Objective To investigate the prognositic factors of small intestine stromal tumors after radical resection.Methods The clinicopathological data of 41 patients with small intestine stromal tumors admitted between January 2005 and December 2010 in Henan Tumor Hospital were analyzed restrospectively.Kaplan-Meier survival rate and COX regression were used to evaluate the prognostic factors.Results There were 22 males and 19 females.The age ranged from 22 to 78 years old (median,55years).Location of tumor included duodenum (n =12),jejunum and ileum (n =29).The 3-year survival rate was 22％ in those 16 cases who reported preoperative gastrointestinal bleeding and 65％ in those without GIT bleeding,the difference was statistically significant (P =0.0012).COX model showed that tumor size,the tumor location,recurrence and metastasis were independent risk factors associated with the prognosis in small intestine stromal patients (P ＜ 0.05).Conclusions The most common clinical presentation of these tumors was gastrointestinal bleeding.The tumor location,recurrence and metastasis and gastrointestinal bleeding was independent risk factors associated with the prognosis of small intestine stromal tumor patients.

Objective To study the expression of HIF-1α and bcl-XL in gastric cancer and their relationship with tumor angiogenesis,clinicopathologic feature and prognosis.Methods Immunohistochemical technique was used to detect the expression of HIF-1α and bcl-XL in 54 cases of gastric canoer.SPSS 12.0 software was used to analyze the relationship between the expression of HIF-1α, bcl-XL and tumor angiogenesis,clinicopathologic feature of patients.Results The positive expression rate of HIF-1α in gastric cancer(74.07%) was significantly higher than that in normal gastric tissue(0),P＜0.01;The expression of HIF-1α in gastric cancer was significantly associated with TNM stage,invasive depth and lymph-node metastasis,P＜0.05 or P＜0.01;The positive expression rate of bcl-XL in gastric cancer(53.7%) was significantly higher than that in normal gastric tissue(33.3%),P＜0.05;The expression of bcl-XL in gastric cancer was significantly associated with histological types,TNM stage and lymph-node metastasis,P＜0.05;There was a positive correlation between expression of HIF-1α and bcl-XL (r=0.41,P＜0.05).Conclusion HIF-1α and bcl-XL play a very important role in the development in gastric cancer and could be a factor in diagnosis of gastric cancer and estimation of prognosis.

Objective To explore the prospect of clinical application of indocyanine green (ICG) in sentinel lymph node biopsy (SLNB) in patients with breast cancer. Methods Seventy-two female breast cancer patients were selected from those receiving surgery during July 2014 and December 2014, with an age range of 33-67 years and a median age of 50 years, and they were randomly divided into experimental group (n=35) and control group (n=37), ICG and methylene blue as tracers were used respectively for SLNB. The surgical specimens were submitted to frozen section for pathological examination. The patients with metastasis to SLN received axillary lymph node dissection. Results The successful detection rate of metastasis to SLN by ICG method was 94.3%, with a total of 111 SLNs, with an average of 3.17 SLNs for each patient, and the accuracy rate was 94.3%, the sensitivity and false negative rate were 100% and 0%, respectively. On the other hand, the detection rate with methylene blue method was 92.0%, including 78 SLNs, with an average of 2.1 SLNs for each patient, and the accuracy rate was 89.2%, the sensitivity and false negative rates were 92.9% and 7.7%, respectively. The differences between two methods in the average SLNs and false-negative rate were statistically significant (P<0.05), but the differences in detection rate, accuracy and sensitivity were not statistically significant (P>0.05). Conclusion ICG method for SLNB in breast cancer shows a higher success rate and lower false negative rate, indicating that its clinical efficacy is superior to that of methylene blue, therefore it may be hopeful to be used alone in SLNB for breast cancer.

Objective To investigate the curative effect of percutaneous transhepatic cholangial drainage(PTCD) on patients with non-anastomotic stricture after liver transplantation when treated with endoscopic retrograde cholangio-pancreatography(ERCP) unsuccessfully.Method The clinical data of 29 patients with non-anastomotic biliary stricture after liver transplantation were retrospectively analyzed,who failed to respond to ERCP and underwent PTCD from January 2005 to December 2007.Result All patients were performed PTCD successfully including cholangiography in 141 cases,drainage tube replacement in 115 cases,and balloon dilation of bile duct stricture in 39cases.The intubation time ranged from 2 months to 65 months.The mean levels (x ± SD) of alanine aminotransferase,aspartate aminotransferase and total bilirubin were 68.0 ± 29.1 U/L,52.6 ± 34.8 U/L,63.2 ± 33.3 μmol/L after treatment in comparison to 178.3 ± 63.3 U/L,144.0 ± 59.1 U/L,154.2 ± 92.0 μmol/L before treatment.Conclusion PTCD,which could improve the symptoms and prolong the survival time of both grafts and patients in spite of inconvenience of intubation,is suggested for patients with non-anastomotic biliary stricture if they are not suitable for liver retransplantation.

ObjectiveTo evaluate the feasibility and efficacy of ex-vivo liver resection combined liver autotransplantation for patients with massive primary liver cancer who underwent complex liver resection.Methods The clinical data of 4 patients suffering from massive primary liver cancer who were admitted to the Beijing Chaoyang Hospital from January 2008 to May 2010 were retrospectively analyzed.Regular liver resection could not be carried out because the first,second and third hepatic hilum of the 4 patients were invaded by the tumors,so ex-vivo liver resection combined liver autotransplantation were performed.ResultsThe operation was successfully carried out for the 4 patients.The operation time,the duration of anhepatic phase and the volume of operative blood loss were 690-840 minutes,250-300 minutes and 400-1400 ml,respectively.Portacaval bypass operation was not performed.After ex-vivo liver resection,the inferior vena eava or hepatic vein and portal vein of the 4patients were repaired,and the allogenous blood vessels were kept to extend the superior vena cava of the remnant liver so as to facilitate the anastomosis of blood vessels and reconstruction of the first hepatic hilum. After operation,the hepatic function of 1 patient was back to normal; 1 patient who stfffered from abdominal hemorrhage received reoperation for hemostasia; 1 patient was found with hepatic dysfunction; 1 patient died of hepatorenal dysfunction at postoperative day 5.Compensatory hypertrophy was observed in the 3 patients who survived at postoperative months 1-2.Of the 3 patients,2 were found with multiple pulmonary metastases at postoperative months 8 and 9,and they died at postoperative mouths 13 and 15.Until April 2012,1 patient survived for 37 months with no tumor recurrence or metastasis. ConclusionsEx-vivo liver resection combined liver autotransplantation provides the technical feasibility for performing complex liver resection for patients. The incomplete compensation of liver function and the short-term recurrence of tumors after operation are still the main issues which hinder the development of this technique.

Objective To probe the indication of biliary tract reconstruction without T-tube in orthotopic liver transplantation.Methods We put forward indications of biliary tract reconstruction without T-tube in orthotopic liver transplantation since January 2004 and there were 102 patients who underwent liver transplantation in our hospital without a T-tube in place after biliary tract reconstruction.The incidence of biliary tract complication was observed in these patients.Results All patients were followed up for more than 6 months.The incidence of biliary tract complication was 4.9 percent(5/102)in this group with 3 patients of intrahepatic difluse bile duct stenosis necessitating liver re-transplantation.The other 2 patients with common hepatic duct nonanastomotic stenosis were healed by ERCP plus stent placement.Conclusions Biliary tract reconstruction without T-tube placement helps to decrease the incidence of biliary tract complications resulting from the T-tube removal.

Objective To study the clinical significance of CD39 on regulatory T (Treg) cells in the peripheral blood (PB) of patients following liver transplantation and to evaluate the relationship between the levels of CD39+ Treg cells in the PB and acute rejection.Methods A prospective study was conducted to compare the CD39+ Treg cells from 76 liver transplant patients with those coming from 20 age-matched healthy individuals.The PB samples were collected within one year at different time points post-transplant.Blood samples and liver biopsies were collected at the time when acute rejection was diagnosed.The percentages of CD39 within the CD4+ CD25+ T cells were measured by using flow cytometry.The liver transplant patients were classified into two groups:the rejection group which consisted of 17 patients who an episode of acute rejection,and the non-rejection group consisted of the remaining 59 patients who had no acute rejection episodes.The percentages of CD39 within the CD4 + CD25 + T cells and the inhibition function of the CD39+ Treg cells were compared between the two liver transplant groups.Results The percentages of CD39 within the CD4+ CD25+ cells were significantly lower in the rejection group during acute rejection as compared to the non-rejection group (P ＜ 0.05).The percentages of CD39 within the CD4 + CD25 + cells were negatively correlated with the Rejection Activity Index (r =-0.86,P ＜ 0.05).The inhibition rate regarding the CD4+ CD25+ CD39+ Treg cells in patients with acute rejection was significantly lower than those without rejection (P ＜ 0.05).Conclusions The percentages of CD39 within the CD4+ CD25+ T cells were significantly lower in the rejection group during acute rejection and were negatively correlated with the RAI.The inhibition rate regarding the CD4+ CD25+ CD39+ Treg cells in patients with acute rejection was significantly lower than those without rejection.

Objective To evaluate the effect of ADV-TK gene in its inhibition of the recurrence and metastasis of hepatocellular carcinoma after curative resection in a nude mouse model. Methods In the two experimental groups, GFP-labelled ADV-TK gene transfection was determined 24 h after injection in one-each mouse. Nude mice with inplanted intrahepatic hepatocellular carcinoma underwent curative tumor resection, in the end of the operation ADV-TK gene was injected in incisional margin (11 mice) or retroperitoneally (11 mice). Ganciclovir at a dosage of 50 μg/10 g bw was given in the next day after resection. Mice in control group did not receive ADV-TK gene injection. After six weeks, mice were sacrificed. Results 1. It was showed that organs were all transfected by ADV-TK gene.2. Compared with the control group in which the recurrent tumor number of (8.7±6.5) ,tumor volume of (2933±597) mm3, and recurrence involved liver lobes of (4.3±2.2), that was (0.0±0.0), (0.0±0.0) mm3, and (0.0±0.0)(X2 = 3.05 all P<0.01) in incisional margin gene injection group, and (2.2±1.3), (265±109) mm3, and (2.1±1.3) (X2= 5.32, all P<0.01 ) respectively in intraperitoneally gene injection group.3. Compared with the control group in which the lung metastasis rate of (10/10)、number of distant organ involved by metastasis of (7.2±5.3 ), and serum AFP level of (1322±702), that was (2/10) , (3.2±1.5) and (322±102), (X2=4.33, all P<0.01) in incisional margin group, and ( 1/10)、( 1.8±1.2 ), and (268±133 ) ( X2=7.15, all P<0.01 ) in retroperitoneal group, respectively. Conclusions ADV-TK gene inhibits recurrence and metastasis of HCC after curative resection in this nude mouse model.

Objective To study the clinical effect of celecoxib combined with radiotherapy in the treatment of malignant glioma tumor of brain. Methods A total of 80 patients diagnosed as brain malignant tumor were randomly divided into control group (n=40) and observation group (n=40). The control group received three-dimensional conformal radiotherapy for 5 times a week, with dosage 4-6 Gy each time. Base on control group, the observation group received celecoxib 0.2 g/time twice a day during treatment.After 6 weeks,the clinical efficacy,immune function,quality of life and the serum levels of metalloprotease-9 (MMP-9), transforming growth factor-β (TGF-β) and vascular endothelial growth factor (VEGF) were compared between two groups of patients. Results After 6 weeks of the current therapy, the total effective rate was better in observation group than that of control group(P<0.05).After treatment,the levels of CD3+,CD4+and CD4+/CD8+increased in the both groups.The level of CD8+decreased,and the changes of CD3+,CD4+and CD4+/CD8+were significantly higher after treatment in the observation group than those of control group, but CD8+was lower in the observation group than that of control group (P < 0.05). Meanwhile, the levels of MMP-9, TGF-β and VEGF were significantly decreased after treatment in both two groups.The levels of MMP-9,TGF-β and VEGF were significantly lower after treatment in the observation group(P<0.05).The life quality was significantly better and the overall efficiency of the improvement of the disease was higher in observation group than those of control group(P<0.05).Conclusion Celecoxib can enhance the radiosensitivity of glioma patients.The combined treatment can improve the clinical efficacy and quality of life of patients.Moreover,it improves patients'immune function and reduces the levels of VEGF,TGF-β and MMP-9.

This paper discusses variations of laparoscopic transgastric cystogastrostomy in management of retrogastric pancreatic pseudocysts for 8 patients with symptom or pseudocysts (larger than 6 cm) companied with clinical manifestations.Using a Harmonic scalpel,two 3-5-cm incisions were made in the anterior and posterior gastric wall respectively.In the last step,the anterior gastrotomy was closed with an Endo-GIA stapler.All cases were successfully treated without large blood loss and without conversion to open surgery.The mean operative time was 114.29±19.24 min,blood loss was 157.14±78.70 mL,and mean hospital stay was 8.29±2.98 days,Gastric fistula occurred in one case on the postoperative day 7,and closed 1 month later.No bleeding was seen in all patients during the perioperative follow-up period.CT scans,given one month after the surgeries,displayed that the pancreatic pseudocysts disappeared or decreased in size,and ultrasounds showed no fluid or food residue in stomas at the third and fifth month following surgery.No patient experienced a recurrence during the follow-up period.Transgastric laparoscopic cystogastrostomy is a minimally invasive surgical procedure with a high rate of success and a low rate of recurrence,accompanied by rapid recovery.It is easy to master,safe to perform and may be the preferred option to treat retrogastric pancreatic pseudocysts.