Xanthogranulomatous cholecystitis (XGC) is benign and chronic, which is rarely seen in clinical practice.The clinical and imaging presentation of XGC is similar to that of chronic cholecystitis, cholecystolithiasis and gallbladder cancer.Summarizing the computed tomography (CT) presentations of XGC is helpful in improving the diagnostic accuracy. According to the result of a retrospective analysis based on the clinical data of 17 patients with XGC, we concluded that rim enhancement sign and hypodense band sign in the arterial phase of contrast enhanced CT, and clear in interface between liver and gallbladder and trimness of internal wall in gallbladder are the CT characteristics of XGC.

Preoperative diagnosis of biliary obstruction mainly depends on imaging examination.Percutaneous transhepatic cholangiography (PTC) is a common method in detecting biliary obstruction.PTC combined with computed tomography (CT) could enhance the diagnostic rate.From April 2009 to April 2011,8 patients with biliary obstruction were admitted to the Shenzhen Hospital of Peking University.Contrast solution (30 ml of iodine solution at a concentration of 1.5％ -2.0％)was injected through a PTC tube,and then CT scan was performed.An iohexol contrast solution at a concentration of 300 mgl/ml was injected at a dosage of 1.5 ml/kg and at 3-5 ml/s,then the arterial phase,venous phase and delayed phase were scanned.The original data were uploaded to Vitrea 2 workstation for multiplane reconstruction,maximum intensity projection and volume rendering.The procedure was successfully performed on all patients,and the position of the biliary obstruction was identified in 7 patients.Five patients were diagnosed as with hilar cholangiocarcinoma,1 with sclerosing cholangitis and 2 with adenoma of the distal common bile duct.The patients' symptoms were alleviated after percutaneous transhepatic biliary drainage.

The efficacy of laparoscopic Dixon operation for the treatment of rectal cancer has been proven,while at the same time there are opportunities to make the procedure less invasive.From January 2010 to March 2011,9 cases of single access laparoscopic Dixon operation have been performed at the Shengjing Hospital.An incision with the length of 3 cm was created in umbilicus and 3 trocars were inserted through the fascia on the abdominal wall.The dissection and anastomosis were performed through the incision.The resected tumors were removed through the umbilical incision or anus.The operation was successfully performed on 9 patients,and one more incision with the length of 12 mm was created on the lower abdominal wall in 1 patient in order to install the stapling device.The average operation time was 202 minutes.No postoperative bleeding,intestinal obstruction or anastomosis leakage was found.

Objective To assess the risks of complications of loop colostomy and loop ileostomy.Methods The databases of Medline,Embase,Cochrane Library,Google Scholar and Wanfang were retrieved to identify the published studies comparing the advantages between loop colostomy and loop ileostomy.All the articles retrieved were published before April 15,2011.The incidence of complications was analyzed by Meta-analysis.The data were analyzed by the Z test and the heterogeneity of the data was analyzed by the Q test.Results Five randomized controlled trials and 8 non-randomized controlled trials with 1752 cases were included in the Meta-analysis.Compared with loop ileostomy,loop colostomy was associated with significantly increased risk of stoma prolapse ( OR =3.46,95％ CI:1.81-6.63,P ＜ 0.05 ).There were no significant differences in the incidences of stoma hemorrhage and stenosis,wound infection,stoma necrosis,parastoma dermatitis and hernia between patients who received loop ileostomy and those who received loop colostomy.Compared with loop ileostomy,loop colostomy was associated with increased risk of wound infection following stoma closure(OR =3.44,95％ CI:1.95-6.05,P ＜0.05).Compared with loop colostomy,loop ileostomy was associated with increased risk of postoperative bowel obstruction following stoma closure(OR =0.43,95 ％ CI:0.20-0.91,P ＜ 0.05 ).There was no significant difference in the risk of anastomotic leak between loop ileostomy and loop colostomy.Conclusion Compared with loop ileostomy,loop colostomy is associated with increased risk of stoma prolapse and wound infection after stoma closure,while a higher risk of bowel obstruction following stoma closure is observed after loop ileostomy.

Objective To compare the reversal effects of short hairpin RNA (shRNA) interference and tetrandrine on multidrug resistance (MDR) of human colorectal cancer cell line LoVo/5-fluorouracil(5-FU ).Methods An eukaryotic expression plasmid of shRNA targeting MDR1 was constructed and transfected into human colorectal cancer cell line LoVo/5-FU (transfection group).LoVo/5-FU was also pretreated with tetrandrine (tetrandrine group).Drug sensitivity was detected by methyl thiazolyltetrazolium colorimetric method.Cell cycle,apoptosis of cells and positive expression rate of P-glycoprotein (P-gp) were determined by flow cytometry assay.The expressions of MDR1 mRNA and P-gp were detected by real-time polymerase chain reaction and Western blot,respectively.All data were analyzed by analysis of variance and SNK-q test.Results (1)Drug sensitivity:the 50％ concentration of inhibition(IC50)of the control group,tetrandrine group and transfection group were (7.3 ± 0.3),(4.4 ±0.7) and (2.4 ±0.4) mmol/L,respectively,a significant difference between the 3 groups was found(F =65.27,P ＜ 0.05 ).There was a significant difference in the IC50 between the tetrandrine group and the transfection group (q =6.67,P ＜ 0.05 ).(2) Changes of cell cycle:the proportion of cells in the G1 phase and S phase of the control group,tetrandrine group and transfection group were 38.13％ ± 3.75％,51.36％ ± 2.76％,59.24％±4.31％ and 20.46％±2.23％,14.32％± 1.91％,9.40％± 1.65％,respectively,a significant difference between the 3 groups was found(F =25.23,24.37,P ＜ 0.05 ).There were significant differences in the proportion of cells in the G1 phase and S phase between the tetrandrine group and the transfection group(q =3.67,4.35,P ＜ 0.05 ).(3) Cell apoptosis:the cell apoptotic rates of the control group,tetrandrine group and transfection group were 1.32％ ± 0.47％,3.24％ ± 0.26％,5.88％ ±- 0.44％,respectively,a significant difference between the 3 groups was found(F =99.26,P ＜ 0.05 ).There was a significant difference in the cell apoptotic rate between the tetrandrine group and transfection group(q =11.48,P ＜ 0.05 ).(4)The expression of P-gp:the positive expression rates of P-gp of the control group,tetrandrine group and transfection group were 96.9％ ± 2.3％,61.6％ ± 4.9％,76.6％ ± 3.6％,respectively,a significant difference between the 3 groups was found(F =67.83,P ＜ 0.05 ).There was a significant difference in the positive expression rate of P-gp between the tetrandrine group and transfection group (q =6.97,P ＜ 0.05 ).(5)The mRNA expression of MDR1:the mRNA expressions of MDR1 of the control group,tetrandrine group and transfection group were 1462 ±161,570 ±85,233 ± 81,respectively,a significant difference between the 3 groups was found(F =90.59,P ＜ 0.05 ).There was a significant difference in the mRNA expression of MDR1 between the tetrandrine group and transfection group (q =5.12,P ＜ 0.05 ).Conclusions MDR1 shRNA and tetrandrine could reverse M DR1 gene-mediated m.ultidrug resistance in human colon cancer cell line LoVo/5-FU,but the effect of MDR1 shRNA is better than that of tetrandrine.MDR1 shRNA and tetrandrine might take effect by inhibiting P-gp expression and down-regulating mRNA expression of MDR1.

Objective To investigate the expression of Ezrin in gastric cancer tissues and its clinical significance.Methods Gastric cancer tissues and adjacent normal gastric tissues from 60 patients with gastric cancer were collected from June 2008 to May 2009 at the Southwest Hospital.The mRNA and protein expressions of Ezrin were detected by using the reverse transcription polymerase chain reaction and western blot.The relationship between Ezrin and the gender and age of patients,and tumor differentiation,pathological staging,depth of invasion and lymph node metastasis was analyzed.All data were analyzed using the t test,chi-square test and Spearman rank correlation.Results The Ezrin mRNA expression level was increased in 33 (55％) cases of adjacent normal gastric tissues and 21 (35％) cases of gastric cancer tissues; the Ezrin protein expression level was increased in 45 (75％) cases of adjacent normal gastric tissues and 22 (37％) cases of gastric cancer tissues.The mRNA and protein expressions of Ezrin in the normal adjacent gastric tissues were 1.30 ± 0.04 and 3.57 ± 0.45,respectively,which were significantly higher than 0.53 ± 0.36 and 0.96 ± 0.18 in the gastric cancer tissues ( t =5.309,22.617,P ＜ 0.05 ).The mRNA expression of Ezrin was positively correlated with the protein expression of Ezrin (r =0.602,P ＜ 0.05 ).The mRNA and protein expressions of Ezrin were related to the pathological stages,depth of invasion and state of lymph node metastasis (x2 =6.41,6.49,4.62; 5.40,8.87,4.12,P ＜ 0.05),but not to the gender,age and tumor differentiation (x2 =0.50,0.07,1.07 ; 0.01,1.16,1.96,P ＞ 0.05).Conclusion The mRNA and protein expressions of Ezrin are significantly decreased in the gastric cancer tissue,which might be responsible for genesis,development and metastasis of gastric cancer.

In October 2010,the Department of Medical Administration of the Ministry of Healthy of China published Diagnosis and Treatment Standard of Colorectal Cancer.Since then,the diagnosis and treatment of rectal cancer are under regulation.Standardization of preoperative diagnosis and proper selection of imaging or histopathological examinations are key points in improving the efficacy of individual treatment of patients with rectal cancer.In this article,suggestions from the National Comprehensive Cancer Network (2011 version ),American College of Radiology and College of American Pathologists are analyzed,and the recommendations of imaging and histopathological examinations are highlighted.

Surgery for gastric cancer is based on basic surgical techniques and modern theory of surgery.Accurate and safe surgical procedures are carried out based on application of scientific principles.The knowledge of gastric anatomy,physiology and pathophysiology is the basis of the gastric cancer surgery.The technical aspects of vascular control,lymph node dissection,digestive tract resection and reconstruction are important for the gastric cancer surgery.Full use of these techniques and mastery of the technology is an important guarantee for reducing surgical complications,improving the quality of life and longterm survival of gastric cancer patients.

Objective To obtain colon cancer spheroid cells from human colon cancer cell lines cultured in serum-free medium (SFM),and investigate the proliferative and migratory properties of colon cancer spheroid cells.Methods Human colon cancer cell lines HCT116 and HT29 were cultured in SFM,and then the generation of spheroid cells was observed.The expression of stem cell surface marker CD133 was detected by flow cytometry,and the proliferative and migratory properties of colon cancer spheroid cells were detected by cell counting kit-8 and Transwell migration assay,respectively.All data were analyzed by using the t test.Results Spheroid cells were obtained from colon cancer cell lines HCT116 and HT29 in SFM.The ratios of spheroid cells with positive expression of CD133 generated by HCT116 and HT29 were 75.44％ ± 11.41％ and 76.22％ ± 14.23％,respectively.Compared with original colon cancer cells cultured in serum supplemented medium,the number of HCT116 and HT29 spheroid cells with positive expression of CD133 was significantly greater (t =11.43,9.17,P ＜ 0.05 ),and the proliferative and migratory abilities were much stronger also.Conclusion Colon cancer spheroid cells cultured in SFM have higher positive expression of CD133 and stronger proliferative and migratory abilities,and it can be utilized as a feasible model for further studies of colonic stem cells.

Despite progress in the understanding of perirectal anatomy and subsequent adoption of total mesorectal excision,local recurrence after curative resection for rectal cancer continues to be a significant concern.Local recurrence of rectal cancer is associated with a wide spectrum of clinical symptoms and morbidities,and decreased quality of life.The management of locally recurrent rectal cancer is challenging because of the altered pelvic anatomy,postoperative adhesion and difficulty in obtaining a definite diagnosis before surgery.Surgery is the mainstay treatment for locally recurrent rectal cancer,and the use of radiation and chemotherapeutic agents provides significant improvement in survival rate and quality of life.