Hepatocellular carcinoma (HCC) is one of the common malignant tumors in China. The most important treatment for middle-late stage HCC is chemotherapy. However, the development of multidrug resistance (MDR) in HCC can dramatically reduce the efficacy of chemotherapeutic treatment. At present, the mechanisms regulating the development of MDR in HCC are still unknown. These mechanisms involve ATP-dependent drug efflux pump, enzymatic deactivation, the activation of MAPK signal pathway, apoptosis gene and protein changing, the influence of the tumor microenvironment, and so on. With the development of the research, some new mechanisms are found, such as the endoplasmic reticulum stress and the effect of microRNA, which cannot be ignored. This review aims to summarize the mechanisms of MDR in HCC and discuss potential therapeutic targets for anticancer intervention.

Objective To investigate the clinical value of a preoperative predictive scoring system established by National Cancer Center Hospital (NCCH) for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).Methods The clinical data of 100 patients with periampullary tumor who underwent PD in the Cancer Hospital of Tianjin Medical University from October 2008 to January 2012 were retrospectively analyzed.Five indexes including gender,pancreatic cancer,main pancreatic duct index,portal invasion and intra-abdominal fat thickness were in the NCCH preoperative predictive scoring system.Patients with score ＞ 4 were defined as with high risk of POPF,and those with score≤4 were defined as with low risk of POPF.Factors associated with POPF were analyzed using the Pearson chi-square test.The sensitivity and specificity of the predictive scoring system were determined by receiver operating characteristic (ROC) curve analysis.Results Of the 100 patients,20 had POPF,including 9 in grade A,6 in grade B and 5 in grade C.Gender,pancreatic cancer,portal invasion,texture of pancreas and method of pancreaticojejunostomy were closely correlated with POPF (x2=5.613,4.785,15.479,7.145,7.050,P ＜ 0.05).The incidence of POPF was 86.4％ (19/22) for patients with high risk of POPF,and 1.3％ (1/78) for patients with low risk of POPF,with significant difference (x2=77.637,P ＜ 0.05).The results of ROC curve analysis showed that the sensitivity and specificity of the predictive scoring system were 95.0％ and 96.3％,respectively.The nomogram showed an area under the curve of 99.0％ (P ＜ 0.05).Conclusion The NCCH preoperative predictive scoring system could accurately predict the occurrence of POPF.

Thioredoxin (Trx) is a class of small redox proteins which is widely found in all organisms.It acts as antioxidant by facilitating the reduction of other proteins by cysteine thiol-disulfide exchange.Recently,thioredoxin is found to be over-expressed in many kinds of tumor,which is closely associated with tumor cell proliferation,apoptosis and cell cycle control.Trx is also found to promote the synthesis and stabilization of the HIF-1α protein.It is also related to the control of reactive oxygen species and chemoresistance of tumor cells.Trx has been proved to play an important role in promoting the metastasis of cancer,and may become a potential target for anti-metastasis of cancer.

ObjectiveTo determine the efficacy and safety of peroral endoscopic myotomy with transverse entry incision (T-POEM).MethodsThe data of 31 patients with achalasia (AC) who underwent T-POEM were collected and analyzed.ResultsThe success rate of T-POEM was 100％ with an average operation time of 78.6 minutes.Patients were followed up for (6.3 ± 5.4) months averagely.The symptom remission rate was 100％ with complication rate of 19.4％ (6/31).The mena Eckardt score after T-POEM was 0.7 ± 0.5,which was significantly lower than that before the procedure ( 7.8 ± 0.9) ( P ＜ 0.05 ).ConclusionThe short term results of T-POEM is satisfying with low complication rate.

Objective To determine the efficacy of endoscopic treatment for chronic pancreatitis(CP).Methods The clinical data of CP patients in our department from December of 2000 to March of 2009 were reviewed retrospectively.Results 77 patients had been successfully followed up.The short-term clinical symptom remission rate was 86.9% and the long-term 61.0%.9 patients underwent surgery after endoscopic treatment during the follow-up.The incidence of complications related to endoscopic treatment was 5.1% including post-ERCP(endoscopic retrograde cholangiopancreatography) pancreatitis,hemorrhage,cholangitis and perforation.No death related to endoscopic treatment occurred.Conclusion Endoscopic treatment for CP is safe and effective.

Objective Observe the effect of Danqi-Suoniao decoction combined with conventional western medicine on urodynamics of diabetic neurogenic bladder. Methods 34 cases of the patients with diabetic neurogenic bladder were divided into a control group and an observation group,with 17 cases in each group. Both groups were treated control diet,proper exercise and bladder training. On this basis, the control blood was treated with insulin, and the observation group was additionally added Danqi Suoniao Fang on the basis of the control group. After 12 weeks of treatment,the difference of urodynamics,glycosylated hemoglobin, urine albumin excretion rate lipids in blood and blood pressure were observed. Results After 12 weeks of treatment,the residual urine volume (100.71 ± 28.37 ml vs. 130.24 ± 44.56 ml, t=2.719), the beginning of the bladder to urinate capacity (136.57 ± 19.42 ml vs. 150.65 ± 17.65 ml, t=2.334), the biggest urinate capacity (458.48 ± 107.80 ml vs. 520.73 ± 112.47 ml, t=2.463) were significantly decreased in observation group than the control group(P<0.01); the biggest stress detrusor urine flow rate (38.64 ± 10.79 cmH2O vs. 30.09 ± 9.32 cmH2O, t=2.708),maximum urinary flow rate (14.59 ± 4.52 ml/s vs. 10.27±3.70 ml/s, t=2.691), maximum urethral pressure (60.07 ± 16.65 cmH2O vs. 44.68 ± 16.62 cmH2O, t=2.810) were significantly increased in observation group than the control group (P<0.05). There was no significant difference in glycosylated hemoglobin,urine albumin excretion rate,lipids in blood and blood pressure (t=0.731, 0.689, 0.719, 0.764, 0.711, 0.737, P>0.05). Conclusion Danqi-Suoniao decoction is effective in treating diabetic neurogenic bladder on the basis of controlling blood glucose with western medicine.

Objective:To discusse the clinical features of sarcomatoid hepatocellular carcinoma to improve the understanding of diagnosis and treatment for sarcomatoid hepatocellular carcinoma. Methods:Data including clinical features and follow-up from 8 pa-tients admitted in Tianjin Medical University Cancer Institute and Hospital from January 2009 to April 2014 were retrospectively ana-lyzed. Results: The average age of all patients was 56.6 years old, and the male-to-female ratio was 3:1. Preoperative CT or MRI showed specific characteristics but it was difficult to confirm diagnosis. Pathological and immunohistochemical examination revealed an expressed epithelial-like phenotype. All 8 patients had advanced local tumor invasion and high lymph node metastasis rates. These patients received surgery, and the median survival time was 10.8 months (3 months to 35 months). Conclusion:Diagnosis of sarcoma-toid hepatocellular carcinoma mainly depended on postoperative pathological examination. Immunohistochemistry was beneficial for sarcomatoid hepatocellular carcinoma diagnosis and differential diagnosis. Surgical treatment prolonged survival time, but the overall prognosis remained poor.

Objective To investigate the clinical and pathological characteristics,surgical treatment strategy and prognosis of primary malignant neoplasms of the appendix.Methods The clinical data of 74 patients with primary malignant neoplasms of the appendix in our hospital from January 1982 to December 2012 were retrospectively studied.Results Among the 74 cases of primary malignant neoplasms of the appendix,carcinoids were the most common accounting for approximately 70％,adenocarcinoma accounting for 22％ and lymphoma accounting for 8％.The prognosis of primary malignant neoplasms of the appendix is rather poor,nainly because of patients' later presentetion.The overall 1,3,5-year survival rate is respectively 95％,74％,60％,the prognosis of carcinoid is good,while that of adenocarcinoma is poor.Conclusions The incidence of primary malignant neoplasms of the appendix is relatively low.It is difficult to diagnose preoperatively,and the diagnosis relies mainly on rapid intraoperative frozen section and postoperative pathology.

Objective To evaluate the the safety and efficiency of precise liver resection for patients with primary liver cancer. Methods 86 patients with primary liver cancer were randomized to receive conventional routine hepatectomy (n=44) or the precise liver resection (n=42). Outcomes were compared between the precise hepatectomy group and the routine group, including, the blood loss, operation time, morbidity and mortality. Results There were significant differences in morbidity rates (7.1% vs. 20.5%; P<0.001), the blood loss [(320±315) ml vs. (613±526) ml;P<0.001) , postoperative alanine aminotransferase (ALT) value (in postoperation 7 d, 82.7 U/L vs.321.7 U/L; P<0.001) and length of hospital stay (12.3 d vs. 18.6 d; P<0.001) between precise hepatectomy and routine groups. The 1 year tumor recurrence rate and 1 year survival rate were 26.2%(11/42) and 78.6% (33/42) in precise liver resection group, 38.6% (17/44) and 65.9%(29/44) in routine liver resection group,with significant difference (P=0.010;P=0.018). Conclusion Precise liver resection is safe and effective in the treatment of liver tumor without much injury to patients.

Objective To identify the prognostic factors for patients with intrahepatic cholangiocarcinoma.Methods The clinical data of 99 patients with intrahepatic cholangiocarcinoma who received surgical treatment at the Cancer Hospital of Tianjin Medical University from January 2000 to January 2010 were analyzed retrospectively.Lymph nodes at the hepatic portal and group 12,13 and 8 lymph nodes were resected.The range of hepatectomy was decided according to the size,location,number of tumor and the hepatic function.Patients were followed up every month within the first 6 months after operation,every 3 months at 6 months later,and they were followed up every half year at 2 years later.Patients who were suspected as with tumor recurrence or progression were followed up every month.All the patients were followed up till death or March of 2013.The survival was analyzed using the Log-rank test,and multivariate analysis was done using the COX regression model.Results Forty patients received hemi-hepatectomy,27 received extended hemi-hepatectomy,20 received segmentectomy,and 12 received hemi-hepatectomy + wedge resection.All the patients were followed up and the median time of follow-up was 33 months (range 21.1-44.9 months).The 1-,3-,5-year recurrence-free survival rates and total survival rates of the 99 patients were 64.6％,29.2％,22.7％ and 78.8％,46.4％ and 30.3％,respectively.The results of univariate analysis showed that hepatitis B or C virus infection,preoperative CA19-9 level,TNM staging,lymph node metastasis,microvascular invasion,number of nodules and Ro resection were risk factors influencing the recurrence-free survival time (Log-rank value =5.048,5.982,20.128,13.148,29.632,32.488,50.574,P ＜0.05).The peroperative CA19-9 level,TNM staging,lymph node metastasis,microvascular invasion,number of nodules and R0 resection were risk factors influencing the total survival rate (Log-rank value =4.302,17.267,11.756,23.840,36.411,47.126,P ＜0.05).There were significant differences in the recurrence-free survival time and total survival time between patients in different TNM stages (20 patients in stage Ⅰ,44 in stage Ⅱ,8 in stage Ⅲ and 27 in stage Ⅳ) (Log-rank value =20.128,17.267,P ＜0.05).There were significant difference in the recurrence-free survival time between patients in stage Ⅰ and Ⅲ,patients in stage Ⅰ and Ⅳ,and between patients in stage Ⅱ and Ⅳ (Log-rank value =10.807,19.368,6.347,P ＜ 0.05).There were significant difference in the total survival time between patients in stage Ⅰ and Ⅱ,patients in stage Ⅰ and Ⅲ,patients in stage Ⅰ and Ⅳ and between patients in stage Ⅱ and Ⅳ (Log-rank value =6.119,4.015,16.282,4.929,P＜0.05).There was no significant difference in the survival time between patients in other TNM stages (P ＞ 0.05).The results of multivariate analysis showed that TNM stage Ⅲ and Ⅳ,microvascular invasion,multiple nodules and R0 resection were independent risk factors influencing the recurrence-free survival time (RR =1.413,3.073,2.737,3.916,95％ confidence interval:1.119-1.784,1.837-5.140,1.338-4.207,1.849-8.291,P＜0.05) ; lymph node metastasis,microvascular invasion,multiple tumors and R0 resection were the independent risk factors influencing the total survival time (RR =2.025,2.948,0.327,3.494,95％ confidence interval:1.215-3.374,1.774-4.900,0.183-0.583,1.670-7.310,P ＜ 0.05).Conclusions TNM stage Ⅲ and Ⅳ,lymph node metastasis,microvascular invasion,multiple nodules,non-R0 resection shorten the recurrence-free survival time and total survival time of patients who received surgical resection for intrahepatic cholangiocarcinoma,and they are the main factors influencing the prognosis.R0 resection could improve the survival of patients with intrahepatic cholangiocarcinoma.