Pancreatic cancer is the third leading cause of cancer-related death in the world due to its high malignancy, difficult in early diagnosis, poor treatment efficacy, and high mortality. In recent years, benefiting from the progress of combined chemotherapy and neoadjuvant therapy, the prognosis of patients with pancreatic cancer has been improved to a certain extent. However, compared with other tumors, progress of precision medicine in pancreatic cancer is slow. The authors introduce the latest progress and difficulties in precision medicine of pancreatic cancer including molecular classification based on single gene and omics, monitoring tumor progression and guide treatment by minimally invasive liquid biopsy, as well as targeting therapy and immuno-therapy, in order to accelerate the development of precision medicine of pancreatic cancer.

Objective To explore clinical effect and safety of intermittent androgen suppression treatment of advanced prostate cancer in elderly patients.Methods 78 patients with advanced prostate cancer were enrolled,and randomly divided into the observation group and the control group (n=39 each).Patients in observation group were treated with intermittent androgen suppression treatment.Patients in control group were treated with persistent androgen suppression treatment.Results The time of therapy was much longer in observation group than in control group (P＜ 0.001).Quality of life was better in observation group than in control group (P＜0.05).The incidences of adverse reactions including anemia,fever and abnormal liver function were lower in observation group than in control group (all P＜0.05).Conclusions Intermittent androgen suppression treatment prolongs time to androgen-independent progression,improve the quality of life,reduce drug dosage and the incidence of adverse reactions in the treatment of advanced prostate cancer in the elderly.

Objective To investigate the effect of Wushen decoction on levels of serum cardiac troponin Ⅰ (cTnI),cardiac muscle enzyme and clinical parameters in patients with sepsis heart failure,and to analyze the correlations between cTnI and myocardial enzyme level and clinical parameters.Methods Forty-two patients diagnosed as sepsis admitted to Wuhan Hospital of Traditional Chinese Medicine from March 2014 to March 2016 were enrolled,and they were divided into a Wushen decoction treatment group and a control group by principle of single blind complete randomized method,21 cases in each group.The patients in control gToup were treated by conventional western medicine,while the patients in Wushen decoction treatment group,on the basis of conventional western medicine,they were treated additionally by Wushen decoction (composed of ginseng,radix sophorae flavescentis,radix glehniae,radix adenophorae,salvia,astragalus,notoginseng radix,rosewood,etc.),one dose a day,the therapeutic course in both groups being 7 days.The changes of biochemical indicators [cTnI,creatine kinase (CK),CK isoenzyme (CK-MB)],haemodynamics parameters [cardiac index (CI),central venous pressure (CVP),extravascular lung water index (ELWI),global ejection fraction (GEF),mean arterial pressure (MAP),heart rate (HR)],treatment condition and prognostic parameters [vasoactive drug dosage index,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,duration of mechanical ventilation,the length of stay in intensive care unit (ICU) and total hospitalization time] were compared before and after treatment for 7 days in the two groups.The correlations between the level of cTnI on admission before treatment and CK,CK-MB,APACHE Ⅱ,vasoactive drug dosage index,duration of mechanical ventilation,the length of stay in ICU and total hospitalization time were analyzed.Results The levels of cTnI,CK,CK-MB,CVP,ELWI,HR,vasoactive drug dosage index,APACHE Ⅱ score in two groups after treatment were obviously lower than those before treatment,the levels of CI,GEF,MAP were markedly higher than those before treatment,the duration of mechanical ventilation,the length of stay in ICU and total hospitalization time were significantly shorter than those before treatment,and the changes of above indexes were more remarkable in Wushen decoction group than those in control group [cTnI (mg/L):0.94-± 0.29 vs.1.30 ± 0.67,CK (U/L):96.00 ± 24.30 vs.101.38 ± 24.55,CK-MB (U/L):31.14 ± 6.78 vs.36.48 ± 8.17,CI (mL· s-1 · m-2):64.51 ± 5.83 vs.53.34 ± 4.67,CVP (cmH2O,1 cmH2O =0.098 kPa):10.56 ± 1.84 vs.11.94--2.16,ELWI (mL/kg):8.81±1.61 vs.11.66±2.30,GEF:(33.62±3.88)％ vs.(27.14±4.55)％,MAP (mmHg,1 mmHg =0.133 kPa):84.67 ± 5.58 vs.79.52 ± 5.74,HR (bpm):87.86 ± 9.02 vs.82.95 ± 5.26,vasoactive drug dosage index:2.44 ± 0.53 vs.2.89 ± 0.68,APACHE Ⅱ score:10.66 ± 1.66 vs.14.43 ± 1.82,duration of mechanical ventilation (days):1.67 ± 2.11 vs.2.10 ± 2.26,the length of stay in ICU (days):8.86 ± 2.59 vs.10.67 ± 2.96,total hospitalization time (days):13.24 ± 4.53vs.16.76 ± 5.04,all P ＜ 0.05].On admission before treatment,the correlations between the level of cTnI and CK,APACHE Ⅱ score,vasoactive drug dosage index,duration of mechanical ventilation and the length of stay in ICU were all positive (r =0.322,0.335,0.327,0.328,0.338,P =0.038,0.030,0.030,0.034,0.029).Conclusions The elevation of cTnI level may reflect the degree of myocardial damage in patients with sepsis cardiac failure,and it can be used as an indicator to predict the prognosis of the disease;the changes of many biochemical and clinical indexes suggest that the addition of Wushen decoction might elevate the clinical efficacy for treatment of patients with sepsis heart failure.

Xanthelasma palpebrum is the most common type of xanthoma that develops mainly on the inner epicanthus of upper eyelids with symmetrical distribution. The lesion tends to be permanent, progressive and cosmetically disfiguring. The recommended treatment has been surgical excision, local treatment with chemicals, and carbon dioxide laser. All of the mentioned treatment have some disadvantages including scarring, pigmentary change and need for local anesthesia. We describe the treatment of xanthelasma palpebrum with the pulsed dye laser which coagulates the hyperpermeable vessels so that the lipid leakage could be blocked and prevent recurrence and further progression.
Anesthesia, Local ; Cicatrix ; Eyelids ; Lasers, Dye* ; Lasers, Gas ; Recurrence ; Xanthomatosis

Congenital adrenal hyperplasia(CAH) results from an inherited defect in enzymatic steps required to synthesize cortisol from cholesterol. 21-hydroxylase deficiency accounts for 95% cases of CAH. We have analyzed CYP21 genes of CAH by PCR direct sequencing. Our results shows three cases of CAH owing to multiple mutations of CYP21 gene; first case, IVS2AS, A/G, -13, Ile172Asn; second case, IVS2AS, A/G, -13, Ile236Asn, Val237Glu, Met239Lys; third case, Ile172Asn, C to G at 1590nt, Val281Leu, Arg484Pro, G to A at 2697nt. Mutations such as Ile236Asn, Val237Glu, Met239Lys, and Arg484Pro are first noted in Korea.
Adrenal Hyperplasia, Congenital* ; Cholesterol ; Hydrocortisone ; Korea ; Polymerase Chain Reaction ; Steroid 21-Hydroxylase

Objective To investigate laparoscopic-guided selective portal vein ligation in the two-stage hepatectomy for patients with primary hepatocellular carcinoma (HCC).Methods Twenty-three patients with HCC who were not suitable for one-stage hepatectomy were admitted to the Sichuan Provincial People's Hospital from March 2009 to February 2012.Their clinical data were retrospectively analyzed.Laparoscopic-guided selective portal vein ligation was firstly performed,dynamic changes of hepatic volume and predicted volume of liver to be resected were detected by computed tomography.Two-stage open hepatectomy was performed after assessment of resectability of HCC.All data were analyzed using the analysis of variance or q test.Results Laparoscopic-guided selective portal vein ligation was successfully performed on 22 patients (2 patients received concomitant cholecystectomy because the right branch of portal vein was difficult to expose),1 patient was converted to open surgery because of hemorrhage during portal vein separation.Three patients with multiple lesions received transcatheter arterial chemoembolization at 1 week after selective portal vein ligation.Dull pain in the hepatic region,low fever,nausea and vomiting were observed in the 23 patients,while no severe complications including peritoneal hemorrhage,bile leakage,hepatapostema was observed.The levels of aspartate aminotransferase,alanine aminotransferase and total bilirubin were back to normal at 1 week after the surgery.The right liver volume at postoperative week 3 was (590 ± 154)cm3,which was significantly smaller than (698 ± 135)cm3 before surgery.Compared with right liver volume at postoperative week 1,2,3,the right liver volume before operation was significantly smaller (F=15.62,P ＜0.05).The left hepatic volume at postoperative week 3 was (408 ± 149)cm3,which was significantly bigger than (331 ± 68)cm3 before operation.The left liver volume before operation was significantly different from those at postoperative week 1,2,3 (F =17.48,P ＜ 0.05).The predicted ratio of liver to be resected was 60％ ± 18％ at postoperative week 3,which was significantly smaller than 67％ ± 15％ before operation (F =12.35,P ＜ 0.05).Two patients with insufficient hyperplasia of offside liver,2 patients with intrahepatic metastasis at postoperative week 3,2 patients were lost to follow up and 3 patients gave up hepatectomy,14 patients received hepatectomy at 2-4 weeks after laparoscopic-guided selective portal vein ligation.The resection rate was 60.9％ (14/23).There were 2 patients received extended right hepatectomy,8 received right hepatectomy,4 received non-anatomical hepatectomy.All the 14 patients recovered well,and no hepatic failure,severe peritoneal effusion and infection was observed.Conclusion Laparoscopic-guided selective portal vein ligation is easy to perform,and it extends the indication of hepatectomy,increases the safety of two-stage hepatectomy.

Objective To compare the advantages and disadvantages between laparoscopic operation and laparotomy in the treatment of Mirizzi syndrome.MethodsThe clinical data of 67 cases with Mirizzi syndrome were analyzed retrospectively from January 2008 to June 2011.Thirty-five cases were treated with laparoscopic operation(laparoscopic operation group),type Ⅰ in 24 cases,type Ⅱ in 11 cases,3 cases with conversion to laparotomy were rejected (type Ⅱ in 8 cases really).Thirty-five cases were treated with laparotomy(laparotomy group),type Ⅰ in 20 cases,type Ⅱ in 15 cases.The operation time,blood loss duringoperation,intake time of food,postoperative complications and hospital stay were compared between two groups.ResultsThe operation time was (53.2 ± 21.5) min,blood loss during operation was (23.2 ± 21.5)ml,intake time of food was 6 h,postoperative complications were with 3 cases (9.4％,3/32),hospital stay was(5.4 ±2.3) d in laparoscopic operation group.The operation time was(98.7 ± 17.2) min,blood loss during operation was ( 113.4 ± 31.6) ml,intake time of food was (46.8 ± 12.4) h,postoperative complications were with 5 cases( 14.3％,5/35 ),hospital stay was ( 11.3 ± 2.7) d in laparotomy group.Except for postoperative complications,there were significant differences in the operation time,blood loss during operation,intake time of food and hospital stay between two groups(P＜0.05).ConclusionsLaparoscopic operation is safe and feasible in treating type Ⅰ and most type Ⅱ Mirizzi syndrome.It has more advantages than laparotomy.

SUN Shu-chun,the chief researcher,is one of the famous expert of osteo-traumatology of TCM.He makes systematic sort and study on chirismus on basis of succeeding experience predecessors and his own years of clinic experience.He is good at treating cervical syndrome with TCM chirismus,especially combine it with drugs.In osteo-traumatology academic circles,he is called "the best doctor at home".Professor SUN advocates that the rule of applying various therapies according to different conditions,combination of rigid-flexible,light,skill,gentle,harmony should be obey when we use chirismus.His diagnostic and therapeutic methods and thoughts are original and ingenious.In this article,the author analyzes the academic experience of tendon trauma of professor SUN.

Aged ; Antigens, CD ; metabolism ; Antigens, CD20 ; metabolism ; Antigens, Differentiation, Myelomonocytic ; metabolism ; CD3 Complex ; metabolism ; CD79 Antigens ; metabolism ; Diagnosis, Differential ; Histiocytes ; immunology ; pathology ; Hodgkin Disease ; immunology ; pathology ; Humans ; Leukocyte Common Antigens ; metabolism ; Lymphoma, B-Cell ; immunology ; pathology ; Lymphoma, Large B-Cell, Diffuse ; immunology ; pathology ; Male ; T-Lymphocytes ; immunology ; pathology

Objective To analyze the clonal gene rearrangement and complementarity determining region 3 (CDR3) repertoire of TCR β-chain in fine needle aspiration biopsy (FNAB) specimens of lymph node metastasis in patients with breast cancer. Methods The TCR CDR3 region genes of 24 TCR Vβ subfamilies were amplified by utilizing RT-PCR technology, and the CDR3 lengths of TCR β-chain were analyzed with gene scan technology for 2 cases with lymph node reactive hyperplasia and 3 patients with lymph node metastasis of breast cancer. The clonality of T cells presumed by spectra typing was further confirmed by CDR3 sequencing. Results TCR β-chain presented specific repertoire skewing in metastatic lymph node,and only 3-5 TCR Vβ subfamily of T cells were identified, respectively. Clonal expanded T cells, including oligoclonal, polyclonal patterns, in one or more Vβ subfamilies were found in all cases. The oligoclonal expanded T cells had different CDR3 amino acid sequences. Conclusion There are characteristic T cells cloning proliferation and selected usage of TCR Vβ subfamily T cells could be found in metastatic lymph node.The sequences of CDR3 in different TCR clone proliferation are mostly different.