ObjectiveTo evaluate the reasonableness of total mesorectal excision (TME) in the management of rectal cancer. Methods The carcinoembryonic antigen (CEA) level of surgically removed distal mesorectum (3?cm below the tumor),tumor tissue and normal mesocolon was detected by microparticle enzyme immunoassay in 26 rectal cancer patients. Results The CEA level in normal mesocolon was (1.6?1.0)?ng/g, and (62.5?85.2)?ng/g in distal mesorectum(P1?000?ng/g).ConclusionsIn patients with rectal cancer, much higher CEA level in distal mesorectum than in normal mesocolon might indicate distal mesorectal dissemination. It is necessary to routinely perform TME in the surgical management of middle and lower rectal cancer.

Objective To evaluate transsphincteric operation (Mason operation) for rectal tumors.Methods Retrospective study was used to analyze the experience of Mason operation for 150 patients with mid and lower rectal tumors between Aug 1990 to Dee 2008. Results There were villous adenoma in 75 cases,early rectal cancer in 48 and advanced rectal cancer in 9,submucosal carcinoid nodule in 23.Of the 126 rectal tumor patients,120 underwent partial rectectomy,6 underwent segmental rectectomy.Seventeen out of the 21 rectovaginal fistula or rectourethral fistula cases underwent successful one-stage repair.Six patients(4%)developed wound infection.Five patients(3.3%)were complicated with recto-cutaneous fistula.Two patients(4.3%) suffered from local recurrence in 46 followed up early staged rectal carcinoma with a five-year survival rate of 84.5%(39/46).On discharge from hospital no patient suffered from incontinence.Conclusion Mason operation is satisfactory with good exposure and simple access to the rectum,which Was suitable for those lesions that could be locally resected on mid and lower rectum.

Objective To evaluate transanal endoscopic microsurgery (TEM) for the resection of rectal neoplasms. Methods In order to analyze the therapeutic effect of TEM in the management of rectal tumors, clinical data of 110 patients with rectal neoplasms treated by TEM between April 2006 and August 2009 were summarized and analyzed retrospectively. Result The mean diameter of rectal lesions was 1.7±0.8 (range, 0.5 ～5.5)cm. The average distance of lesions from the anal verge was 7.4 ±2.6(range, 4 ～20) cm. 40 lesions were located at the anterior wall of the rectum, 29 on the posterior wall,22 on the left wall and 19 on the right. Surgical procedures included the transmural excision (98 cases) and the submucosal excision with partial muscular layer excision (12 cases). The average operating time was 73.5 ±31.1 (range, 25 ～180) min. The mean operative blood loss was 10.8 ±7.8 (range, 3 ～60) ml.The postoperative pathological examination identified 41 rectal adenomas、 35 rectal adenocarcinomas or carcinomatous changes of adenomas (21 Tis, 6 T1, and 8 T2 cases), 14 rectal carcinoids, 1 stromal tumor、1 leiomyoma and 18 cases of inflammatory polyps or others. Surgical margins of all specimens were negative.Postoperative complications included 2 cases of anal hemorrhage, one case of pulmonary infection and one urinary infection with a postoperative morbidity of 3.6%. The average postoperative stay was 3.4 ± 1.3( range, 2 ～ 8 ) d. With a mean follow-up period of 12. 5 (3 ～ 40) months, no tumor recurrence or metastasis was found. Conclusions TEM shows advantages of decreased blood loss, good therapeutic effect, and fast recovery of the patients, which can be adopted as the choice of therapy for small and well confined rectal neoplasms.

ObjectiveTo investigate the relationship between surgical manipulation and hematogenous spreading micrometastasis in patients with colorectal carcinoma.MethodsNested RT-PCR was used to detect the expression of cytokeratin 20 (CK20) mRNA in the peripheral blood of 37 colorectal cancer patients without distal metastasis (experimental group) undergoing radical resection which were subdivided into group A (tumor drainage veins were first ligated) and group B (without precedent ligation of the veins).Results CK20 mRNA was positive by nested RT-PCR in the peripheral blood in 9 out of 10 colorectal cancer patients with known distant metastasis,while it was negative in all 10 volunteers and all 10 patients with benign colorectal lesions. CK20 mRNA was detected in 14 of 37 (37 8%) cases in the peripheral blood sampled preoperatively, while the positive ratio rose to 59 5% (22/37) during surgical procedures (? 2=4 900, P0 05). ConclusionCK20 mRNA by nested RT-PCR was highly sensitive and specific for the determination of circulating micrometastasis in colorectal cancer patients. Surgical manipulation significantly increased the incidence of hematogenous spreading micrometastasis, which can′t be prevented by precedent ligation of the refluent veins of the tumor during operation.

Objective To analyse the pathogeny of pregnancy with virus hepatitis,the change of index of hepatic function and the clinical pathogenetic characteristic,and to explore the relationship between pregnancy and hepatitis.Methods The clinical datas of 96 pregnant patients with virus hepatitis were retrospectively analyzed,and compared with non-pregnancy during the reprodective age in the corresponding period.The pathogeny,index of hepatic function and clinical pathogenetic characteristic were compared.Results Virus hepatitis in the pregnancy were mostly type B hepatits,the morbility of hepatitis increased gradually along with the progress of pregnant weeks,the prothrombin time(PT) significantly prolonged in pregnancy with virus hepatitis,and the albumin decreased significantly,the complications of hepatocerebral disease and hepatorenal syndrome were more than non-pregnancy with virus hepatits,the incidence rate of serious hepatiti was higher than non-pregnancy with virus hepatitis(P

Objective To investigate the expression and sensitivity of 6 muhidmg resistance gene products(MDR) : GST-π、LRP、MRP、Topo Ⅱ、P-gp、TS in gastric cancer during neoadjuvant chemotherapy. Methods Expression of the 6 muhidrug resistance gene was detected by immunohistoehemistry in 35 cases of stomach cancer tissues before and after neoadjuvant chemotherapy. The relationship between muhidrug resistance gene and neoadjuvant chemotherapy was analyzed. All patients were given FOLFOX4, and the effects were evaluated according to World Health Organization criteria. Results The overall response rates to chemotherapy was 46%, expression of the 6 mtdtidrug resistance gene in 35 cases of stomach cancer tissues were as follows:GST-π was 40% ,LRP was 69% ,MRP was 34% ,Topo Ⅱ was 37% ,P-gp was 86%, TS was 40%, expression of the 6 muhidrug resistance gene did not change during neoadjuvant chemotherapy; GST-π、LRP、MRP、Topo Ⅱ、P-gp were not correlated with chemotherapy sensitivity(P > 0.05), while TS was significantly correlated with chemotherapy sensitivity (P = 0.0048). Conclusion FOLFOX4 does not effect a change in the expression of the 6 muhidrug resistance gene: GST-π、LRP、MRP、Topo Ⅱ、P-gp and TS, while TS is significantly correlated with gastric cancer chemotherapy sensitivity.

Objective To provide the experimental basis for the further research of the interacting proteins with Stathmin ,the Stathmin gene Pichia pastoris expression system was constructed ,the expressed Stathmin product was purified and identified .Meth‐ods Stathmin gene was amplified from tumor cell line of SKBR3 by PCR method and cloned into the yeast expression vector pPIC3 .5K .The recombinant vector pPIC3 .5K‐Stathmin was constructed and transformed into Pichia pastoris GS115 .The positive clones were screened by YPD medium containing Geneticin 600 μg/mL .Expression was induced with 0 .5% methanol and expres‐sion products were identified by SDS‐PAGE and Western Blotting .Results DNA sequencing result showed that the gene fragment was consistent with Stathmin gene sequence .pPIC3 .5K‐Stathmin was selected from YPD culture medium containing Geneticin ,and the positive clones were identified by PCR .SDS‐PAGE showed that a 37 × 103 protein band could be seen on the PAGE gel after Coomassie Blue staining ,which was further confirmed and identified as Stathmin protein by Western Blotting .Conclusion Stathmin yeast expression vector is successfully constructed and expressed in Pichia pastoris ,which laid the foundation for the study of inter‐acting proteins with Stathmin ,and for the preparation of the biological treatment drugs of Stahtmin target .

Objective To gain the virus like particles (VLPs) based on Trop2 targets ,which provided the basis for further in vi‐vo induced experiments and anti‐tumor vaccine studies .Methods Using molecular cloning method to constract eukaryotic expres‐sion vector of pCAGGs/Trop2 and baculovirus expression vector of pFastbac1/Trop2 ,expression product of pCAGGs/Trop2 in HeLa cells were intended to be to be anchored to the cell membrane by the methods of Immunohistochemistry ;pFastbac1/Trop2 were transformed into E .coliDH10bac isolates to gain recombinant bacmids ,which were transfected into insect cells to express re‐combinant baculovirus with Gag rBV ,then sucrose density gradient centrifugation ,Western Blot and electron microscope were per‐formed to purify and identify the Trop2 VLPs .Results Building recombinant bacmids which were transfected into insect cells to express recombinant baculovirus with Gag rBV ,gained the recombinant Virus like Particles .Conclusion Trop2 VLPs was success‐fully prepared ,which laid the foundation for the subsequent induction of humoral and cellular immune response .

Objective:To obtain some effective objective markers used to predict the early liver metastasis of colorectal tumor,the relationship of liver metastasis of colorectal tumor with associate detection three markers such as CK20mRNA、CD44V6 and PCNA was studied. Methods:The expression of CK20mRNA in portal venous blood from 30 colorectal cancer patients was detected by fluorescent quarto RT-PCR,and the results of CD44V6 and PCNA in colorectal cancer tissue were determined by means of immunohistochemistry, and then compared with control groups through statistics analysis. Results:The rate of positive expression of CK20mRNA in colorectal cancer patients' portal venous blood was obviously superior to the level of benign pathological changes controls(P

Objective To investigate the causes and outcome of different treatment methods of iatrogenic rectovaginal fistula. Methods Clinical data of 52 patients with iatrogenic rectovaginal fistula were analyzed retrospectively. Results Twenty-two fistulae occurred after gynecological operation (42.3%), fourteen after obstetric injury (26.9%), thirteen after colorectal operation (25.0%) and three due to miscellaneous causes (5.8%). The fistulae were located in the lower rectum in 27 cases(51.9%), mid rectum in 10 cases(19.2%) and upper rectum in 15 cases(28.9%). They were treated by non-surgical treatment in 9 cases(17.3%), permanent diverting stoma(loop transverse colostomy) in 8 cases(15.4%), and surgical repair by various approaches in 35 cases(67.3%). The fistulae of all nine patients who received non-surgical treatment failed to heal. Eight patients who received permanent diverting stoma had symptomatic improvement without fistula healing. The overall cure rate of surgical repairs in 35 cases was 77.1%(27/35). The cure rates of trans-sphincteric (Mason′s operation), transanal, transabdominal, transperineal and transvaginal approaches were 100%(8/8), 100%(2/2), 83.3%(5/6), 0%(0/1) and 66.7%(12/18), respectively. The cure rate of Mason′s operation for the mid and lower rectovaginal fistulae was higher than that of transvaginal approach (100% vs 66.7%). Conclusions Iatrogenic rectovaginal fistula is caused by obstetric injury or injury of rectovaginal septum due to surgical mismanagement. Surgical repair is the only method that can cure rectovaginal fistulae. Mason′s operation is a favorable treatment method for the mid and lower (especially mid) rectovaginal fistulae.