Cancer metastasis is the most dangerous stage of tumorigenesis and evolution, the primary cause of death in cancer patients. Clinically, more than 60% of cancer patients have found metastasis at the time of examination. Modern medicine has made significant progress on the mechanisms of cancer metastasis in recent years, from the simple "anatomy and machinery" theory forward to the "seed and soil" theory, then to the "microenvironmental" theory and the "cancer stem cell" theory. The emerging "cancer stem cell" theory successfully explains phenomenon such as tumor genetic heterogeneity, anoikis resistance, tumor dormancy, providing more new targets and ideas for the diagnosis and treatment of cancer metastasis.
Animals ; Humans ; Medicine ; methods ; Neoplasm Metastasis ; Neoplasms ; drug therapy ; pathology

Objective Todiscuss the diagnosis and therapy of the pancreatoblastoma(PB).Methods The data of 2 cases of PB were analyzed retrospectively and related literatures were reviewed.Results Both cases were males,11 years old and 8 years old respectively.The 2 cases both had solid mass located in the tail of the pancreas.Alpha-fetal protein(AFP) was normal in case 1 and 2 903 ng/ml in case 2.The 2 cases underwent resection of the pancreas tail,and the postoperative pathological examination confirmed the diagnosis of PB.Followup of 26 months in case 1 and 10 months in case 2 showed that the survival was good.Conclusions PB is an extremely rare tumor of exocrine pancreas and often occurs in male children.The solid mass located in the pancreas with elevated AFP can be considered as PB.Our experience showed a pancreatic mass with normal AFP can also be PB.Surgery is the best management of PB.

OBJECTIVE:To evaluate the clinical effects of urapidil on cardiovascular response induced by sympathetic stimulation during front approach cervical vertebra operation.METHODS:One hundred and twenty patients undergoing front approach cervical vertebra operation were randomly divided into three groups.Patients in URA group treated with0.5mg/kg urapidil and patients in NIC group treated with5?g/kg nicardipine when systolic blood pressure(SBP)and heart rate(HR)increased by sympathetic nerve stimulation during the operation.And patients in COM group only increased their anesthesia degree with isoflurane at the same situation.The patients’SBP and HR were observed and compared among three groups at the time before the sympathetic nerve stimulation,and5minutes and10minutes after the drugs treatment respective?ly.RESULTS:The patients’SBP and HR in URA group had no significantly increase after administration of urapidil.In NIC group,although the patients’SBP had no significantly increase,the patients’HR increased significantly after nicardipine was used.But the patients’SBP and HR increased significantly after improved anesthesia degree with isoflurane.CONCLUSION:Urapidil has better effect on sympathetic cardiovascular response during the front approach cervical vertebra operation com?pared with nicardipine.

OBJECTIVETo investigate the significance, effects and precautions of enteral nutritional support in patients with short bowel syndrome (SBS).

METHODSClinical data of 40 SBS patients who were maintained on enteral nutrition (EN) for more than 2 years were retrospectively summarized. The cost of EN and parenteral nutrition (PN), the PN-free duration, and the current nutritional status of these patients were analyzed.

RESULTSThe mean length of the remnant small bowel was (50.8 +/- 29.4) cm. All the patients currently lived on high-carbohydrate low-fat diet supplemented with EN (3284.0 +/- 1408.8) kJ/d, the cost was significantly lower than that of PN (P < 0.01). Mean PN-free duration was (29.1 +/- 9.2) months for these patients. The current defecation frequency and volume were (3.4 +/- 1.7) times/d and (720.2 +/- 350.3) ml/d, respectively. As for the patients' nutritional index, mean BMI, blood hemoglobin and serum albumin level were (17.8 +/- 3.2) kg/m(2), (113.3 +/- 14.8) g/L and (35.0 +/- 4.1) g/L, respectively.

CONCLUSIONSEnteral nutrition is a cost-effective method for maintaining the nutritional status in patients with short bowel syndrome, but proper management in clinical practice to avoid diarrhea or other complications should be ensured.

Adolescent ; Adult ; Enteral Nutrition ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Parenteral Nutrition ; Retrospective Studies ; Short Bowel Syndrome ; therapy ; Treatment Outcome

Objective To study the characteristics of a new neuron-specific marker in the cerebral cortex and its application method.Methods According to immunofluorescence principles,the neurons in the cerebral cortex cultured in vitro were stained by fluorescein isothiocyanate (FITC)-labeled Tet1; and FITC-Tet1 with NSE or GFAP was employed to determine whether the neurons can be marked and whether they can be distinguished from astrocytes; the conditions of application of FITC-Tet1 were quantified.The HEK and C6 cell lines were performed the above experiments as controls.Results The final concentration was the key factor,which indicated that when the FITC-Tet1 was about 30 μg/mL,the neuron marking ability was the best,and the astrocytes,HEK and C6 were not stained.Neither high (100μg/mL) or low (10μg/mL) levels of FITC-Tet1 were suitableforstainingneurons.Conclusion Tet1 can specifically combine with the neuron in the cerebral cortex,which may make it to be a new staining method or a targeting molecule to neurons in the central nervous system.

OBJECTIVETo investigate the effect of preoperative nutritional support in the management of patients with chronic radiation enteritis (CRE) with intestinal obstruction undergoing resectional surgery.

METHODSClinical data of 158 CRE patients undergoing diseased bowel resection from 2001 to 2011 were analyzed retrospectively. A total of 130 patients received preoperative nutritional support, including 28 patients with enteral nutrition support, 60 patients with total parenteral nutrition support, and 42 patients with combined nutritional support. The nutritional parameters, procedures, operation-related complications, and postoperative hospital stay were recorded.

RESULTSAfter aggressive nutritional support in 130 patients, patients nutritional index, such as serum prealbumin, transferrin, serum albumin improved significantly preoperatively, while the change of body mass index and hemoglobin was not significant. Compared to those without preoperative nutritional support, those who received preoperative nutritional support had lower stoma rate (31.5% vs. 53.6%, P=0.027), less postoperative infection rate (13.8% vs. 32.1%, P=0.019), shorter postoperative hospital stay [(14.1±7.3) d vs. (18.8±15.8) d, P=0.013). Enteral nutrition group had less postoperative infection rate (7.1% vs. 21.7%, P=0.017), lower stoma rate (28.6% vs. 48.3%, P=0.02), and shorter postoperative hospital stay [(15.5±9.6) d vs. (21.7±19.0) d, P=0.025) as compared to total parenteral nutrition group.

CONCLUSIONSPreoperative nutritional support can decrease the stoma rate, postoperative infection rate, and shorten hospital stay in CRE patients complicated with intestinal obstruction. If tolerated, enteral nutrition support should be chosen.

Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Enteritis ; etiology ; surgery ; Female ; Humans ; Intestinal Obstruction ; complications ; surgery ; Male ; Middle Aged ; Nutritional Support ; methods ; Preoperative Care ; Radiation Injuries ; complications ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo examine the outcome of damage control surgery (DCS) in patients with acute mesenteric ischemia (AMI).

METHODSClinical data of 15 consecutive AMI cases treated with DCS from May 2001 to March 2009 at the Research Institute of General Surgery, Jinling Hospital were retrospectively analyzed. Eleven patients had acute superior mesenteric vein thrombosis (MVT) on admission, and 4 suffered from acute mesenteric arterial embolism/thrombosis (MAE/MAT). The staged damage control approach included immediate resection of the involved bowel (but no attempts to restore gastrointestinal continuity), open thrombectomy, transfer of the patients to ICU for resuscitation, and thrombolysis prior to the planned definitive reconstructive procedure.

RESULTSOf 15 patients, 10 (66.7%) survived. The mean remnant small bowel length was (209.0+/-53.8) cm (120 to 280 cm). None of the survived patients was parenteral nutrition-dependent. Of the 5 deaths, 2 died of recurrence of thrombosis and necrosis of the remaining bowel,1 of massive gastrointestinal bleeding. One patient abandoned treatment intra-operatively, and another with total small bowel resection abandoned treatment postoperatively.

CONCLUSIONSDamage control approach improves the survival of patients with AMI. Thrombectomy and thrombolysis are necessary for AMI management to prevent progression or further development of the thrombosis.

Acute Disease ; Adult ; Female ; Humans ; Intraoperative Complications ; Ischemia ; surgery ; therapy ; Male ; Mesenteric Vascular Occlusion ; surgery ; therapy ; Mesentery ; surgery ; Middle Aged ; Retrospective Studies ; Thrombectomy ; Thrombolytic Therapy

OBJECTIVETo investigate the potential role of serum citrulline level in evaluating the intestinal absorptive area and capacity in patients with short bowel syndrome (SBS).

METHODSSerum citrulline concentration was determined using high performance liquid chromatography (HPLC) in SBS patients (n=22) and healthy controls (n=33). In SBS patients, the remnant small bowel lengths and diameters were measured by radiography, and their 5- hour urine D- xylose excretion and intestinal protein absorption were also determined. The correlationship of serum citrulline level with remnant small bowel length, surface area, protein and D- xylose absorption was analyzed. The 6 patients receiving intestinal rehabilitative therapy, serum citrulline level, protein and D- xylose absorption after therapy were also measured.

RESULTSSerum citrulline level of SBS patients was significantly lower than that of healthy controls [(5.94+/- 2.65) vs [(16.87 +/- 5.97) micromol/L, P < 0.01]. In SBS patients, serum citrulline was positively correlated with remnant small bowel length and surface area (r=0.82 and r=0.86 respectively). There was also a significant correlationship of serum citrulline level with 5- hour D- xylose excretion (r=0.56) and intestinal protein absorption (r=0.48). Serum citrulline, 5- hour D- xylose excretion and intestinal protein absorption were all significantly raised in patients after rehabilitative therapy, although no correlation of increasing percentage was found among above three parameters.

CONCLUSIONSSerum citrulline concentration is positively correlated with intestinal absorptive area and capacity in SBS patients. It is a potential marker for evaluating the severity of intestinal failure and the efficacy of rehabilitative therapy in short bowel patients.

Adolescent ; Adult ; Aged ; Case-Control Studies ; Citrulline ; blood ; Female ; Humans ; Intestine, Small ; metabolism ; Male ; Middle Aged ; Short Bowel Syndrome ; blood ; metabolism ; physiopathology ; Xylose ; metabolism ; Young Adult

OBJECTIVETo study the pulmonary pathology in patients died of fatal human influenza A(H1N1) infection.

METHODSEight cases of fatal human influenza A (H1N1) infection, including 2 autopsy cases and 6 paramortem needle puncture biopsies, were enrolled into the study. Histologic examination, immunohistochemitry, flow cytometry and Western blotting were carried out.

RESULTSThe major pathologic changes included necrotizing bronchiolitis with surrounding inflammation, diffuse alveolar damage and pulmonary hemorrhage. Influenza viral antigen expression was detected in the lung tissue by Western blotting. Immunohistochemical study demonstrated the presence of nuclear protein and hemagglutinin virus antigens in parts of trachea, bronchial epithelium and glands, alveolar epithelium, macrophages and endothelium. Flow cytometry showed that the apoptotic rate of type II pneumocytes (32.15%, 78.15%) was significantly higher than that of the controls (1.93%, 3.77%).

CONCLUSIONNecrotizing bronchiolitis, diffuse alveolar damage and pulmonary hemorrhage followed by pulmonary fibrosis in late stage are the major pathologic changes in fatal human influenza A (H1N1) infection.

Adolescent ; Adult ; Aged ; Alveolar Epithelial Cells ; pathology ; Antigens, Viral ; metabolism ; Apoptosis ; Autopsy ; Biopsy, Needle ; Bronchiolitis, Viral ; pathology ; Child ; Child, Preschool ; Female ; Hemagglutinin Glycoproteins, Influenza Virus ; metabolism ; Humans ; Influenza A Virus, H1N1 Subtype ; immunology ; Influenza, Human ; metabolism ; mortality ; pathology ; virology ; Lung ; immunology ; metabolism ; pathology ; Male ; Middle Aged ; Nuclear Proteins ; metabolism ; Pulmonary Alveoli ; pathology ; Pulmonary Fibrosis ; pathology ; Young Adult

OBJECTIVETo determine whether the perioperative disease activity is associated with recurrence and complications after bowel resection for Crohn's disease (CD).

METHODSClinical data of patients underwent bowel resection for CD at the Nanjing General Hospital of Nanjing Military Command from January 2002 to January 2011 was retrospectively analyzed. Postoperative recurrence and complications in patients with active disease were compared with those in patients with remission.

RESULTSA total of 90 patients underwent bowel resection for CD, active disease were seen in 43 patients at the time of surgery, while the rest 47 patients were in remission. The postoperative cumulative endoscopic recurrence rate was 8.5% at 1 year, 27.7% at 2 years and 44.7% at 3 years in the patients with remission, and was 27.9% at 1 year, 37.2% at 2 years and 53.5% at 3 years in patients with active disease. Data indicated the endoscopic recurrence were statistically significant in the first year after surgery (χ² = 4.605, P = 0.032). Additional, the postoperative complication rates in patients with remission (14.9%) was significantly lower than that in patients with active disease (51.2%) (χ² = 6.979, P < 0.001).

CONCLUSIONPatients with active disease at the time of surgery were encountered with early postoperative recurrence and increased complications after intestinal resection for CD.

Adult ; Colon ; surgery ; Crohn Disease ; physiopathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Young Adult