and middle differentiation in pathology respectively. Six cases suffered from recurrence or metastasis in both local and extended excision groups. The 5-year survival rate after local and extended excision were 79% and 76% respectively. Conclusions Most rectal villous adenomas with malignant change were less invasive; Prudent selection of surgical modality is both effective and less dangerous for the treatment of this entity.

Objective: Combined detection of anti-mutated citrullinated vimentin ( anti-MCV ) antibodies, anti-cyclic citrullinated peptide ( anti-CCP) antibodies and rheumatoid factor ( RF-IgM) levels to investigate the diagnostic value of anti-mutated citrullinated vimentin (anti-MCV) antibodies for rheumatoid arthritis(RA).Methods: A total of 359 patients with RA,128 patients with other rheumatic diseases and 90 healthy controls were involved.Enzyme linked immunosorbent assay ( ELISA) was used to detect anti-MCV and anti-CCP, and dynamic immune nephelometry was applied to detect RF-IgM .The sensitivity and specificity were obtained from the experimental data.Results:The sensitivities of anti-MCV,anti-CCP and RF-IgM were 85.1%,76.7% and 82.7%in RA respectively.The specificities were 93.2%,95.1%and 80.1%respectively.Combined detection of anti-MCV and anti-CCP,the sensitivity decreased to 70.2%; but the specificity increased to 98.7%.The sensitivity reached to 89.5% with specificity 97.6%when the union of anti-MCV and anti-CCP positivity was used as criterion.Conclusion:Anti-MCV and anti-CCP are novel makers for RA diagnosis with high sensitivity and high specificity.Combination of anti-MCV and anti-CCP is more helpful for RA diagnosis.

Objective To observe the short-term clinical efficacy of modified transanal Soave surgery on infants with hirschsprung′s disease (HD) in initial radial resection, and to analyze the influencing factors. Methods 132 HD infants were selected. After initial radial resection with modified transanal , Soave surgery was conducted under general or sacral anesthesia. Postoperative antibiotics were routinely given. Results 19-56 cm intestinal canal samples were excised, with average length of (35.07 ± 3.15) cm. The average surgical duration and intra-operative hemorrhagic volume were (120.48 ± 18.34) min and verage was (45.74 ± 8.14) mL. All infants′ gastrointestinal function was recovered in 24 h postoperatively. The total excellent and effective rate of anal function in 6 months was 90.90% postoperatively. Cox modal multivariate analysis suggested that anastomotic orifice stenosis and enteritis were the two factors that greatly influenced the excellent and effective rate of anal function 6 months after the surgery (P < 0.05). Conclusion The modified transanal Soave surgery has small trauma and low complication rate on HD infants in initial radial resection , and the postoperative enteritis and anastomotic orifice stenosis are independent influencing factors for the short-term efficacy.