Objective　To study the diagnosis and treatment of perforated congenital choledochal cyst(PTCC). Methods　The clinical data of 10 children with PTCC were retrospectively analysed.Results　6 males, 4 females, average age 4.5 years old. The cyst perforted time within 12 hours was in 4 cases, 12～72 hours in 3, and more than 72 hours in 3. Of these cases, 2 had infection and the others had no obvious discomfort before perforation. Of 7 cases undergoing cyst excision and biliary reconstruction, 5 cases were recovered without complications; 2 occurred anastomostic leakaged(1 case had infection before perforation and the other with perforcted time more than 72 hours). 3 cases subjected to external drainage at first, and cyst excision and biliary reconstruction were performed on three months later. Conclusions　If PTCC is treated earlier, cyst excision and biliary reconstruction can be performed as a primary operation.

To identify the stem cell islands in regenerated epidermis, the same biopsies used in our previous experiments were used in this study. CD87 immunohistochemicy and PAS staining were used. The scant CD87 positive cells could be found in basal membrane. Also, the positive staining of PAS could be seen in the basal membrane in both normal and regenerated epidermis. No CD87 positive cells were found in the spinous and granular layers. The results indicate that the error in metrology could be excluded from both CD87 immunohistochemicy and PAS staining, and that the stem cell islands may come from the cell reversion in regenerated epidermis.

Objective: To evaluate the effect of concomitant chemoradiotherapy for the prevention of recurrence and metastasis of postoperative salivary adenoid cystic carcinoma(SACC).Methods: 14 cases of salivary adenoid cystic carcinoma after operation were treated with concomitant chemoradiotherapy. Regular radiotherapy of 60 Gy and chemotherapy with hydroxycamptothecin (HCPT) at 10 mg/m 2 , 3 times a week, were administered. HCPT was given in 1st, 2nd, 4th and 5th week. Recurrence and metastasis of SACC after operation were observed using CT, MRI, ultrasonography and X ray. Results: After 3～17 months' follow up, relapse free survival was 100%. No recurrence and metastasis of SACC after operation were found. Adverse reactions of the chemotherapy were nausea, vomiting and leukopenia. After suspended in a short time and using ondansetron and /or G CSF the chemotherapy of HCPT was continued and completed. Conclusion: concomitant chemoradiotherapy of HCPT and radiotherapy can prevent recurrence and metastasis of SACC after operation. The efficacy of long term needs further observation.

To gain insight into the mechanisms of an age related difference in ability of wound healing, the characteristics of stem cell differentiation in skins from fetus, child and adult were investiga ted. Integrin ? 1 and keratin 19 (K19) were used as the biochemical markers for stem cells and transit amplifying cells. Biopsies were taken from fetus (22～24week gestational age), children (4～12year) and adults (35～53year). Immunohistochemistry was used. As for the immunostainings of fetal tissue sections, integrin ? 1 and K19 expressions were observed in all epidermal basal cells. In children skin, the ratio of integrin ? 1 and K19 positive cells in the epidermal basal layer was 60%～80%. In adults, the ratio in the epidermal layer decreased. These results indicate that fetal skin epidermis contains a large number of stem cells and transit amplifying cells, and the proportion of stem cells and transit amplifying cells decreases with age after birth, which maybe a reason of the age associated difference in ability of wound healing.

To investigate the different expression of Fas, Fas L and Caspase 3 in hypertrophic scars and normal skins in order to explore their influences on scar formation, the expression intensity and distribution of Fas, Fas L and Caspase 3 were detected by immunohistochemistry and pathological methods in 8 cases of hypertrophic scars and 8 cases of normal skins. In normal skins, Fas and Fas L were mainly located in the cellular membranes and cytoplasms of epidermal cells and some fibroblasts. Caspase 3 was mostly distributed in epidermal basal cells and some fibroblasts. In hypertrophic scars, Fas and Fas L were principally existed in the membranes and cytoplasms of epidermal keratinocytes. The positive cellular ratio of two proteins was significantly reduced ( P

The purpose of this study was to investigate the localization and expression characteristics of phosphorylated form of extracellular-signal regulated-protein kinasel/2 (p-ERKl/2), Ras and C-fos in skin at different development stages and to explore their potential biological significance. Immunohistochemistry and pathological methods were used to detect the expression intensity and distribution of p-ERKl/2, Ras and C-fos in skin of 8 fetuses with different gestational ages (13 to 31 weeks) and 8 adults. Positive immunohistochemical signals of p-ERK1/2, Ras and C-fos. could be found in fetal and postnatal skins. Along with the increment in gestational age, the positive cell rates of p-ERK1/2, Ras and C-fos in the skin elevated progressively. In skins derived from the fetus of late-trimester pregnancy and adult, the positive rates of these three proteins were significantly increased in comparison with skin from the early-trimester fetus (P

Localization and expression of two subunits (IGF ⅠR? and IGF ⅠR?) of insulin like growth factor Ⅰ receptor and phosphorylated tyrosine proteins (P Tyr) in skins at different developmental stages were studied in order to explore their potential biological significance. Immunohistochemistry and pathological methods were used to detect the expression intensity and distribution of IGF ⅠR?, IGF ⅠR? and P Tyr in skins of 12 fetuses with different gestational ages and 8 adults. The results showed that positive immunohistochemical signals of IGF ⅠR?, IGF ⅠR? and P Tyr could be found in fetal and adult skins. Along with growth and development of the fetus, the positive cell rates of IGF ⅠR?, IGF ⅠR? and P Tyr in skins elevated progressively. In adult skins, IGF ⅠR was mainly located in the cell membrane of epidermal cells, while P Tyr was chiefly distributed in epidermal cells and some fibroblasts. These results suggested that IGF ⅠR and its mediating signaling pathway might be involved in cutaneous development at embryonic stage, in cutaneous structure and function maintenance, and in wound healing at postnatal stage.

To explore the change in gene expressions of p38 mitogen-activated protein kinase (p38MAPK) and its upstream signal-regulated molecule (mkk3 and mkk6) in normal skin versus hypertrophic scars underlying its potentially biological significance. Total RNAs were isolated from 8 specimens of hypertrophic scars and 8 specimens of normal skin, then they were purified to mRNAs, and the gene expression of mkk3, mkk6 and p38MAPK was examined with reverse transcription-polymerase chain reaction (RT-PCR). The results showed that the intensities of gene expression of mkk6 and p38MAPK were weak in normal skins, while the expression of these 2 genes was significantly elevated in hypertrophic scars compared with normal skins (P0.05). In hypertrophic scar, the elevation of mkk6 and p38MAPK gene expression, which plays pilot roles in cell proliferation, may be one of the mechanisms controlling the formation of hypertrophic scars.

To study the location and expression characteristics of epidermal stem cells in normal skin and scar epidermis of children, and to explore the relationship between the differences of these two epidermal stem cells and wound healing after burn. ?1 integrin and keratin 19 (K19) were used as the biochemical markers to identify stem cells and transit amplifying cell, keratin 14 (K14) and keratin 10 (K10) were used as the markers for post-mitotic cells and terminally-differentiated cells, respectively. Normal skin and scar tissue were obtained from children of 4 to 12 years of age. Elivision two-step immunohistochemistry was used. The results showed that in the immunostained tissue sections, the positive ?1 integrin and K19 expression cells were observed in 2～3 layers above the basal layer, whereas K10 expression cells were observed in all epidermal cells except basal cell layer in the scar tissue. Observations revealed that the number of stem cells and transit amplifying cells were less in the scar tissue than that in the normal skin, the differentiation process of scar epidermal stem cells was different from that of normal skin, and the proportion between post-mitotic cells and terminally-differentiated cells was abnormal. The results indicated that the self-renewal ability of the scar epidermis was lowered, and the differentiation process of it was deranged, and this might be considered to be a reason of abnormality of structure and function of the epidermis of scar tissue, and its poorer ability in wound healing.

To investigate the expression characteristics of fibroblast growth factor 10 (FGF10) and its receptor (Bek) underlying their effect on the formation of fetal skin appendages (SA). Expressions of FGF10, Bek, cytokeratin (CK19), Bcl-2 and proliferating cell nuclear antigen (PCNA) were detected with pathological and immunohistochemistry techniques in 130 skin specimens, which were obtained from 5 different sites (head, lower jaw, ear lobe, shoulder and presternal region) of 26 fetuses at different embryonic ages (E 8～31weeks). Results showed that FGF10, PCNA and Bcl-2 were over-expressed in interstitial cells distributed in clumps under the epidermis, and all proteins were strongly expressed in epidermal cells and pericytes at E 11weeks. In E 13weeks fetal skin, epidermal cells formed SA anlage through focal proliferation; then they developed, differentiated and migrated towards the dermis. In the skin of E 11～13weeks fetus, the expression of FGF-10, PCNA and Bcl-2 in interstitial cells in the dermis, and the expression of FGF10, Bek, PCNA, CK19, and Bcl-2 proteins in the epithelial cells in SA showed the expression characteristics of these proteins which were in accordance with growth and development of fetal SA. The results suggested that the specific binding of FGF10 from interstitial cells with Bek on the membrane of epithelial cells was the important signal to induce the proliferation and morphogenesis of embryonic SA epithelial \{cells.\ \ \ \}