87 female patients with carcinoma of the colon and rectum were treated in our hospital from 1977 to 1986. Among them seven (8%) were found to have ovarian metastasis, The average age of the patients was 49 years. The primary tumor was mainly located in the sigmoid or ascending colon. The se-rosa was involved in all the 7 cases. Ovarian metastasis were usually bilateral. The prognosis of the patients with ovarian metastasis remained poor despite the performance of a radical operation. It is very important to consider the possibility of the ovarian metastasis in patients with colonic cancer, and prophylactic oophorectomy is imperative in order to effect a cure.

Artificial ureter has been studied for nearly 60 years, however it is still in experimental stage. So far there are no commercially available products for clinical use except autologous intestines loop even though many progresses have been made. Each approach for making artificial ureter has its own inherent advantages, disadvantages and limitations. But some approaches have shown great potential to be used as ureteral substitutes. Preventing the conduit from salt depositing and ensuring a watertight anastomoses with native tissues are the key factors in designing and manufacturing the prosthetic ureter. Along with scientific and technical improvement, artificial ureter will be successfully used in clinical therapeuticsin in the very near future.

Objective To evaluate the reliability of transcranial doppler (TCD) in detection spasm of middle cerebral artery (MCA),vertebral artery (VA ) and basilar artery (BA).Methods TCD and digital subtraction angiography (DSA) examination were undertaken in 50 patients with subarachnoid hemorrhage.Results Arterial spasm was diagnosed in 26 MCA by DSA,21 of which were detected by TCD at same time.4 MCA were showed by TCD but not confirmed by DSA. The sensitivity and specificity of TCD in diagnosing MCA spasm were 80.8% and 84.0% respectively. Higher sensitivity was revealed in those with severe MCA spasm. DSA also found out asterial spasm of BA in 18 BA,among which 13 arteries were detected by TCD simutaneously.4 BA were diagnosed by TCD but not proved by DSA. The sensitivity and the specificity of TCD in diagnosing BA spasm were 72.2% and 76.5% respectively.28 VA were diagnosed by DSA,among which 20 arteries were proved by TCD.6 VA were detected by TCD but not proved by DSA. The sensitivity and specificity of TCD in diagnosing VA spasm were 71.4% and 76.9% respectively.Conclusion TCD is reliable in diagnosing the spasm of MCA,BA and VA.

Objective To evaluate the effect of dexmedetomidine on the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery.Methods Eighty patients of both sexes, aged 30-64 yr, weighing 45-80 kg, with American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective abdominal surgery, were randomly assigned into 2 groups (n =40 each) using a random number table: control group (group C) and dexmedetomidine group (group D).After routine induction of anesthesia, all the patients were tracheally intubated, and mechanically ventilated.Anesthesia was maintained with sevoflurane inhalation and intermittent iv boluses of sufentanil and cisatracurium besylate, and bispectral index values were maintained at 45-60.After induction of anesthesia, dexmedetomidine was infused in a dose of 1 μg/kg over 15 min, followed by a continuous infusion of 0.6 μg · kg-1 · h-1 until 30 min before the end of surgery in group D.Group C received normal saline instead.Heart rate (HR) and mean arterial pressure (MAP) were recorded at the end of surgery, and at 1 min before and after extubation.The emergence time, extubation time, and occurrence of bucking during extubation, and nausea and vomiting, respiratory depression, and agitation during recovery from anesthesia were recorded.Results Compared with group C, MAP and HR were significantly decreased at 1 min before and after extubation, the emergence time and extubation time were shortened, the incidence of bucking, nausea and vomiting, and agitation was decreased, and no significant change was found in the incidence of respiratory depression in group D.Conclusion Dexmedetomidine infused in a dose of 1 μg/kg after routine induction of anesthesia, followed by a continuous infusion of 0.6 μg · kg-1 · h-1 until 30 min before the end of surgery, can significantly increase the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery.

10.3969/j.issn.2095-4344.2013.23.006

Objective To understand the immune regulatory function of monocyte-derived dendritic cells (MoDC) in patients with chronic severe hepatitis B (CSHB) and its roles in the severe illness progression of chronic hepatitis B (CHB) by detecting surface phenotype of MoDC and expression level of cytokines in MoDC after polyl : C treatment. Methods The peripheral blood mononuclear cells (PBMC) were isolated by Ficoll density gradient separation from 37 patients with CSHB, 20 patients with CHB, and 20 healthy controls (NC). Purified PBMC were acquired using immunomagnetic anti-CD14-beads. Then PBMC were induced to immature dendritic cell (iDC) in vitro. PolyI : C was added to induce DC maturation. The mean fluorescence intensity (MFI) of the phenotype marker molecules including HLA-DR, CD83, CD86 and CD80 on surface of iDC and mature DC (mDC) were detected by flow cytometry. The supernatants of MoDC culture were collected at 12,24 and 48 h after polyI : C treatment, respectively and the release levels of interleukin (IL)-12, IL-6and tumor necrosis factor (TNF)-α were determined by enzyme linked immunosorbent assay (ELISA). Comparisons among groups were done by single factor analysis of variance and homogeneity of variance was tested. Results There were no significant differences of phenotype marker molecules on cell surface of iDC, including HLA-DR, CD83, CD86 and CD80 in CSHB, CHB and NC groups.However, the expressions of HLA-DR, CD83, CD86 and CD80 on cell surface of mDC in CSHB group were lower than those in CHB and NC groups (F=59.73, 13.95, 34.80 and 73.02, respectively; all P＜0. 05). The secretions of IL-12 at three time points of 12 h, 24 h and 48 h after polyI : C treatment in group NC were higher than those in CHB and CSHB groups (F= 151.34, 126.65 and 72.76, respectively; P＜0.05), and peaked at 24 h which were (48.2±7.6), (56.7±11.8) and (97.8±16.2) ng/L, respectively. The secretions of IL-6 at the above three time points were CSHB＞CHB＞NC (F=92.50, 86.89 and 64.57, respectively; all P＜0. 05) and peaked at 12 h which were (1698.3±340.4), (965.8±231.7), (697.8±213.6) ng/L, respectively. The secretions of TNF-αat the above three time points were CSHB＞CHB＞NC (F=58.66, 122.36 and 44.73, respectively;all P＜0. 05) and were (19 672. 7±4214. 7), (9946. 1 ± 2586 5), (6659. 2±955. 8) ng/L,respectively at 24 h after treatment. Conclusions MoDCs of CSHB patients show mature defection and abnormal cytokine secretion. The expression level of IL-12 which mediates cellular immune is low.Meanwhile, the productions of IL-6 and TNF-α which mediate inflammatory response are up-regulated. This may be one of the major factors which lead to exacerbation of liver inflammation and ultimately development of severe hepatitis.

Objective To retrospectively analyze the role of 3-dimensioual conformal radiotherapy (3-DCRT) after percutaneous transhepatic portal vein stenting and transcatheter arterial chemoembolization (PTPVS-TACE) in the treatment of patients with hepatocellular carcinoma (HCC) complicated by main portal vein tumor throw.bus (MPVTT).Methods Between July 2002 and July 2007,45 patients with HCC complicated by MPVTT were treated by PTPVS-TACE.Among them,3-DCRT were undertaken for MPVTT in 16 patients (group A),the other 29 patients were not treated with 3-DCRT(group B).The clinical effects,complication,stent patency rates,cumulative survival rates were evaluated among groups.The Kaplan-Meier method and log-rank test were used for survival analysis.Results No patient died during stent placement or within the preceding first 24 hours.No severe procedure-related complications were observed.The 60--,180--,360--day cumulative stent patency rates were 100.0%,62.2% and 34.6% in group A,and 58.6%,21.7% and 10.8% in group B,respectively,showing significant difference between the two groups (X2 =9.672,P <0.01).The mean patency time was(475±137) and (200±61)days,respectively.The 60--,180--,and 360--day cumulative survival rates were 93.8%,81.3% and 32.5% for group A,86.2%,13.8% and 6.9% for group B,respectively.There were significant statistical differences between the two groups(X2=9.672,14.596,P < 0.01).Conclusion Treatment with PTPVS-TACE-3-DCRT is a more effective modality than PTPVS-TACE for HCC complicated by MPVTT.

Objective To investigate the safety and feasibility of intraluminal brachytherapy using iodine-125 seed strand for locally advanced pancreatic ductal adenocarcinoma with obstructive jaundice.Methods Clinical data of 17 consecutive patients,from January 2010 to February 2015,diagnosed with pancreatic ductal adenocarcinoma (4 cases of T4 N0 M0 and 13 of T4 N1M0) with obstructive jaundice and received intraluminal brachytherapy using iodine-125 seed strand were collected and analyzed retrospectively.Liver function was evaluated using paired-samples t test.The iodine-125 seed strand radiation doses were calculated using iodine-125 radiation field distribution calculation software (version 0.1,Institute of Radiation Medicine,Fudan University,Shanghai,China) based on the American Association of Physicists in Medicine TG43U1 brachytherapy formula.Obstruction free survival and overall survival were calculated using the Kaplan-Meier method.Complications were assessed according to the CTCAE 4.0 criteria.Results The estimated mean accumulating dose (r =5 mm,240 days) was 167.2Gy,from 164.19Gy to 170.05Gy.The mean and median obstruction free survival time were (9.62 ± 1.47) months (95％CI:6.73-12.50) and (7.26 ± 1.71) months (95 ％CI:3.90-10.62).The mean and median overall survival time were (9.89 ± 1.59) months (95％CI:6.78-13.00) and (7.26 ± 1.71) months (95 ％ CI:3.90-10.62),retrospectively.Total bilirubin and conjugated bilirubin decreased significantly after the therapy.Two patients had adverse event of Grade 3,one of Grade 4.Stent dysfunction occurred in 1/17 (5.9 ％) patients.Conclusions Intraluminal brachytherapy using iodine-125 seed strand might be considered as a safe treatment option for the locally advanced pancreatic duct adenocarcinoma complicated by obstructive jaundice.

Aim To investigate the effect of astragalus injection on the expression of JNK3(c-jun N terminal kinase)protein and JNK3 mRNA interrelated by apoptosis after hypoxia/hypoglycemia and reoxygenation in hippocampal neurons of rats.Methods The hippocampal neurons cultured for eight days were divided into four groups:normal control group,hypoxia/hypoglycemia and reoxygenation group,astragalus injection group and astragalus solution group.Hypoxia/hypoglycemia and reoxygenation group,astragalus injection group and astragalus solution group were treated with hypoglycemia and reoxygenation after being deprived of oxygen and glucose for 30 minutes.Methods of Western blot,ELISA and RT-PCR were used respectively to measure the expression of JNK3 mRNA after hypoxia/hypoglycemia and reoxygenation 0,0.5,2,6,24,72,120 h.Results Compared with normal control group,the mean optic density(MOD)of expression of JNK3 protein and activation of JNK3 protein in hippocampal neurons of rats every time points increased obviously in hypoxia/hypoglycemia and reoxygenation group except 120 h(P<0.05);compared with hypoxia/ hypoglycemia and reoxygenation group,MOD of expression of JNK3 mRNA and activation of JNK3 protein in hippocampal neurons of rats every time points decreased obviously except 120 h in astragalus injection group (P<0.05);compared with hypoxia/hypoglycemia and reoxygenation group,there was no difference in astragalus solution group.Compared with normal control group,MOD of expression of JNK3 mRNA in hippocampal neurons of rats every time points increased obviously in hypoxia/hypoglycemia and reoxygenation group(P<0.05);compared with hypoxia/ hypoglycemia and reoxygenation group,MOD of expression of JNK3 mRNA in hippocampal neurons of rats every time points decreased obviously in astragalus injection group except 120 h(P<0.05);compared with hypoxia/hypoglycemia and reoxygenation group,there was no difference in astragalus solution group.Conclusion Astragalus injection can inhibit the expression of JNK3 mRNA after hypoxia/hypoglycemia and reoxygenation,moreover,it can inhibit the expression of JNK3 protein and decrease the activation of JNK3 protein,accordingly it inhibits hippocampal neuronal apoptosis.

Objective To investigate vascular endothelial growth factor receptor-2(VEGFR-2)and its phosphorylated state in cancerous and peri-cancerous tissues of hepatocellular carcinoma(HCC)after transcatheter arterial chemoembolization(TACE).Methods Forty-three cases of second-stage surgery of HCC after TACE(TACE & surgery group)and twenty cases of surgery without TACE(direct surgery group)were performed.Surgical specimens were made into paraffin-embedded slices.VEGFR-2,phosphorylated VEGFR-2,hypoxia induced factor-1α(HIF-1α)and microvessel density(MVD,labeled by CD31)were detected using immunohistochemical method.All data was statistically processed with SPSS for Windows.Results The absorption factor(A factor)of phosphorylated VEGFR-2 and HIF-1α in the cancerous tissue of HCC were(0.034±0.016)and(0.047±0.021)in TACE & surgery group,and(0.024±0.009)and(0.035±0.016)in direct-surgery group,which showed statistically significant difference(F=6.75,4.77,P＜0.05).The A factors of VEGFR-2,phosphorylated VEGFR-2 and HIF-1α in the peri-cancerous tissue were(0.040±0.017),(0.031±0.011)and(0.037±0.015)respectively in TACE & surgery group,and(0.030±0.015),(0.020±0.008)and(0.024±0.014)respectively in direct-surgery group,all of which showed statistically significant difference(F=4.60,13.72,11.65,P＜0.05).MVD of the peri-cancerous tissue was(58.3±15.2)/HP in TACE & surgery group and(44.4±10.5)/HP in direct-surgery group,which showed statistically significant difference(χ2=13.64,P＜0.05).Conclusion The cancerous and peri-cancerous tissues in HCC after TACE showed more hypoxic changes.Both expression and function of VEGFR-2 were enhanced following TACE.