Purpose:To evaluate the relationship between po stoperative survival rate and three stage systems (Nevin,AJCC,JSBS) of gallbladd er carcinoma. Methods:From October 1988 to December 1998 a total of 30 patien ts with gallbladder carcinoma underwent radical resection in the Xinhua Hospital . All patients were classified by 3 different methods of staging.The 1-year,3- year ,5-year postoperative survival rates were evaluated according to the stage . Results:All patients with stage Ⅰ were alive. There were less cases in Nevin’s stageⅡ,Ⅲ. The 3-year,5-year survival rates in patients wit h Nevin’s stage Ⅱ,Ⅲ were better than the other two classifications. The 5-ye ar survival rates in patients with Nevin’s stage Ⅲ were better than those with Nevin’s stage Ⅳ. The 3-year,5-year survival rates in patients with Nevin’s stage Ⅳ/Ⅴ were significantly better than the other two classifications (P

Gallbladder cancer is the most common malignancy of biliary tract with a very poor prognosis. The therapeutic strategy of gallbladder cancer has been improved in some aspects. Identifying the accurate stage is the basis of surgical treatment. Radical resection is the only choice of treatment which provides patients long survival. For most patients in T1a stage, simple cholecystectomy is adequate, but dissection of hepatoduodenal ligament should be added when the lesions located in neck and duct of gallbladder. Patients in T1b stage often need radical cholecystectomy. Radical cholecystectomy with Ⅳb and Ⅴ segmentectomy and lymphadenectomy of N2 nodes should be performed to patients in T2 stage. Extended right lobe resection can improve the prognosis of selected T3 and T4 patients.The effect of chemotherapy for gallbladder cancer remains unsatisfactory, and current chemotherapeutic regimens were based on 5-FU, gemcitabine or S-1. The effect of a new chemotherapeutic sensitization scheme with continuous infusion of somatostatin,epirubicin 5-FU/CF and cisplatin is under research, and the preliminary results are promising. Radiation shows some benefits to patients with gallbladder cancer, but its effects are still uncertain.

Comprehensive therapy is the leading method to improve the overall survival for patients with advanced gallbladder cancer, especially the study of new chemotherapy regimen are on demand.From 2010 to 2011, a phase Ⅲ study of new chemotherapy regimen in the treatment of advanced gallbladder carcinoma would be undertaken nationwide to assess the clinical outcome and safety, in 31 clinical centers led by the department of General Surgery of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, and a total of 260 patients would be accrued for this study.Chemotherapy consists of 2 regimes, conventional regime(cisplatin, epirubicin, and 5-fluorouracil, leucovorin)and new regime(conventional regime plus somatostatin).At present, the study has been approved by Clinical Trial Registration Platform of National Institutes of Health in U.S.A., and more than 30 patients are rolling in the study.The clinical trial could provide the high-quality evidence of EBM(evdence based medicine)for the chemotherapy of advanced gallbladder caner, and it will be one of the important components in the large-scale clinical study of chemotherapy for the advanced gallbladder cancer in China and worldwide.

Biliary tract malignant tumours do not have any special symptom or physical sign in early stages.It is easy to be delayed for diagnosis and it is often very serious when the disease was diagnosised.With the development of technology of molecular biology,the biliary tract malignant tumours' diagnosis in molecular biology has been made some progresses,and it is expected to be possible to diagnose and treat the diseases in early stages.

MicroRNA(miRNA),as a class of newly discovered non-protein-coding RNA,is present in eukaryote cells and plays a critical post-transcriptional repressor role in the regulation of gene expression.Many methods have been developed for the harvesting,detection and identification of miRNA and its target genes.Although hundreds of miRNA has been predicted and demonstrated in animals and plants,their definite mechanism,function and target genes are still unknown.Here is a reviews of the research advances methodology of detecting miRNA.

Objective To investigate the relationship between serum levels of CA15-3, CA-125 and CEA in postoperative breast cancer patients and clinicopathological parameters and pathogenetic condition turnover. Methods From January 2004 to December 2007, 219 breast disease cases with integrity clinical information, admitted to general surgery and oncology department of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, were collected. The serum concentrations of CA15-3, CA-125 and CEA were determined by chemiluminescent immunoassay(CLIA). Wilcoxon Kruskal Wallis analysis, crosstable analysis and spearman correlation analysis were used to investigate the association between the serum concentration and clinical parameters and pathogenetic condition turnover. Results The serum concentrations of CA15-3,CA-125 and CEA in metastatic breast cancer group were significantly higher than those in nonmetastatic group(P=0.000). The sensitivity of the 3 tumor markers in combination was 64.1% in metastatic breast cancer diagnosis. CA15-3 and CA-125 at the time of initial metastasis were correlated with estrogen receptor state(PCA15-3=0.039, PCA-125=0.049). The level of 3 tumor markers in multiorgan metastatic group were significantly higher than those in single organ metastastic patients(P=0.000). There were significant differences between the levels of CA15-3 and CEA in distant metastatic group and those in local metastatic group (PCA15-3=0.001,PCEA=0.022). Conclusion The high serum concentrations of CA15-3,CEA and CA-125 were useful in monitoring the metastasis. The high serum levels of CA15-3 and/or CA-125 may indicate that the patients will be more sensitive to endocrine therapy.

Objective To evaluate the role of laparoscopic staging for the resectability of gallbladder cancer. Methods From Jan 2007 to Mar 2010,60 gallbladder cancer patients without of metastatic disease or main hepatic portal vessel invasion as assessed by preoperative imaging underwent staging laparoscopy for tumor resectability evaluation. Peritoneal and liver surface metastases were looked for and assessment of local spread was done if possible. Assessment was based on visual impression and biopsies were obtained routinely. T test and x2 test were used. Results At laparoscopy, 27 (45%) patients were found with disseminated disease on peritoneal cavity or the surface of liver, hence, senseless open surgery was avoided. The other 33 patients were converted to open laparotomy, among those 1 patient was found with disseminated metastasis in the liver and 12 patients with the invasion of main hepatic portal vessel,pancreatic head, duodenum did not undergo any further surgery. Finally 7 patients received surgical bypass procedure and 13 patients underwent radical resection. During the same period, 192 clinically diagnosed gallbladder cancer patients undergoing open laparotomy without laparoscopic pre-assessment served as control. Among those in control group 79 patients received radical or palliative resection. The resectability rate was significantly different between the two groups ( P ＜ 0. 05). Conclusion Staging laparoscopy in patients with gallbladder cancer is helpful in detecting liver and peritoneal metastases overlooked by preoperative imaging, avoiding unnecessary open explorations.

s of enteral nutrition depends on the primary diseases and duration of nutmition support.Nasoenteral tube placement is safe and effective.Percutaneons endoscopic gastrostomy and needle catheter jejunostomy are the alternative approaches.

ObjectiveTo investigate the mechanisms of neonatal transplantation tolerance,especially the role of immature immune system and chimerism in tolerance.MethodsF1 ( or GFP-F1 ) mice were bred by crossing male C57BL/6 (or GPF transgenic C57BL/6) and female BALB/c mice. Within 24 h,newborn C57BL/6 mice were inoculated with different doses of splenocytes from F1 or GFP-F1 mice,irradiated spleen cells were used as control.Six weeks later,the mice were subjected to F1 skin grafting,and mixed-lymphocyte reaction was performed to determine their tolerance.Flow analysis was used to detect chimerism.ResultsLiving F1 spleen cells could induce chimerism and neonatal transplantation tolerance,but irradiated cells not.The chimerism in long-term tolerant mice is higher than that in chronic rejected mice,with 6.48％ ±4.02％ vs 1.57％ ±0.89％,the difference is significant in statistical analysis.The degree of neonatal transplantation tolerance is determined by the dosage of donor cells,the mice induced with 3 × 107 F1 spleen cells have 80％ long-term tolerance,but the dose of0.7×107 F1 spleen cells could only prolong allografts survival.ConclusionNeonatal transplantation tolerance is dependent on chimerism,the chimerism of donor cells leads to clonal deletion of alloreactive T cells.

Objective To compare the p16 dynamic status in primary hepatocellular carcinoma(HCC) and its metastatic lesions.Methods The exon 2 of p16 gene was examined by PCR SSCP analysis in 36 paraffin embedded samples in 18 primary HCC cases and its metastatic lessions. Results p16 alterations were found in 4 (22.2%) of the 18 patients . Among them, 2 patients had alterations only in the metastatic lesions (one was deletion;the other was mutation).The other 2 patients had alterations both in primary and metastatic loci (one was deletion;the other was mutation).The deletion rate of exon 2 was 11.1%(2/18) and the mutation rate was 11.1%(2/18). However,the four alterations of p16 gene were found in 7 patients whose metastasis was accompanied by HCC recurrence ( 57.1% ), which was significantly higher than that in patients with metastasis but without HCC recurrence (P