Objective　To study the preventive effect of hepatic metastasis from colorectal cancer and the immune function influence on postoperative patients with colorectal cancer treated by TIL, rIL-2 and cyclophosphamide by portal vein infusion. Methods　One hundred and twenty-four patients with advanced colorectal cancer (Dukes B and Dukes C stage) were randomly divided into immunotherapy group and control group. The control group were treated with 5-Fu and MMC by intravenous injection after resection of colorectal cancer. The immunotherapy group were treated with TIL, rIL-2 and cyclophosphamide by portal vein infusion after resection of the tumor, then with chemotherapy as the control group. All cases were followed-up for 3 years. Results　Eight cases (12.3%) had hepatic metastases from colorectal cancer in the immunotherapy group, but nineteen cases (33.2%) in the control group. There was significant difference between the two groups (P>0.05). The NK, IL-2 activity and CD3, CD4, CD4/CD8 levels in peripheral blood of the immunotherapy group increased significantly after treatment (P<0.05). Conclusions　The TIL, rIL-2 and cyclophosphamide treatment after resection of colorectal cancer is effective in improving antitumorgenic immune function, and preventing hepatic metastases.

Objective To observe the efficacy of Sorafenib in preventing and treating tumor recurrence after liver transplantation for patients with primary hepatic carcinoma beyond Milan criteria.Methods From March 2008 to June 2010,30 patients of liver transplantation with primary hepatic carcinoma exceeding Milan criteria were randomized into 2 groups,each group of 15 cases.Beginning one month posttransplantatoin patients in the experimental group received oral administration of Sorafenib (400 mg bid),while those in the control group received Capecitabine ( 1500 mg bid) for 14 days every 4 weeks.Drug was withdrawn in patients without recurrence in 18 months after transplantation,recurrent patients maintained the original dose until they were not suitable for the medication.Results The 1 year recurrence rate in experimental group was 53.3％,that in control group was 86.6％ ( x2 =3.968,P ＜ 0.05).The 1 year survival rate in experimental group was 93.3％,that in the control group was 46.6％( x2 =7.777,P ＜ 0.05 ).The mean survival time of patients in experimental group was (24.6 ± 1.7 ) months (7 - 28 months),that in the control group was ( 16.4 ± 2.7 ) months ( 5 - 34 months ) ( x2 =7.154,P ＜ 0.05).Most adverse reactions in both groups were of grade Ⅰ - Ⅱ.The incidence of diarrhea and handfoot syndrome in experimental group is higher than that in control group.Conclusions Using Sorafenib for patients with primary hepatic carcinoma exceeding Milan criteria after liver transplantation may reduce carcinoma recurrence rate,and prolong patients' survival time.

Objective To evaluate early results of Endurant stent-graft in the treatment of abdominal aortic aneurysms (AAAs).Methods From July 2010 to June 2011,68 patients (57 men,11 women; mean age 74.3 years) were treated with Endurant stent-graft at our center.26 cases had hostile proximal neck in the anatomy.According to ASA classification,15 cases were class Ⅱ ; 32 cases were class Ⅲ and 21 cases were class Ⅳ.Results Intraoperative immediate technical success was achieved in all cases.At completion angiography,a type Ⅱ endoleak was detected in 18 (26％) of the 68 patients.The mean operation time was (96 ± 29) min,the mean blood loss was (99 ± 68 ) ml,and the mean contrast usage was (122 ± 65) ml.No intraoperative conversion to open surgery,stent migration,types Ⅰ/Ⅲ endoleak,other major complications,or death was encountered.49 patients (72％) had a postimplantation syndrome with fever,leukocytosis,and increase of C-reactive protein levels,which completely resolved within two weeks.The mean follow-up time was (8 ± 5) months.Conclusions Endurant stent-graft seems to be safe and effective in endovascular aneurysm repair,even in patients with hostile aortoiliac anatomy.

Objective To improve the rate of early diagnosis and prolong the survival of patients with gallbladder carcinoma.Method Clinical data of 111 cases of primary carcinoma of the gallbladder undergoing surgery from Jan 2002 to Dec 2010 were analyzed retrospectively.Result The preoperative diagnositic rate was 61.3％.Among the 111 cases of primary carcinoma of the gallbladder,22 patients received simple cholecystectomy,47 patients received radical resection,18 patients received extended radical resection,12 patients received palliative operation while the other 12 patients only got biopsy due to widespread intraabdominal metastasis.The 3 years survival rate of the patients was 29.7％ (33/111) while the 5 years survival rate was 9.9％ ( 11/111 ).Conclusions B-ultrasonography and CT are the mainstay for the diagnosis of primary carcinoma of the gallbladder.For those suspected of having the carcinoma,an exploration is recommended.

Objective To investigate the expression and significance of caveolin-1 in breast carcinoma.Methods Using immunohistochemical method the protein expression of caveolin-1 were analyzed in 105 cases of breast carcinoma and 50 cases of non-cancerous breast tissues.The relationship between caveolin-1 expression and CK5/6,EGFR,and E-cadherin expression was investigated.Clinical data of 105 cases of breast carcinoma were retrospectively analyzed.Results Among 105 cases of breast carcinoma,there were 20 cases of basal-like subtype,22 cases of luminal subtype A,23 cases of luminal subtype B,23 cases of HER2 over-expressing subtype,17 cases of normal breast-like subtype.Positive rate of caveolin-1 was significantly lower in breast carcinoma than in non-cancerous breast tissues (24.8％ vs.88.0％,P ＜ 0.05).Positive rate of caveolin-1 (75.0％) was higher in breast carcinoma than in luminal subtype A ( 4.8％ ),luminal subtype B ( 17.4％ ),HER2 over-expressing subtype ( 17.4％ ) or normal breast-like subtype( 11.8％ ),all P ＜0.05.Caveolin-1 expression was associated with expression of CK5/6 and EGFR(P ＜0.01 ).In univariate analysis,positive caveolin-1 was associated with higher lymph node metastasis rate (18/26,69.2％ )than negative (37/79,46.8％ ),P =0.047,and shorter 5-year-disease-free survival (38.46％ vs.74.68％,P =0.0004 ),but in multivariate analysis caveolin-1 was not an independent predictor of 5-year- disease-free survival (P ＞ 0.05).Conclusions Caveolin-1 can be seen as a screening mark of basal-like breast carcinoma,it may promote the invasiveness of breast cancer cells,but it is not an independent prognostic predictor of breast cancer patients.

Objective To evaluate the repair of abdominal complicated incisional hernia using acellular dermal matrix (ADM).Methods Retrospective analysis was made on 7 cases with abdominal complicated incisional hernia treated by ADM in our hospital from January 2008 to June 2010,among them there were 4 males and 3 females.Age ranged from 43 to 83 years and the median age was 53 years.Two concurrent indirect inguinal hernia cases were repaired and concurrent gastrointestinal tract problems including 2 small bowd fistulas were operated one stage in 5 cases.Mean diameter of hernia ring was ( 11.6 ± 2.8 ) cm,ranged from 9.2 to 16.5 cm.5 cases were repaired by using intraperitoneal onlay mesh,others using total extraperitoneal prothesis.Results All patients were operated on successfully.Average time was (33 ±12) min.Blood loss was (16 ±4) ml.Hospital stay was 7 - 12 d.7 patients repaired by ADM fully recovered.There were no chronic pain,paresthesia,pneumonia and urinary tract infection cases,no incision swelling,seroma or infection.All patients were followed up with median time of 14 months,ranging from 5 to 26 months.There were not hernia recurrence,nor surgical site infection during follow-up period.Conclusions For the repairing of abdominal complicated incisional hernia,the application of acellular dermal matrix is safe and effective method especially in those of incisional hernia complicated by infection.

Objective To evaluate the efficacy and safety of endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (RAAA).Methods Two reviewers searched PubMed,MEDLINE,EMBASE,Cochrane Library,Chinese Biomedical Literature Database (CBM),Chinese Scientific Journal Full-text Database (CSJD),and Chinese Journal Full-text Database( CJFD),added with handsearching and other retrievals.The Cochrane Collaboration's RevMan 5.0.18 was used for metaanalyses.Results Pooled data in 9 observational studies describing 2402 people.Meta-analyses showed that EVAR was superior to open repair (OR) as measured by the 30-day all cause mortality [ OR =0.47,95％ CI (0.39,0.57 ),P ＜ 0.01 ] and the primary póstoperative complications [ OR =0.59,95％ CI(0.43,0.81 ),P =0.001 ].Endovascular repair compared with open surgery,in the early postoperative reoperation rate [ OR =0.86,95 ％ CI(0.55,1.33 ),P =0.5 ] and the mid-term all-cause mortality [ OR =1.24,95 ％ CI (0.46,3.37 ),P =0.67 ] was not different statistically.Conclusions Short-term decrease of mortality after endovascular repair for ruptured aneurysms appears promising in selected patients,but the overall benefit is still not clear.Further research is needed to define the indications for REVAR in patients presenfing with RAAA.

Objective To evaluate endovascular repair combined with assistant techniques for the treatment of Stanford type B aortic dissection involving aortic arch.Method From July 2002 to June 2010,46 patients of aortic arch dissection with the primary entry tear next to the orifice of left subclavian artery,were treated with endovascular repair.Left subclavian arteries were covered with TEVAR in 43 cases.PDA occludes were used in 6 patients.Nine patients received extrathoracic supra-aortic branches bypass.Double-barrel technique was performed in 8 patients.Fenestrated stent graft was used in 1 patient.Result All patients survived and were followed up for 2 to 76 months.No severe neurological complications happened.All synthetic grafts and carotid artery stents were patent.Type Ⅱ endoleak occurred in 10 patients,among them 6 received PDA occlude implantation in the left subclavian artery,and 2 patients recovered by conservative treatment.Nine patients suffered from ischemia of the left upper extremity,and 8 of them were treated with conservative method,one received bilateral subclavian artery bypass because of severe ischemia after endovascular treatment.In follow-up,all of the stent-grafts and grafts were patent.In the descending aorta,the diameter of true lumen increased significantly and the diameter of false lumen shrank gradually.Conclusions Endovascular aortic repair combined with extrathoracic supra-aortic branches bypass,PDA occlude,double-barrel technique and fenestrated technique is a safe and effective method for Stanford Type B aortic dissection involving aortic arch.

Objective To study the changes in small intestinal motility during the process of gallbladder cholesterol stone formation.Methods Forty guinea pigs were divided into two groups of 20 each,the experiment group fed on high cholesterol diet ( cholesterol 2％ ),while the control group on normal diet.Animals were sacrificed at 8 weeks.Slow wave and tension of the isolated small intestinal muscle specimen were measured using a multi-channel physiological recorder,and its relation to gallstone formation was assessed.Results Compared with the control group,the frequency and amplitude of the slow wave significantly reduced in the experimental group (5.70 ± 1.05/min vs.17.45 ± 1.50/min and 0.23 ± 0.31 my vs.0.78 ±0.17 mv respectively,P ＜0.05).The t-value between the two groups were -27.083 and - 13.236 respectively; Frequency of contraction and muscle tension also reduced significantly (5.94 ± 1.25/min vs.15.85 ± 1.76/min and 0.78 ±0.002 g vs.1.20 ±0.11 g respectively,P ＜0.05).Thet-value between the two groups were - 19.448 and - 17.307 respectively.Conclusions Reduced small intestinal motility is present in guinea pigs fed on a lithogenous diet,and may have a role in the pathogenesis of cholesterol gallstone formation.

Objective To improve the quality of life in gastric cancer patients after total gastrectomy by exogenous trypsin supplement.Method In this study 106 patients were divided into two groups,with 53 patients in each group,oral pancreatic enzyme capsule was given in comparison without in control group.Patients were asked to fill in EORTC QLQ-C30 questionnaire and Korenaga questionnaire at half a year postoperation,stool sample was collected at the same time for fecal fat assay.Results A total of 86 patients completed this test at postoperation half a year.With a comprehensive assessment of quality of life in patients by the scoring system of EORTC QLQ-C30 and Korenaga and the fecal fat contents measurement.Exogenous trypsin plays a positive role in preventing weight loss,improving emotional function,alleviating loss of appetite,insomnia,fatigue,postprandial fullness,nausea,vomiting and diarrhea,and improving intestinal tolerance to fat and the overall health status of patients.Conclusions Total gastrectomy causes exocrine pancreatic dysfunction,exogenous supplement of the enzyme improves postoperative quality of life in these patients.