Objective To investigate the causes and preventive measures of hepatic failure during perioperative period of liver resection for primary hepatic carcinoma in the elderly patients, and to explore its diagnosis and treatment. Methods The 62 patients with primary hepatic carcinoma undergoing hepatectomy were analyzed retrospectively, and they were divided into two groups: elderly group (age≥60 years) and non-elderly group (age＜60 years). The influencing factors for damage of hepatic function were analyzed using single variant and multivariate stepwise regression analysis in elderly and non-elderly group, pringle maneuver and non-pringle maneuver group, more (≥500 ml)and less (＜500 ml) amount of bleeding group. Results The incidence of hepatic damage and mortality rate induced by hepatic failure were 32. 6% and 1.6% respectively after liver resection for primary hepatic carcinoma. Single variant analysis showed that pringle maneuver, intraoperative blood loss, blood transfusion and size of tumor were associated with postoperative hepatic function.Furthermore, multivariate stepwise regression analysis revealed that pringle maneuver was the independent risk factor associated with postoperative hepatic function (β = 0. 314, t= 2. 272, P ＜0. 05). Conclusions The postoperative hepatic damage is significantly correlated with pringle maneuver and intraoperative bleeding in liver resection for hepatocellular carcinoma in senile people.And improving operative techniques, shorting the time of pringle maneuver, decreasing intraoperative bleeding were the main preventive measures for hepatic damage after liver resection for primary hepatic carcinoma in the elderly patients.

Objective To investigate the management of pseudomyxoma peritonei originated in the appendix.Methods The clinical data of 51 patients with pseudomyxoma peritonei originated in the appendix who were admitted to the Beijing Hospital from 1970 to 2010 were retrospectively analyzed.The results of operation,reoperation,adjuvant treatment and follow-up were analyzed.The time from pseudomyxoma peritonei recurrence to the reoperation between patients who did or did not receive chemotherapy was compared by two tailed t test.Results Of the 51 patients,48 received operation,and the operation time was (135 ± 72 )minutes.Tumor recurrence was observed in 34 patients,and 16 of them received cytoreduction procedure,and 33 cytoreduction procedures were performed in total.The median time of follow-up was 49.7 months (range,3-132 months).The disease-specific survival was observed in 25 patients and disease-free survival in 16 patients.Four patients died of tumor recurrence or progression.The results of postoperative pathological examination confirmed that 19 patients were with benign disseminated peritoneal adenomucinosis (DPAM),26 were with malignant peritoneal mucinous carcinomatosis (PMCA) and 6 were with intermediate subtype (PMCA-1).The 3-,5- and 10-year survival rates were 75％ (38/51),55％ (28/51) and 22％ ( 11/51 ),respectively.The survival time and reoperation time interval for patients who received postoperative chemotherapy were ( 21 ± 4) months and ( 10 ± 6 ) months,which were longer than (19 ±7 )months and (7 ±4)months of those who did not receive postoperative chemotherapy (t =1.027,0.361,P ＞ 0.05).The median survival time of patients with benign DPAM,PMCA-1 and malignant PMCA were 96,63,23 months,respectively.The tumor recurrence interval for patients with benign DPAM and those with malignant PMCA were ( 15 ± 5 ) months and (7 ± 4) months,with significant difference ( t =2.193,P ＜ 0.05 ).Conclusions An active cytoreduction surgery is feasible for patients with pseudomyxoma peritonei originated in the appendix in improving survival.Repeated cytoreduction is a treatment of strategy to prolong the recurrence time and improve the prognosis of selected patients.

Objective To evaluate the efficacy and safety of combination chemotherapy with vinorelbine and cisplatin in the treatment of metastatic breast cancer resisting to anthracycline and taxane.Methods 20 patients with advanced metastatic breast cancer were given following regimen:Vinorelbine 25mg/m2 was given intraveniously in day 1 and day 8,cisplatin 75mg/m2 was given intraveniously in day 1 or 25mg/m2 was given intraveniously in day1 to day 3,repeated every 3 weeks.Evaluation of response and adverse reactions were practiced every 2 cycles.Results 20 patients were evaluable,among them,2 cases reach CR,8 cases PR,4 cases SD and 6 cases PD,with a median followup of 6 months(4 ～ 18months),16 patients survived and 4 patients died.The median time to progression and the median survival time was 5 months(3 ～ 15 months) and 8 months(4 ～ 18 months) respectively.The treatment well tolerated,The main toxicity was myelosuppression and gastrointestinal reaction with WHO grade Ⅲ～Ⅳ gastrointestinal reaction,neutropena and thrombocytopenia being in 25% 、65% and 10% .Conclusion The regimen of NP is safe and effective in treating advanced metastatic breast cancer resisting to anthracycline and taxane.In addition,it was able to improve survival rate and adverse reactions could be tolerated.

Objective To investigate the effect of radiofrequency ablation (RFA) in treating unresectable liver caneer. Methods 43 patients(78 lesions) who suffered from unresectable liver cancer were treated with cool-tip RFA from May 2006 to November,2008 in our hospital. 26 cases were treated with RFA in laparotomy besides with reseet of lesion in 6 eases and with alinjection in 5 cases,while 17 eases were treated only with percutaneous RFA. Results All patients were diagnosed by CT and B-ultrasound or MRI,among whom 18 cases were confirmed with primary hepatic carcinoma, 12 eases experienced recurrence following resect of primary hepatic carcinoma and 13 eases developed metastatic carcinoma;Every patient was followed up with AFP, abdominal B-ultrasound, CT scans or MRI from 1 to 28 months after treatment (mean 13.6 months). Before procedure, AFP increased in 20 eases which recovered within 3 months of treatment. 2 cases were suspected having residual on CT scan ,6 cases were found with new masses on liver on CT scan, 1 case complicated with gastrointestinal fistula and then died of systemie metas-tasis 3 months later,1 ease died of postoperative bleeding and 1 died of bleeding and infection after reseet + RFA treatment,and 3 cases died of multi-metastasis during following up who survived on average of 6 months. Conclu-sions B-ultrasound -guided cool-tip circulation RFA is an effective and safe method in treating unresectable liver cancer.

Aim The aim of this study is to determine effect of ST2325 on HER2/neu tyrosine kinase signal pathway and cell cycle in breast cancer BT474 cells. Methods Protein expression was detected with immunoblot analysis. Cell cycle distribution was examined using flow cytometry.Results ST2325 inhibited tyrosine phosphorylation of HER-2/neu in a dose-dependent manner with half maximal inhibition occurring at a concentration of 8.7 ?mol?L -1 without reduced HER-2/neu receptor protein expression. Activation of MAPK and AKT, downstream molecules of HER-2/neu-mediated signal transduction pathway was inhibited following exposure to ST2325. After BT474 cells were treated with different concentrations of ST2325 for 24 h, the results of flow cytometry analysis showed cell cycle arrest in G 1 phase. Western blot assay showed up-regulation of p27 protein expression and decrease of hyperphosphorylated Rb and cyclin D1 protein expression.Conclusions ST2325 inhibits HER2 tyrosine kinase phosphorylation and induces G 1 arrest in BT474 cells. Cell cycle arrest in G 1 is associated with p27 up-regulation, decrease of cyclin D1 protein and hyperphosphorylated Rb.

OBJECTIVEThis study was conducted to observe dynamically the serum and stool level of IL-2, IL-6 and IFN-alpha with RV enteritis, and to analyse the relation of them and their relation to clinical manifestations.

METHODSThe double-antibody sandwich ELISA technique was applied.

RESULTSThe positive rate of RV in 119 enteritis cases was 63.0% and the peak month was November. These cytokines had different peak phases in the course of disease. The earliest cytokine which had peak phase was IFN-alpha, the last ones were serum and stool IL-2. There was a negative relation between stool IL-2 and IL-6 (P<0.01). There were positive relation between IL-2 and IFN-alpha, stool IL-6 and IFN-alpha, serum IL-2 and IL-6, stool IL-2 and the recovery time of the enteritis (P<0.01 or P<0.05). Serum and stool level of IL-2 and IFN-alpha had positive relation to the number of lymphocyte plus mononuclear cells (P<0.01 or P<0.05).

CONCLUSIONSIL-2, IL-6 and IFN-alpha play important roles of immunoregulation in RV enteritis, and have close relation to clinical manifestations.

Enteritis ; blood ; virology ; Feces ; chemistry ; Female ; Humans ; Infant ; Interferon-gamma ; metabolism ; Interleukin-2 ; metabolism ; Interleukin-6 ; metabolism ; Male ; Rotavirus Infections ; blood

Aim To investigate apoptosis induced by 3,3'-diethyl-9-methylthia-carbocyanine iodide(DMTCCI) , an inhibitor of DNA primase found in our previous study, and the mechanism of DMTCCI in human myelogenous leukemia HL-60 cells. Methods HL-60 cells were cultured in RPMI-1640 medium and treated with different concentrations of DMTCCI. MTT assay was used to detect growth inhibition.Flow cytometry and DNA ladders were used to detect apoptosis. Western blotting was used to observe the expression of survivin, Bcl-xL, Bad, Bax, Bcl-2, caspase-9, caspase-3, caspase-6, PARP, DFF45 and lamin B protein. Caspase-3 activity was measured by ApoAlert Caspase-3 Assay Kit. Results DMTCCI inhibited proliferation of human leukemia HL-60 cells with IC50 value of 0. 24 μmol · L-1. The results of flow cytometry and DNA ladders showed that DMTCCI could induce apoptosis of HL-60 cells. The expression levels of protein survivin and Bcl-xL were down-regulated, Bad and Bax were up-regulated,while Bcl-2 protein had no change in response to DMTCCI treatment in HL-60 cells. Treatment of HL-60cells with DMTCCI induced the proteolytic cleavage of caspase-9, caspase-3, caspase-6, PARP, DFF45and lamin B protein. Caspase-3 activity apparently increased at 3 h and reached a peak at 12 h after exposure to 1 μmol · L-1 of DMTCCI in HL-60 cells. Conclusion DMTCCI inhibited proliferation and induced apoptosis of human leukemia HL-60 cells. Bcl-2 family proteins, survivin and caspases family proteins might playa role in the apoptosis process induced by DMTCCI.

Objective To evaluate the effects of a carbohydrate-electrolyte solution on serum glucose, pancreas islet function and inflammatory response in elderly patients after abdominal operation.Methods It was a prospective, randomized, double-blinded and controlled trial. Totally 40 elderly patients after abdominal operation who met the defined criteria were enrolled. The subjects in study group were administered with 1000 ml carbohydrate-electrolyte solution intravenously in consecutive three days since 1st or 2nd postoperative day. Control group was administered with 1000 ml of 10% glucose on the same method. The changes of serum glucose, insulin, C-peptide and inflammatory response cytokine (IL-6, TNF-α, CRP) were detected before and after injection.Systemic inflammatory response syndrome (SIRS) was observed.Results All the 40 patients completed the study according to the study protocol. The incremental rate of serum glucose was significantly lower in study group than in control group on the 2nd and 3rd day after administration [(4.40±2.58) mmol/L vs. (14.97±3.44) mmol/L, t=2.984, P=0.008; (2.70± 1.55) mmol/L vs. (8.11± 2.60) mmol/L, t= 5.659, P= 0.000]. The changes of insulin and C-peptide of two group were similar before and after operation. The levels of IL-6 and TNF-α were significantly lower in study group than in control group on the 3rd day after administration[IL-6: (21.76±10.40) ng/Lvs. (50.17±35.24) ng/L, t=-2.447, P=0.034; TNF-α:(23.92±14.89) ng/L vs. (51.48±42.81) ng/L, t=-2.268, P=0.043]. In study group, 6 cases experienced SIRS and 4 cases had infective complications, but in control group the numbers were 8 and 6 respectively.Conclusions Appropriate application of carbohydrate-electrolyte solution intravenously has relatively mild effects on serum glucose and inflammatory response cytokine in elderly patients after abdominal operation, it decreases incidence of SIRS and maybe decrease infective complications.

This study was aimed to evaluate the quantitative analysis of MCE in diagnosing coronary atherosclerotic heart disease. MCE was performed on 10 patients with coronary artery disease. The parameters were extracted from imaging during the refilling period by time-intensity curve. SIpeak represents the peak of the signal intensity at the end of the perfusion process. Rt denotes refilling time, b indicates refilling rate. SI x b represents myocardial blood flow. SIpeak, Rt, b and SI x b showed significant differences in various segment of one patient. SIpeak exhibited significant difference between the control and observation groups (P < 0.05). The area under curve (AUC) of ROC was determined to be 0.782 and the optimum critical point was 64.4. SIpeak < or = 64.4 could predict the risk of coronary atherosclerotic heart disease with a sensitivity of 83.3% and a specificity of 69.0%. With the use of CnTI, myocardial perfusion was satisfactorily shown. The data from this initial study indicate that MCE and Qontrasts quantitative analysis software can evaluate the defect and damage area of myocardial infarction and low blood flow. SIpeak is a valuable predictor of coronary atherosclerotic heart disease.
Adult ; Aged ; Contrast Media ; Coronary Artery Disease ; diagnosis ; Echocardiography ; methods ; Female ; Humans ; Image Interpretation, Computer-Assisted ; Injections, Intravenous ; Male ; Middle Aged ; Phospholipids ; ROC Curve ; Sensitivity and Specificity ; Sulfur Hexafluoride

Objective To establish a simple scoring system for the diagnosis of liver fibrosis in chronic hepatitis B (CHB), and to observe its sensitivity and specificity. Methods Two hundred and thirty-three patients diagnosed as CHB by liver biopsy were divided into model group (N = 154) and validation group (N = 79). The general information, biochemical parameters and imaging data of all patients were observed. With hepatic fibrosis being obvious or not as the end point of primary study in the model group, we established a simple scoring system for the diagnosis. The cut-off, sensitivity and specificity of the system were tested in the model group by ROC curve, and its diagnostic efficacy was tested in the validation group. Results(1) A simple scoring system for the diagnosis of liver fibrosis called MDFS was established in the model group, and the dimensions of the system included sex, HBV-DNA, Fibroscan (FS) value and splenomegaly. In MDFS, male, HBV-DNA≥ 107 U/mL,FS value≥7.3 kPa, and splenomegaly were assigned 1 point, -2 points, 3 points, and 2 points respectively. (2) The best cut-off value in MDFS was 2 points.(3) ROC curve of the model group indicated that the specificity and sensitivity were 92.86% and 54.76% respectively, the area under curve(AUC) was 0.790, and the Youden index was 0.4762. In the validation group, the diagnostic cut-off value was over 2 points, and the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 52.17%, 82.35%, 2.96, and 0.58 respectively. (4) The scoring results of MDFS for different traditional Chinese medical syndromes of CHB showed that the scores of blood stasis blocking collaterals > damp-heat accumulation > deficiency of spleen and kidney yang> liver depression and spleen deficiency = stagnation of liver Qi. Conclusion The MDFS diagnostic scoring system has medium efficiency. The specificity of MDFS is relatively high and MDFs has a relatively low misdiagnosis rate for the diagnosis of obvious hepatic fibrosis in CHB. The MDFS is expected to be a noninvasive and simple diagnosing way for hepatic fibrosis in CHB.