Objective To investigate the effects of neoadjuvant chemotherapy on the hepatic function and histology of liver in patients with hepatic metastasis of colorectal cancer.Methods The clinical data of 65 patients with hepatic metastasis of colorectal cancer who received hepatectomy at the First People's Hospital of Foshan from January 2010 to September 2012 were retrospectively analyzed.Thirty-nine patients were in the experimental group,and they received partial hepatectomy 1 month after receiving a 6-month continous FOLFOX7 chemotherapy (5-fluorouracil + calcium leucovorin + oxaloplatin) ; 39 patients were in the control group,and they received partial hepatectomy without adjuvant chemotherapy.The perioperative condition,pre-and postoperative hepatic function,postoperative complications and the histopathological changes of the hepatic tissues of the 2 groups were compared by t test or chi-square test,data repeated measured were analyzed using the repeated measure analysis of variance.Results The operation time of the experimental group and the control group were (195 ± 37)minutes and (190 ±41) minutes,respectively,with no significant difference (t =0.1,P＞0.05).The operative blood loss of the experimental group was (410 ± 75)ml,which was significantly greater than (348 ± 44) ml of the control group (t =6.3,P ＜ 0.05).The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) at postoperative day 3 were (328 ± 121)U/L and (330 ± 120)U/L in the experimental group,which were significantly higher than (160 ±22) U/L and (168 ±26) U/L of the control group (t =13.4,12.8,P ＜ 0.05).There were no significant differences in the levels of prothrombin time,AST,ALT,total bilirubin and albumin between the experimental group and the control group (t =1.0,0.0,1.4,1.3,0.4,P ＞ 0.05).The levels of AST and ALT at postoperative day 7 were (243 ± 132) U/L and (253 ± 147)U/L in the experimental group,which were significantly higher than (90 ± 17)U/L and (99 ± 16)U/L of the control group (t=12.5,12.0,P＜0.05).The incidence of congestion and edema of the liver was 71.8％ (28/39) in the experimental group,which was significantly higher than 0 (0/26) of the control group (x2 =90.0,P ＜ 0.05).The incidence of hepatic sinusoid expansion with liver cellular altrophy and necrosis was 48.7％ (19/39),which was significantly higher than 15.4％ (4/26) of the control group (x2=89.2,P ＜ 0.05).Conclusion There is no effect of long-time FOLFOX7 chemotherapy on the hepatic function of the patients with hepatic metastasis of colorectal cancer who received hepatectomy 1 month later,but the postoperative hepatic function is affected.The hepatic parenchyma is changed after adjuvant chemotherapy,which might have adverse effect on hepatectomy.

Acute Disease ; Adolescent ; Child ; Child, Preschool ; Drug Resistance, Multiple ; genetics ; Drug Resistance, Neoplasm ; genetics ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Leukemia ; physiopathology ; Male ; Neoplasm Proteins ; genetics ; RNA, Messenger ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Vault Ribonucleoprotein Particles ; genetics

Objective To assess the impact of respiratory motion on the displacement of target area and to analyze the discrimination between free breathing and active breathing control (ABC) in patients with gastric cancer treated with post-operative radiotherapy. Methods From January 2005 to November 2006, 22 patients with post-operatively confirmed gastric cancer were enrolled in this study. All diseases were T_3/ N +, staging Ⅱ - Ⅳ. Patients were CT scanned and treated by radiation with the use of ABC. Image J software was used in image processing, motion measurement and data analysis. Surgical clips were implanted as fiducial marks in the tumor bed and lymphatic drainage area. The motion range of each clip was measured in the resultant-projection image. Motions of the clips in superior-inferior (S-I), right-left (R-L) and anterior-posterior (A-P) directions were determined from fluoroscopy movies obtained in the treatment position. Results The motion ranges in S-I, R-L and A-P directions were 11.1 mam, 1.9 mm and 2.5 mm (F = 85.15, P = 0. 000) under free breathing, with 2.2 mm, 1.1 mm and 1.7 nun under ABC (F = 17.64, P = 0. 000), and the reduction of motion ranges was significant in both S-I and A-P directions (t = 4.36, P = 0. 000;t = 3.73,P = 0.000). When compared with under free-breathing, the motion ranges under ABC were kept unchanged in the same breathing phase of the same treatment fraction, while significant increased in different breathing phase in all three directions (t = - 4.36, P = 0. 000; t = - 3.52, P = 0.000; t =-3.79, P = 0. 000), with a numerical value of 3.7 mm, 1.6 mm and 2.8 mm, respectively (F = 19.46, P = 0. 000) . With ABC between different treatment fractions , the maximum displacements were 2.7 mm, 1.7 mm and 2.5 mm for the centre of the clip cluster (F =4.07,P =0. 019), and were 4.6 mm, 3.1 mm and 4.2 mm for the clips (F =5.17 ,P =0.007). The motion ranges were significant increased in all the three directions (t = - 4.09, P=0.000 ; t =-4.46, P = 0.000 ; t = - 3.45, P =0.000). Conclusions In the irradiation of post-operative gastric cancer, the maximum displacement of organ motions induced by respiration is in S-1 direction and the minimum in R-L direction under free breathing. The use of ABC can reduce the motions significantly in S-I and A-P directions, and the same changes exist in both inter-and intra-fraction treatment.

Objective To investigate the application value of double-layer continuous suture in pancreatic jejunum anastomosis of pancreatoduodenectomy (PD).Methods A retrospective analysis of 114 consecutive patients (67 men and 47 women) who underwent PD from June 2012 to July 2013 were conducted. There were 79 patients who were treated by double-layer continuous suture technique and 35 patients by double-layer interrupted suture technique .The incidence of pancreatic fistula and other complications after PD with two different suture techniques were compared .Results The operation time of double-layer continuous suture group and double-layer interrupted suture group is respectively ( 284 ±5 ) and ( 288 ±7 ) mins, the intraoperative bleeding volume is respectively (236 ±29) and (282 ±49) ml, the differences between two groups were no statistical significance .The postoperative fasting time in two group was respectively (7.8 ± 0.5) and (9.7 ±0.5) days, the length of hospital stay time was respectively (14.0 ±1.0) and (17.2 ± 10.0) days, the incidence of postoperative pancreatic fistula ( POPF) was respectively 17.1%(6/35) and 39.2%(317/9 ), the differences between two groups were statistically significant (all P<0.05).Grade A POPF was found in 4 patients ( 11.4%) from the double-layer continuous suture group and in 5 patients (6.3%) from the double-layer interrupted suture group.Grade B POPF was identified only in 1 patients (2.9%) from the double-layer continuous suture group and in 23 patients (29.1%) from the double-layer interrupted suture group .The presence of Grade C POPF was only documented in 1 patient from the double-layer continuous suture group and in 3 patients from the interrupted suture group .Conclusions Continuous suture can be safely used in the duct-to-mucosa pancreatojejunostomy .The double-layer continuous suture can be more effective in reducing pancreatic fistula , improving the feeding time , and reducing the length of hospital stay, and it is worthy of clinical popularization and application .

Objective To compare the dose distribution of the target and normal tissues in gastric cancers between three-dimension conformal radiation therapy (3DCRT) and intensity modulated radiation therapy (IMRT) plan when respiratory motion factors integrated in the plan. Methods From January 2005to November 2006, 10 patients with post-operatively radiation of gastric cancer were enrolled in this study.Planning CT were acquired conventionally with free-breath mode and the static treatment plans of the 3DCRT and IMRT were designed respectively. Probability distribution functions (PDF) were generated and convoluted with the static dose distributions from 3DCRT and IMRT plans to obtain the integrated plans. The dose distributions of the target and normal tissues were compared between 3DCRT and IMRT integration treatment plans, such as V45 of clinical target volume, V4o of liver and V15, V18 of left and right kidney.Results In the respiratory integrated treatment planning, the target volume coverage and homogeneity with IMRT are superior to those with 3DCRT ( ( V45 98%∶ 87% (t = -3. 35 ,P =0. 010) ,mean dose 46. 81 Gy ±0. 75 Gy∶45.99 Gy ± 1.12 Gy (t = -0. 31 ,P=0. 020) ). The V40 of teh liver in IMRT are smaller than those in 3DCRT ( 12%∶ 16% ;t=3.75,P=0.010). For the left kidney, the V15 and V18 in IMRT are smaller than those in 3DCRT ( (34%∶ 50% (t = 2. 17 ,P = 0. 050) and 27%∶46% (t = 3. 11 ,P = 0. 020) ),but for the right kidney, V15 and V18 in 3DCRT are smaller than those in IMRT ( ( 15%∶ 21% (t = - 2. 42,P=0.040) and 11%∶15% (t= -2.71,P=0.030)). Conclusions When respiratory motion factor integrated in the treatment plan, IMRT showed advantage both in target coverage and normal tissue sparing in the high dose region of liver and left kidney.

Objective To investigate the distribution of pelvic recurrence in rectal cancer after radical resection and analyze the outcome and prognostic factors of pelvic recurrent rectal cancer treated with radiotherapy. Methods Ninety-three patients with pelvic recurrent rectal cancer who received radiotherapy from August 2000 to August 2006 were retrospectively analyzed. Of them, 21 patients received pelvic radiation alone;56 received pelvic radiation plus chemotherapy and 16 received pelvic radiation plus surgery and/or chemotherapy. Radiotherapy was delivered with 60Coγor 6/15 MV X ray to a median dose of 59. 4Gy (range,20-74 Gy). Conventional fractionation was used in 90 patients. Chemotherapy was given to 68patients with a median number of 3 cycles ( range, 1 - 8 cycles). Concurrent chemo-radiation with 5-FU based regimen was given to 42 patients. After radiotherapy, 16 patients underwent surgical resection, with 7R0 resection and 9 palliative resection. Results The entire cohort included 132 recurrent sites. The most common recurrent sites were peri-rectal region ( 31.8% ), pre-sacral region ( 30. 3% ) and internal iliac nodal region (20. 2% ). The follow-up rate was 92% for the entire cohort, 39 and 4 patients had minimum follow-up time of 2 and 5 years respectively. Overall clinical response ( complete and partial symptomatic relief) was achieved in 83% of the patients after radiation therapy. The 2-and 5-year local progression-free survival rates were 49% and 22% respectively, and the 2-and 5-year overall survival rates were 46% and 14% respectively. Multivariate analysis showed that treatment modality was the independent prognostic factor for local progression-free survival. Patients treated with radiation plus surgery and/or chemotherapy had better local progression-free survival than those treated with radiation plus chemotherapy or radiation alone.Recurrent tumors larger than 5 cm in diameter, disease-free interval less than 2 years and distant metastasis after radiotherapy were independent unfavorable prognostic factors for overall survival. Conclusions Perirectal region, pre-sacral region and internal iliac nodal region were the most common pelvic recurrent sites in rectal cancer. Radiotherapy is an effective palliative approach for patients with pelvic recurrent rectal cancer.Radiotherapy plus surgery and/or chemotherapy was associated with better local progression-free survival,and recurrent tumors lager than 5 cm in diameter, disease-free interval less than 2 years and distant metastasis after radiotherapy were unfavorable prognostic factors for overall survival of pelvic recurrent rectal caner.

OBJECTIVETo discuss the electrophysiologic effects of regenerative nerve fibres affected by control releasing of FK506.

METHODSFrom Mar. to Sep. in 2008, the body weigh of 32 Sprague-Dawley rats which was 200 to 250 g,anesthesia was performed with an intraperitoneal injection of 30 mg/kg 1% continal. The sciatic nerve was transected in each rat by the excision of a 10 mm gap just proximal to the trifurcation of the nerve. The 10 mm gap of sciatic nerve had been bridged with the new double channel nerve conduit of fusiform shape, which were randomly divided into two groups basing on the different drug in the channel, each group contained 16 animals. In group A,100 microl of chitin for medical use was injected into the conduit,in group B the two branches of the conduit respectively contained 100 microl of the chitin and 10 microl FK506 (group B2) or physiologic saline (group B1). At 8 and 12 week after operation, the morphology in regenerative nerve and electrophysiologic effects by detect compound muscle active potential (CMAP) and cortical somatosensory evoked potential (CSEP) were evaluated.

RESULTSThere were not significant differences of the regenerative nerve fibres between two channels in group A, but in group B2, the number of the regenerative fibres was much more than that in group B1. The latency of CMAP and CSEP in group B2 was shorter than that in group B1. But its amplitude was higher. There were highly significant difference between the groups (P < 0.01).

CONCLUSIONThe electrophysiologic effects of regenerative nerve fibres can be significantly promoted by FK506, which provide theory base for immunosuppressive treatment of peripheral nerve.

Animals ; Chitin ; administration & dosage ; Delayed-Action Preparations ; Female ; Immunosuppressive Agents ; administration & dosage ; pharmacology ; Male ; Nerve Fibers ; drug effects ; physiology ; Nerve Regeneration ; Rats ; Rats, Sprague-Dawley ; Tacrolimus ; administration & dosage ; pharmacology

Acute Disease ; Adult ; CD56 Antigen ; immunology ; Female ; Humans ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; immunology ; surgery ; Recurrence ; Stem Cell Transplantation

Objective To construct and implement the training model of eight-year medical education with characteristics of Shanghai Jiaotong University. Methods Based on survey,discussion and consultation,the experiences of long schooling medical education in Shanghai Jiaotong University School of Medicine were summarized.Training plan and education reform scheme were established. Results Training objective,guideline and major reform measures had been clarified.The training plan and reform scheme were under process of implementation. Conclusion The training objective of eight-year medical education should be further confirmed.The curriculum should be in accordance with the training objective,and education reform is important and necessary for the eight-year medical education.

Objective To prepare T-helper cell(Th)epitnpe-modified human soluble B cell activating factor belonging to the tumor necrosis factor family(BAFF)mutants and evaluate their immune response in vaccinated mice.Methods Recombinant cDNAs were cloned and ligated into the prokaryotie expression vec- tor pQE-80L respectively.The recombinant proteins were induced to express by IPTG in E.coli DH5?and purified with Ni-NTA chromatography.BALB/c mice were immunized with recombinant proteins respectively and the titres of the antibodies that were cross-reactive with BAFF in sera were analyzed by ELISA.Inhibiting ability of the antibodies in sera was analyzed by MTT assay.Results The recombinant proteins were highly expressed in E.coli DH5?.After purification,the purity of recombinant proteins was more than 90%.BALB/c mice immunized with recombinant proteins produced high levels of BAFF-specific antibodies.Cell proliferation assay showed that the sera of immunized mice could inhibit the proliferation-inducing activity of recombinant sBAFF and natural sBAFF.Conclusion The immune inhibitors of human BAFF which can induce polyclonal antibodies that are cross-reactive with BAFF are successfully prepared.These results may provide the basis for further study of their therapeutic effects.