Objective To study the correlation between clinicopathological characteristics and lymph node metastasis and prognosis of rectal neuroendocrine tumors (NET),and try to explore the choice of surgical approach.Methods The clinicopathological data of 48 postoperative rectal NET patients were collected.The univariate and multivariate analysis of the correlation between clinicopathologic characteristics and lymph node metastasis were performed by chi-square test and Logistic regression.The prognosis single factor survival analysis was analyzed by Kaplan-Meier method.The survival rates were compared by Log-rank test.The prognosis multivariate survival analysis was performed by the use of Cox model.Results The results of univariate analysis indicated that clinicopathological characteristics related with lymph node metastasis were tumor distance from anal verge less than six cm,tumor diameter over two cm,muscularis invasion,distant metastasis and histological grade 3.The results of multivariate analysis showed that histological grade 3 was an independent risk factor of lymph node metastasis (OR=9.333,95 ％CI:1.054 to 82.635,P=0.045).The results of univariate survival analysis suggested that factors correlated with poor prognosis were tumor distance from anal verge less than six cm,tumor diameter over two cm,muscularis invasion,lymph node metastasis,distant metastasis and histological grade 3.The results of multivariate survival analysis indicated that tumor distance from anal verge less than six cm (HR=0.215,95 ％CI:0.047 to 0.980,P=0.047),distant metastasis (HR=8.788,95％CI:2.612 to 29.571,P＜0.01) and histological grade3 (HR=5.510,95％CI:1.692-17.944,P=0.005) were independent factors associated with poor prognosis.Conclusions For histological grade 1 and 2 rectal NET patients without distant metastasis,radical surgery is recommended when tumor diameter over two cm or muscularis invasion exists.For histological grade 3 rectal NET patients without distant metastasis,radical surgery is recommended.

Objective To screen the plasma differential expressed proteins in patients with Crohn's disease(CD)and ulcerative colitis(UC)using surface-enhanced laser desorption ionizationtime of flight mass spectrometry,and to establish decision trees algorithms.Methods The plasma samples from 24 UC patients,25 CD patients and 25 healthy controls were analyzed with CM10 protein chip.The proteomic spectra of CD,UC and inflammatory bowel disease(IBD)were compared with controls respectively.The differential proteins that significantly altered expression levels were selected to establish decision trees algorithms of CD.UC and IBD and then blind validations were tested.Results In the range of m/z 2000-30 000,differential expressed proteins that changed at least 2-fold between CD and controls were 9.between UC and controls were 5,and between IBD and controls were 11(P＜0.05).The software automatically picked up the m/z 8208 and 8837 as decision trees algorithms for differentiating CD from controls and m/z 6985 for differentiating UC from controls as well as m/z 8208,1752,28840 and 1702 for differentiating IBD from controls.The sensitivities of decision trees algorithms for CD,UC and IBD were 96%,82%and 91%respectively,and the specificities were 100%,85%and 100%respectively.Conclusions The protein of m/z 8208 which has high sensitivity in differentiating CD from controls is worthy of further study.

Purpose:To evaluate the role of COX 2 in the carcinogenesis and progression of human colorectal neoplasms. Methods:The expression level of COX 2 in 122 colorectal neoplasm tissues(including 35 colorectal adenomas, 67 colorectal carcinoma and 23 colorectal cancer with synchoronous hepatic metastasis) was assayed by immunohistochemical methods. All specimens was analyzed by Conformation quantitative assay system, their stain strength was calculated.Results:Conformation quantitative assay showed the mean stain strength is 704.5 131.8 in colorectal adenoma, 1197.2 204.3 in colorectal cancer without hepatic metastasis and 1901.2 324.8 in colorectal cancer with synchoronous hepatic metastasis, there are significant differences among them statistically. According to the Dukes stages, mean stain strength is 1145.3 187.0 in B stage,1237.0?298.7 in C stage,1901.2 in D stage. There is statistic difference between Dukes stage D and B, C. Also our study indicated there was no relationship between age, sex, tumor location, tumor differentiation or tumor size with the level of COX 2 protein expression.Conclusions:In our test,higher COX 2 expression is seen in colorectal cancer than colorectal adenomas, colorectal cancer with synchoronous hepatic metastasis than colorectal cancer without hepatic metastasis,and Dukes D stage than the B?C. Thus COX 2 responses is important in the carcinogenesis and progression of colorectal cancer. NSAIDs or the others may play a role in the chemoprevention strategies of colorectal neoplasm as the COX 2 inhibitor.

Objective To study the effects of formaldehyde on the level of microelements in mouse liver and blood and explore the microelements as biomarker in injury induced by formaldehyde.Methods The mice were randomly divided into control,low(1/40LD50),moderate(1/20LD50) and high(1/10LD50) dose groups exposed to formaldehyde by inhalation(n=20),two hours per day for three and six weeks,and than the contents of Cu,Fe,Zn and Mn in mouse liver and blood were measured.Results The contents of Fe,Zn and Mn in liver in high dose group three weeks after exposure and the contents of Fe and Zn in liver in high dose group six weeks after exposure were significantly lower than those in control group(P

Background and purpose: Currently endoscopic ultrasonography is clinically accepted for preoperative staging of gastric cancers. Endoscopic raucosai resection (EMR) and endoscopic subraucosal dissection (ESD) have been widely applied in the treatment of early gastric cancer. We need to improve the accuracy of pre-operative staging of gastric cancers, especially of early gastric cancers. This paper was to investigate the clinical significance of high frequency endoscopic ultrasound mini probe (UMP) in the preoperative T-staging of gastric cancer. Methods: Both UMP and MSCT were performed in 63 patients with pathologically proven gastric cancer frora Oct. 2008 to Apr.2009, and the results of UMP and MSCT were compared with surgical pathologic findings. Results: The accuracy of UMP and MSCT in T staging was 82.26% (51/62) and 88.71% (55/62) respectively, and there was no statistical difference (P>0.05). The accuracy of UMP and MSCT for early gastric cancer was 100.00% and 88.89% respectively.The accuracy of UMP and MSCT for advanced gastric cancer was 79.25% and 88.68% respectively. Conclusion: UMP appears to have a substantial diagnostic value for early stage gastric cancer. It is the approach of choice for superficial lesions.

Objective To investigate the clinical features,therapeutic approach and prognosis of focal nodular hyperplasia (FNH) of the liver. Methods Clinical data of 34 FNH patients confirmed by operation were analyzed retrospectively. Results Focal nodular hyperplasia of the liver was found mainly in males (67. 6% ) , Mean nodular size was significantly smaller in men than women. Most of the patients (64.7%) had no significant clinical symptoms. Tumor markers including CA19-9 and A-fetoprotein were within normal range. MRI is helpful to achieve a more accurate diagnosis of the disease, correct preoperative diagnosis rate was 54. 5%. All patients underwent liver resection with no recurrence within 17 - 134 months of follow up. Conclusions FHN of the liver is benign in entity. If a definite diagnosis can be obtained preoperatively, observation follow-up are recommended. Hepatectomy is indicated when there is a suspicion of malignancy.

Objective To investigate the differentiation of neuroendocrine component (NEC) in colorectal adenocarcinoma in relation to its significance by comparing the outcome between patients with or without NEC.Methods The paraffin sections from patients with pathologically confirmed colorectal adenocarcinoma were retrospectively collected and screened for those with NEC by morphological examination and immunohistochemistry with neuroendocrine markers.Control patients (n=54) without NEC were selected from colorectal cancer database and 2: 1 matched on the basis of clinical features with NEC positive patients (n=27).Relative analysis was performed between two groups.Results With a median follow-up of 72 months,the 5-year disease free survival was 58.0% (16/27) in NEC positive group and 79.1% (43/54) in control group (P=0.036).Similarly,the 5-year cancer-specific overall survival was significantly lower in NEC positive group than in control group (58.3% versus 81.1%,P=0.037).Cox regression showed that the 5-year cumulative risks of disease recurrence and cancer-caused death in NEC positive patients were 2.38 and 2.41 times higher than those in control patients,respectively.Conclusions NEC appears to bear a poor prognosis in patients with colorectal adenocarcinoma.

Objective To investigate the clinical features,imaging and pathologic findings of fibrolamellar hepatocellular carcinoma (FL-HCC).Methods Clinical data from 2 patients with FL-HCC confirmed by operation were analyzed retrospectively.Results There were 1 man and 1 woman,both of them were younger than 40 years.The man had hepatitis B,the woman did not have underlying hepatitis.The 2 patients had a normal hepatic function and α-fetoprotein level.Under dynamic contrast material-enhanced computed tomography,hepatic arterial phase CT images demonstrated heterogeneous enhancement of the tumor.Calcification was depicted in the CT images of 1 patients.Both of them underwent a successful operation.After 8 months of follow-up,1 patient had recurrence.And the other patient had no evidence of recurrence during 16 months follow-up time.Conclusion FL-HCC is a rare liver tumor that has distinct clinicopathologic features comparing with hepatocellular carcinoma.Most of FL-HCC occurs in young patients with normal level of α-fetoprotein and no history of hepatitis.Tumors may have calcification and become predominantly on hepatic arterial phase CT images.The most effective treatment for FL-HCC is surgical resection and prognosis is good.

Objective To review the clinical features,therapeutic approach and prognosis of hepatocellular adenoma(HCA)and liver adenomatosis(LA).Methods The clinical data from patients with histopathological diagnosis confirmed on operative specimens were analyzed retrospectively.Results There were 10 patients with HCA and 1 with LA.The disease was found mainly in females (n=7,63.6％),and only one female patient with LA had a history of use of oral contraceptive.The median age at presentation was 33 years(range,25-70 years).Most patients(n=8,72.7％)had no significant symptom.Tumor markers including CA19-9 and alpha fetoprotein(AFP)were normal.On dynamic ultrasonography,CT and MRI,most lesions showed contrast enhancement in the arterial phase and washout in the portal venous phase and delayed phase.For the 10 patients with HCA,the lesion was solitary.On histopathology,atypia and dysplasia were present in 1 patient,dysplasia in 1 patient,and active tumor cell growth in 1 patient.The patients with liver adenomatosis had multiple lesions and atypia.All patients underwent liver resection.There was no recurrence on follow-up which ranged from 21 to 125 months.Conclusions Most patients had no clinical symptoms.Hepatic steato sis may be a potential cause for HCA and LA.Oral contraceptive plays an important role in the patho genesis of LA.Dynamic imaging examinations were helpful for diagnosis.In view of the associated risks of hemorrhage and malignant transformation,surgical resection is the optimal treatment.The prognosis is good.

Objective To investigate the clinical characteristics and analyze prognostic risk factors of combined hepatocellular-cholangiocarcinoma. Methods The clinical data of 19 cases of combined hepatocellular-cholangiocarcinoma admitted in our hospital from January 1999 to December 2009 were analyzed retrospectively. The survival function was analyzed by Kaplan-Meier. The possible prognostic risk factors were tested by χ2-test. Results Hepatocellular-cholangiocarcinoma was diagnosed by pathology in the 19 patients, among which hepatic tunic was infiltrated in 13 cases, peritoneum involved in 1 case, intravascular cancer embolus in 1 case. At that time lymphocyte nodes metastasis in 2 cases were found by regional lymphadenectomy in 7cases. The 1-year and 3-year survival rates were 61% and 42%,respectively. Prognosis of patients with tumor size ＞ 5 cm ( χ2 = 4. 392, P = 0. 036 ), history of heavy drinking ( χ2 = 11.010, P = 0.001 ) or intraoperative blood transfusion ( χ2 = 4. 645,P = 0. 031 ) were worse than others. Conclusion It was difficult to get correct preoperative diagnosis of combined hepatocellularcholangiocarcinoma. Tumor size, history of heavy drinking and blood transfusion were all prognostic related risk factors.