Objective: To investigate the expression of Bcl-2, the apoptosis inhibitor, and Bax, the apoptosis promoter in hepatocellular carcinomas (HCCs). Methods: 35 formalin-fixed and paraffin-embedded samples of histologically confirmed HCC, were examined using immunohis to chemical staining for Bcl-2 and Bax protein. Results : 7 of 35 HCCs were positive for Bcl-2 protein and 13 of 35 positive for Bax protein. Immunoreactivity for Bcl-2 protein was present in 24 of 35 HCC cases and Bax protein in 25 of 35 cases. Furthermore, all positive cells were cytoplasmic stained. 6 of 7 Bcl-2 protein positive HCCs were (histological grade Ⅱ ), Bax protein expression had little association with histological grading. Co-expression of Bcl-2 and Bax protein was only present in 4 cases. At any rate, a significant high Bcl-2 and Bax protein expression was detected in small HCCs. Also, Bcl-2 protein expression tended to decrease with clinical stage. Conclusion: Bcl-2 and Bax immunohistochemical expression in HCCs seems to be associated with histological grading. Also, Bcl-2 protein seems to be relative to tumors with good prognosis. It supports the hypothesis that Bcl-2 expression has prognostic value.

Objective To determine the effect of laparoscopic abdominal wall components separation procedure on a porcine model of intra-abdominal hypertension (IAH). Methods IAH to 25 nun Hg was created by insufllating carbon dioxide into abdominal cavity of eight anesthetized pigs. Bilateral subcutaneous tunnels above the plane of the abdominal musculature were developed. Dissection of the external oblique insertion and development of the plane between external and internal oblique muscles was performed using ultrasonic scalpel monitored by laparoscopy. Changes in intra-abdominal pressure (IAP), waistline (WL), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP) were recorded. Results Following intra-abdominal hypertension, WL, MAP, HR and CVP changed significantly. After laparoscopic abdominal wall components separation, there was a significant decrease in IAP from 25 mm Hg to ( 16. 0 ± 1.5 ) mm Hg ( P < 0. 01 ). Also, this procedure increased WL by (5.6 ± 2. 0) cm [ from (65.3 ± 2. 5 ) cm to (88 ± 14) cm; P < 0. 01 ]. Due to abdominal depression, the MAP was significantly increased from to (88 ± 14) mm Hg to ( 100 ± 12) mm Hg ( P <0. 01 ). Moreover, there were significant improvements in circulation status including HR from (115 ± 9) beat per minute (bpm) to (97 ± 7) bpm (P<0.01), CVP from (10.8±2.2) cm H2O to (7.3 ± 1.8) cm H2O (P<0.01), etc. Conclusions IAH results in changes of hemedynnmies. Laparoscopic abdominal wall components separation significantly decreases IAH improving porcine hemodynamics.

Objective To investigate the incidence of metabolic syndrome (MS) in patients with gastric cancer, and to explore the relationship between MS and the tumor site and the influence of MS on surgical procedure and short-term outcomes of patients with gastric cancer. Methods The clinical data of 639 patients with gastric cancer who were admitted to the Affiliated Hospital of Qingdao University from January 2006 to June 2008 were retrospectively analyzed. Patients with MS were in the MS group ( n= 64) and those without MS were in the control group ( n = 575 ). The surgical and postoperative complications were reviewed and the tumor site, intraoperative conditions and short-term outcomes between the two groups were analyzed. All data were analyzed using the chi-square test or t test. Results The incidence of MS in patients with gastric cancer was 10.0% (64/639).The incidence of MS in female patients was 14.4% (27/188), which was significantly higher than 8.2% (37/451)of male patients ( χ2= 6.265, P < 0.05). The operation time of the MS group was ( 185 ± 133 ) minutes, which was significantly longer than ( 168 ± 50) minutes of the control group ( t = 2. 126, P < 0. 05 ). The number of lymph nodes dissected in the MS group was 18 ± 11, which was significantly lower than 21 ± 11 of the control group ( t = 2. 125, P < 0.05 ). The postoperative period of fever of the MS group was (3.0 ± 1.4) days, which was significantly longer than (2.5 ± 1.4) days of the control group (t = 2. 433, P < 0.05 ). The incidence of postoperative complications of the MS group was 31.3% (20/64), which was significantly higher than 14.3% (82/575) of the control group ( χ2 = 12.291, P < 0.05 ). The length of hospital stay of the MS group was ( 19 ± 11 ) days,which was significantly longer than ( 16±11 ) days of the control group ( t = 2. 141, P< 0.05 ). The mortalities of MS group and control group were 0 and 0. 5% (3/575), respectively, with no significant difference ( χ2 = 0.000,P >0.05). Condusions A low prevalence of MS is found in patients with gastric cancer. However, patients with gastric cancer complicated with MS may present with prolonged surgical procedure, reduced amount of lymph nodes dissected and increased incidence of postoperative complications, hospital stay and costs. Perioperative management of patients with gastric cancer complicated with MS should be paid more attention.

ObjectivesTo evaluate the therapeutic result of various management for severe radiation injury of the bowels.MethodsThe clinical presentation, diagnostic approach, managements and therapeutic effects were analysed retrospectively in 28 severe radiation therapy caused enteric injury patients. In all intestinal stricture cases, partial ileal resection was performed in 14 patients, right hemicolectomy in 1 patient, rectosigmoid resection in 3 patients. Instestinal fistulae was treated by diseased segment resection and reanastomosis in 7 patients, sigmoidostomy was undertaken in 2 patients.ResultsThere was no inhospital mortality. One case suffered from low colonic fistula,4 died of recurrence of the primary tumor.Postoperative bowel function and nutrition status significantly improved in all patients.ConclusionSurgical management combined with nutrition support is safe and effective for the treatment of severe radiation caused enteric injury.

ition research with higher quality should be advocated.

Objective To study lymph node metastasis in early gastric carcinoma. Methods From July 2001 to July 2007, 177 patients with early gastric carcinoma underwent radical gastrectomy and the clinicopathologic data were analyzed by binary logistic regression. Results The overall rate of lymph node metastasis in early gastric carcinoma was 13%, involving 13% and 3% in level I (NI) and level Ⅱlymph nodes (N2), respectively. The rate of lymph node metastasis was 22%(20/89) in cases of submucosal lesion (SM), which was significantly higher than 3%(3/88) in cases of mucosal lesion (M) (X2=14. 222, P<0.01). The rate of lymph node metastasis was 3%(4/117) when the primary tumor was ≤2cmin diameter compared with 32%(19/60) when the tumor was >2cm (X2=27.992, P<0.01). The lymph node metastasis rate was 4%(3/81) and 21%(20/96) in differentiated and undifferentiated lesion (X2=11.402, P=0.001), and it was 33%(2/6)、8%(7/99) and 19% (14/92) in macroscopic type I, Ⅱ and Ⅲ (X2=8.172, P=0.014). Binarylogistic analysis found that the tumour diameter greater than 2.0cm (OR=8.408, P<0.01), infiltration of the submucosal layer (OR=5.926, P=0.009) and undifferentiated lesion (OR=4.880, P=0.020) were the independent risk factors. Conclusion Lymph node metastasis in early gastric carcinoma is significantly cantingent on the depth of infiltration, tumor size and histological type.

The body fat measurements in old persons were carried out using two indirect methods; hydrostatic weighing and skinfold measurement.In comparison it was discovered that the skinfold measurement was significantly different from hydrostatic weighing method. Based on data of the circumference measurements which included forearm circumference (xl), arm circumference (x2), leg circumference(x3) thigh circumference(x4), abdomen circumference (x5) and buttock circumference(x6), two regression equations for the percentage of the body fat measurements were established as follows: male: F(%)=- 15.88 + 1.37BMI + 0.0102Y, female. F(%)= -34.9684 + 0.51BMI + 0.1469Y. Where Y = x1 + x2 + x3 + x4 + x5 + x6; BM1 (Body mass index) = weight(kg)/height(m)2Because the systematic error of skinfold measurements was bigger than those of circumference measurements, it was suggested that the above regression models could be used to estimate body fat in a simpler and easier way. At the same time the method of using percentage of body fat to classify obesity was compared with other two methods, excess body weight and BMI. The results showed that the rate of obesity based on BMI method was higher, and that based on excess body weight was lower than that of percentage of body fat measured by the water displacement method.

Objective To evaluate the status of lymph node micrometastases in "non-metastatic" No11P lymph nodes as judged by conventional pathology in the lower third of gastric cancer. Methods In this study 43 No11P lymph nodes harvested from 43 patients which was histologically free of metastasis were examined by consecutive sections and TRAP( telomeric repeat amplification protocol)-ELISA (enzyme linked immunosorbent assay). The data were statistically analyzed according to the clinicopathological features of the patients. Results Micrometastasis was discovered in 4 lymph nodes from 4 patients by consecutive sections. The micrometastatic rate of the conventional pathologic non-metastatic No11P lymph nodes was 9%. The micrometastatic rate of the conventional pathologic non-metastasis No11P lymph nodes detected by TRAP-ELISA was 44%, including 4 lymph nodes observed by consecutive sections It revealed that lymph nodes micrometastases were correlated with the size of the tumor( x2 = 8. 488, P < 0. 05 )、and tumor stage (x2 = 12. 022,P < 0. 05 ). It also showed that the micrometastatic rate increased proportionally to tumor infiltration depth(x2 =6. 473, P <0. 05), not correlated with patients' demographic features, general type and histological differentiation of the tumor. Conclusions There was a high rate of micrometastasis in No11P lymph nodes. This lymph nodes micrometastasis was correlated with the size of the tumor, invasion depth of primary tumor and patients' clinical stage.

Objective To review the experience on the surgical management for advanced gastric carcinoma with portal hypertension. Methods In this study, 14 advanced gastric carcinoma with portal hypertension patients were analyzed retrospectively, liver cirrhosis was found in 13 cases. In 10 esophageal variceal patients, 5 had upper gastrointestinal bleeding history. All of those cases were associated with different degree of hypersplenism. The tumours situated at the upper third of the stomach in 2 patients, middle and upper third in 2 and lower third in 10. Five patients underwent curative distal subtotal gastrectomy and splenectomy, 2 cases did radical distal subtotal gatrectomy and pericardial devascularizaion, 2 curative distal subtotal gastrectomy combined with splenic artery ligation,2 did total gastrectomy and pericardial devascularizaion,2 cases did radical proximal gastrectomy and pericardial devascularization and 1 patient did distal subtotal gastrectomy only. Results Three died from extensive wound bleeding, jejunal fistula and liver failure respectively. 3 patients were complicated by left subdiaphragmatic abscess, hepatic dysfunction and massive ascites individually. The morbidity and mortality rate were 42.86% and 21.43% respectively. Conclusion The surgical procedures for patients of advanced gastric carcinoma with portal hypertension caused a considerably high postoperative mortality and morbidity rate.

Objective To assess the clinical diagnosis and treatment of 21-hydroxylase deficiency nonclassic congenital adrenal hyperplasia (NCCAH) complicated by testicular adrenal rest tumors (TART),thus to improve the recognition of the disease.Methods The clinical data of one patient of NCCAH with TART from our department in 2016 were retrospectively studied,and were analyzed combined with related literature,and the diagnosis was established for treatment.Results The patient was a 17 years old boy.At the age of seven began to appear the pubic hair,voice and other secondary sexual performance.More than their big penis development was significantly higher than their peers.At the age of 12 found bilateral testicular gradually enlarged and attendance.Physical examination:bilateral testicular swelling and a sense of nodules,hard texture,epididymis,normal bilateral varicocele.Laboratory exam indications showed increased levels of progesterone(P),adrenocorticotropic hormone(ACTH),17 hydroxyprogesterone(17α-OHP),aaldosterone(ALD),17-hydroxyl corticosteroids(17-OHCS),17-ketone corticosteroids(17-KS).By the ACTH stimulating test,17α-OHP was increased.Bilateral testes MRI:irregular bilateral testes,signal,see in space.Enhanced scan lesions uniform reinforcement,germ cell tumors to row.Adrenal CT:bilateral adrenal hyperplasia.Testicular biopsy:testicular adrenal genital syndrome tumor.Genetic testing:CYP21A2 heterozygous mutations.The above test results were diagnosed of NCCAH 21-OHD with TART.The patient was orally given 10mg/d prednisone 2 time.3 months after treatment,the 17α-OHP,CO and sex hormones returned to normal.Review the adrenal CT showed significant bilateral adrenal shrink,Pa/testis tubercle was narrow,but not obvious.Semen routine still suggested no sperm,considering the TART medical treatment effect was poor.Hence,further line tumor removed,followed up for 3 months without tumor recurrence at present.Conclusion NCCAH complex and varied clinical manifestations and hidden.Not easy to be noticed by patients and clinicians.For the early childhood in pubic hair growth accelerated leading to premature epiphyseal fusion and make the adult height is short stature consideration should be given to the disease.Further lines of sex hormones,adrenal related endocrine examination,genetic testing and ACTH stimulating test,etc.If concurrent bilateral testicular nodules,should consider to merge TART may.Testicular biopsy can be clear.Treatment can choose according to TART classification of glucocorticoid (a hormone steroid) or surgical treatment,concrete scheme should be individualized.