Objective To study the expression of VEGF and microvascular density (MVD) in pancreatic carcinoma and their prognostic value. Methods The protein expression of VEGF and MVD were determined with immunohistochemistry in 48 cases of pancreatic ductal carcinomas, which were surgically resected and pathologically confirmed. Results In 64.6% of pancreatic carcinomas the expression of VEGF was positive, and it was significantly higher than that of normal pancreatic tissues (P

Objective To evaluate the rate of residual tumor after local resection of thyroid carcinoma,and provide theoretical basis to determine the indications for re-operation.Methods The clinical data of 56 patients,who had re-operation in our hospital after local resection of thyroid carcinoma,were summarized.Results As confirmed by pathology,the rate of residual tumor of patients was 42.8% at re-operation.When the tumor was larger than 4 cm,or smaller than 2 cm before the first operation,the residual tumor rate was 80% and 11.1% respectively.The residual tumor rate was 86.3% in patients with tumor invading thyroid capsule,14.7% in patients without capsule invasion,47.6% in patients who had only nodule resection,50% after ipsi-lateral partial lobectomy,and 12.5% after subtotal thyroidectomy.The sensitivity of finding residual tumor by CT and doppler ultrasound examiination before re-operation was 64.0% and 60.0% respectively,and the positive predictive value was 80.0% and 30.0% respectively.Conclusions The rate of residual tumor is high in patients with thyroid cancer operated by local resection.And it′s necessary to re-operation.The condition of tumor before the first operation and CT examination are significant for selection of patients to have re-operation.

Objective To evaluate the surgical technique and outcome of the extended radical resections for hilar cholangiocarcinoma.Methods A patient with Bismuth-Corlette type Ⅳ Klatskin's tumor, which invaded the secondary intrahepatic bile duct and the pancreatic portion along the common bile duct, underwent the HPLT_ X . And then, the digest cannel was reconstructed according to the Child's methods. By using immunohistochemistry, the expression of cytokeratin9, 17, CEA and hepatocyte protein was detected. After operation, the immunosuppressive agents consisting of Tacrolimus and steroids were given; lamivudine and HBIg were used to prevent HBV from recurrence.Results Pathologic examination revealed low differentiated adenocarcinoma and immunohistochemistry stains confirmed the positive expression of cytokeratin9 and 17, carcinoembryonic antigen, and the negative expression of hepatocyte protein. Neither the margins of resection nor periductal lymph nodes were pathologically involved. She was currently alive for 17 months after the operation, the liver graft function was within normal range, and the patient was back to the previous work without any evidence of recurrent cancer. The tumor marker in plasma was decreased to the controllable level.Conclusion The HPLT_ X may be the treatment choice for unresectable Klatskin's tumor and provide the higher rate of radical resection and better prognosis.

Objective To evaluate the safety and feasibility of totally thoracoscopic anatomic pulmonary segmentectomy (TTAS) for the treatment of the peripheral stage ⅠA non small cell lung cancer(NSCLC).Methods The study involved 50 consecutive patients undergoing totally thoracoscopic anatomic segmentectomy (TTAS) from September 2010 to November 2012 in the First People's Hospital affiliatied to Nanjing Medical University.The diameter of the tumors were less than 2 cm [(mean diameter(1.35 ±0.48) cm].All lymph node sampling of N1 and N2 were neglive,All patients received symtematic lymph node dissection.The pulmonary vessels were individually ligated,and the bronchi were closed using an endoscopic stapler.The intersegmental plane was identified using the demarcation between the resected(inflated) and preserved(collapsed) lungs.Staplers were used for intersegmental dissection.Results The mean operative time and intraoperative bleeding were (191.5 ± 50.4) min and (49.2 ± 54.6) ml respectively.The chest tube drainage duration was (3 ± 1) days.The number of stapler cartridges used for intersegmental division was 3.9 ±0.8.The mean number of lymph nodes and nodal stations dissected were 12.6 ± 2.8 and 6.0 ± 1.5 respectively.No mortality and complications were observed 30 days after the surgery.Further,no local recurrence or metastases were observed during follow-up.Conclusion Totally thoracoscopic anatomic segmentectomy(TTAS) is a feasible and safe technique.With systematic lymph node dissection,TTAS can be a reasonable therapeutic option for stage ⅠA NSCLC.

BACKGROUND:Screw loosening and shedding may occur after osteoporosis associated with lumbar degenerative disease treated with pedicle screw fixation. Application of pedicle screw enhanced with cured materials can improve the therapeutic effect.
OBJECTIVE:To compare the clinical effect of pedicle screws enhanced with poly(methyl methacrylate) and injectable calcium sulfate cement in the lumbar internal fixation of osteoporosis.
METHODS:Sixty-one patients diagnosed with osteoporosis combined with lumbar spondylolisthesis, lumbar spinal instability, and severe lumbar spinal stenosis were col ected. Al patients were divided into two groups according to the treatment method:poly(methyl methacrylate) bone cement enhanced pedicle screw group and calcium sulfate bone cement enhanced pedicle screw group.
RESULTS AND CONCLUSION:There were no significant differences in the operation time, blood loss, preoperative and postoperative visual analog scale score, Japanese Orthopedic Association scores and the Japanese Orthopedic Association score improvement rate between two groups (P>0.05). The results showed that two patients had bone cement leakage in poly(methyl methacrylate) group which had no neurological symptoms caused by new symptoms during fol ow-up period. The bone mineral density was not improved gradual y in poly(methyl methacrylate) group with fol ow-up time prolonging;however, in calcium sulfate group, the bone mineral density was increased significantly after treatment, and the change of bone mineral density was linearly related with Japanese Orthopaedic Association score improvement rate in calcium sulfate group. No screw loosening, pul ing out or neurological dysfunction occurred in both groups. The results indicate that like poly(methyl methacrylate), balcium sulfate bone cement can increase the stability of pedicle screws.

Objective To study the clinical effects of the clavicular hook plate in treatment of acromioclavicular joint dislocation. Methods 37 cases with the acromioclavicular joint dislocation surgery were carried out.Results After internal fixation for 6 to 12 months, remove the plate, and then follow up for 3 to 18 months. According to the grading standards in shoulder joint function by Karlsson ,31 cases of A grade,4 cases of B grade,and 2 cases of C grade,the excellent rate is 94.6%. Conclusions Internal fixation with clavicular hook plate is a good method in the treatment of acromioclavicular joint dislocation.

Humans ; Lung Neoplasms ; classification ; Neoplasm Staging

Objective The aim of this study was designed to investigate the changes of macrophages and activated microglias in white matter damage (WMD) in premature infants and effects of allopurinol. Methods An animal model for WMD was established by bilateral carotid artery occulation (BCAO). Forty-two newborn SD rats (1 day old) were divided randomly into 3 groups: sham surgery group (Sham), BCAO group (BCAO) and allopurinol treated group (ALLO). Pathological changes were studied 7 days and 14 days after BCAO, respectively. Macrophages and activated microglias were detected by immunohistochemistry 7 days and 14 days after BCAO, respectively. Results In BCAO group, Ten cases had mild or severe rarefaction in the corpus callosum area, especially at the cingulum. Pathological changes of white matter were found in 4 cases in internal capsule. Eight cases had subcortex white matter rarefaction. The extent of white matter rarefaction in ALLO group was reduced significantly. Enlargement of bilateral ventricles was found in 6 of 8 cases in BCAO group. Compared to BCAD group [(3.27±0.73)%] the average ventricle size was reduced significantly in ALLO group [(2.44±0.71)%] (P<0.05). ED1 positive cells were found in corpus callosum,hippocampus, and internal capsule in all groups. BCAO group had more ED1 positive cells than the other two groups, and the staining extent in BCAO group was stronger than that in the other two groups. Conclusions BCAO could be used in newborn rats (1 day old) to establish a premature WMD animal model. Macrophages and microglias may play an important role in premature WMD. ALLO may have a potential protective effect on premature SD rat with ischemic WMD.

Objective To investigate the effects of vitamin E (VE) on renal ischemia/reperfusion (I/R) injury of rats.Methods A total of 18 male Wistar rats were randomly divided into sham-operated group,I/R group,VE + I/R group,and each group of 6 rats.All the animals were killed at the end of 24 h of reperfusion.Nephridial tissue were examined by light microscopy,and the level of blood urea nitrogen(BUN) and serum creatinine (SCr) were measured.The protein expressions of tumor necrosis factor α (TNF-α) were detected by Western blotting.Results Compared with sham-operated group,tubulointerstitial pathological injury in I/R group was significantly aggravated,which was shown by HE and PAS stain.Compared with I/R group,the degree of morphological changes as well as renal dysfunction in VE + I/R group were obviously lessened.Meanwhile,the levels of BUN,SCr in I/R group,VE + I/R group were (10.13 ± 2.14) mmol/L and (7.67 ± 1.63) mmol/L,(80.33 ±7.15) μmol/L and (63.67 ±5.40) μ mol/L,significantly higher than those in shamed-operated group ((3.85 ± 0.21) mmol/L,(48.67 ± 3.61) μmol/L;P ＜ 0.05).And the level of BUN and SCr in VE + I/R group were significant lower than those in I/R group(P ＜0.05).Western Blotting showed that the protein expressions of TNF-α in VE + I/R group were obviously lower compared with those in group of I/R without VE treatment (P ＜ 0.05).Conclusion Vitamin E can attenuate over-expressions of TNF-α in kidney following I/R,thus protect against structural damages and renal dysfunction in I/R rat models.

AIM:To investigate the role of damaged mitochondria in dendritic cell ( DC) apoptosis induced by Vibrio vulnificus (Vv) and its possible mechanism.METHODS: DC2.4 cells were co-cultured with Vv 1.1758 strain. Fluorescent probes DCFH-DA and Fluo-8-AM were used to detect reactive oxygen species ( ROS) and intracellular Ca 2+concentration in the invaded cells , respectively .The cellular apoptotic rates and mitochondrial membrane potential (Δψm ) were measured by flow cytometry.The expression of nuclear factor-kappa B p65 (NF-κB p65) and tumor necrosis factor-al-pha (TNF-α) was detected by Western blotting.RESULTS:Vv 1.1758 induced DC2.4 cell apoptosis.Vv 1.1758 bacte-ria invaded into the DC2.4 cells by binding with cellular membrane though the end of the body .In the invaded DC2.4 cells, the visible mitochondrial damage, elevated ROS and intracellular Ca2+levels, and declinedΔψm were presented.Af-ter 1 h of co-culture, NF-κB p65 began to rise and reached the peak at 5 h, and then slightly decreased at 6 h.The TNF-αlevel increased after 2 h of co-culture and reached the peak at 6 h.CONCLUSION:The damaged mitochondria play an important role in DC apoptosis induced by Vv , and its possible mechanism may associate with the elevation of ROS and in-tracellular Ca2+level, and the declined Δψm.Meanwhile, NF-κB p65 and TNF-αare potential critical signaling molecules in the process of apoptosis .