Objective There is close relationship between ubiquitin-specific protease 9X(USP9X) and the biological behav-ior of some tumor.The aim of this study is to investigate the expression and clinical significance of USP 9X in pancreatic carcinoma of elderly patients. Methods The expression of USP9X was detected in 30 pieces of surgically resected primary pancreatic carcinoma tissue and adjacent nontumorous pancreatic tissue of elderly patients by streptavidin -perosidase immunohistochemical method . Results The rate of USP9X positive expression was 56.7%, there was not positive expression in adjacent nontumorous pancreatic tissue .There was no relation between the expression of USP 9X with gender, age, the tumor positin, the tumor size and degree of differentiation (P>0.05), while it was significantly correlated with lymph node metastasis and TNM stages (P<0.05).By using Cox proportional haz-ards analysis, multivariable analysis revealed that TNM stages , lymph node metastasis and USP9X expression were independent risk factor(P<0.05). Conclusion The results indicated that USP9X may play a role in the pathogenesis and prognosis of pancreatic cancer of elderly patients .

Objective To evaluate the safety and efficacy of the technique of transoral Orvil EEA stapler (OrVil) for laparoscopic gastrectomy of gastric cancer in our hospital.Methods Between Sep 2012 and Aug 2013,73 patients at our department underwent open (n =36) or laparoscopic (being reconstructed by OrVil,n =37) gastrectomy.Early surgical outcomes of the two groups were compared to assess the effectiveness,security and postoperative complications of OrVil procedure.Results The two groups had similar mean numbers of dissected lymph nodes (29 ± 10 vs.31 ± 14,t =-0.697,P =0.488),lengths of postoperative hospital stay (14 ± 5 vs.12 ± 3 d,t =1.933,P =0.057) and postoperative complications (11 vs.11,P =0.939).Intraoperative blood loss was significantly less (189 ± 79 vs.343 ± 90 ml,t =-7.782,P =0.000) and time to first flatus significantly shorter (2.9 ±0.5 vs.3.5 ±0.6 d,t =-4.714,P =0.000) with the use of OrVil.Operation time of laparoscopic group was significantly longer than that of open group (266 ± 97 vs.204 ± 39 min,t =3.607,P =0.001).There was one each anastomotic leakage in both groups.Conclusions With the suitable approach and skillful technique,OrVil is a technically safe and feasible surgical procedure for the treatment of gastric cancer.

Objective To prepare gadolinium-loaded stearic acid grafted chitooligosaccharide (COSSA-DTPA-Gd) and evaluate its micelle properties,cytotoxicity,relaxation rate in vitro,and pancreatic tumor in vivo imaging.Methods Stear ic acid grafted chitooligosaccharide (COSSA) was synthesized by acetylation reaction between stearic acid and chitooligosaccharide.Diethylenetriaminepentaacetic dianhydride (DTPA) was conjugated to the residual amino groups of COSSA,then Gd3+ was chelated to obtain the final product.The micelle properties were measured using an electron microscopy and a laser particle sizer.The MTT assay was adopted to determine cytotoxicity.The in vitro relaxation rate and in vivo imaging of pancreatic tumor were evaluated using an MR scanner.Results COSSA-DTPA-Gd could self-assemble into stable micelles in aqueous solutions with a critical micelle concentration of (5.12±0.43)μg/ml.The micelles had positive charge and exhibited roughly spherical shape with a mean diameter of (58.3± 5.7)nm.The content of Gd3+ in COSSA-DTPA-Gd was 330.31 μmol/g.The nanoprobe and Magnevist,the commercial formulation,showed similar cytotoxicity (P＞0.05).The cell survival rate within 24 h were higher than 85％.The in vitro relaxation rate of COSSA-DTPA-Gd was 8.23 mM-1 ·s-1.After intravenous injection,COSSA-DTPA-Gd showed a better positive contrast-enhancing effect for pancreatic tumor than Magnevist.The MR images at the tumor periphery was rapidly enhanced,while a slow increase in image quality was observed in tumor core.Conclusion The prepared COSSA-DTPA-Gd can be used for efficient MR imaging of pancreatic tumor.

Objective To evaluate transoral Orvil EEA stapler (OrVil) procedure in laparoscopic total gastrectomy for cardiac carcinoma compared with conventional anvil head method (purse-string suture).Methods From May 2014 to December 2014 20 cases were included into OrVil group,and 25 cases into purse-string suture group.Results The two groups had similar mean numbers of dissected lymph nodes [(25 ± 3) vs.(24 ± 4),t =1.067,P =0.292],the mean time of operation,intraoperative blood loss,and postoperative complications (5 vs.6,P =0.938).The length of incision was significantly shorter [(5 ±1) cm vs.(11 ± 2) cm,t =-10.724,P ＜ 0.0l] and the esophagojejunostomy time was significantly less [(28 ± 4) min vs.(39 ± 5) min,t =-7.996,P ＜ 0.01] with the use of OrVil.The time to first flatus and postoperative hospital stay were (3.7 ± 0.9) d vs.(4.4 ± 1.0) d,t =-2.485,P =0.017 and (13 ± 5) d vs.(16 ±4) d,t =-2.184,P =0.035.Conclusions OrVil is a technically safe and feasible surgical procedure for esophagojejunostomy in laparoscopy assisted total gastrectomy in the treatment of cardiac carcinoma.

Objective To observe the resection of the scapholunate interosseous ligament (SLIL)and its subregions on the three-dimensional(3-D)movement of the scaphoid and lunate so as to discuss the role of SLIL in the 3D flexion-extension motion of the scaphoid and lunate.Methods Twelve upper extremities(six left extremities and six right extremities)from adult cadaver were used in this study and divided into five groups:normal group,proximal subregion resection group,proximal subregion plus dorsal subregion resection group,proximal subregion plus palmar subregion resection group and whole SLIL resection group.The 3-D laser scan and reconstruction technique were used for meusure ment of the 3-D flexion-extension motion of the scaphoid and lunate.Results In the normal group,the scaphoid and lunate flexed and the radial deviated at the same direction during wrist flexion-extension motion.At the same time,there was minimal scaphoid and lunate pronation-supination during wrist flexionextension.After resection of the proximal and palmar(or dorsal)subregions of the SLIL,some different movements were found compared with the normal specimen.Whole SLIL resection resulted in increase of the flexion motion of the scaphoid but decrease of the palmar flexion of the lunate.Conclusions 3-D laser scanning and image reconstruction techniques can accurately measure the 3D motion of the scaphoid and lunate.Partial or whole resection of SLIL may exert significant effect on the flexion-extension motion of the scaphoid and lunate.However,the proximal subregion of SLIL has no prominent effect on the motion of the scaphoid and lunate.

Objective To investigate current status of cognitive behavior on chronic obstructive pulmonary disease (COPD) to provide evidence for targeted intervention.Methods A questionnaire survey on COPD was conducted at 12 settings of 4 prefectures that were sampled from Ningxia Province using multistage stratified cluster random sampling method,and 4268 residents at least 40 years old were interviewed.Multivariate linear regression method was used for data analysis.Results A total of 4056 valid questionnaires were returned from 4200 participants with an effective response rate of 96.57％.Only 6.51％(264/4056) had an idea of COPD,13.88％ (563/4056) regarded cigarette smoking as a risk factor of chronic bronchitis and emphysema,and 6.39％ (259/4056) knew pulmonary function tests.Home income,living area,education level and ethnicity were main factors influencing COPD awareness.The percentage of current cigarette smoking was 28.80％ (1168/4056) with 20.40％ in Hui (Muslim) ethnic group and 34.63％ in Han ethnic group (P ＜ 0.05 ) ; smoking index and severe smokers were not significantly different between the two groups ( P ＞ 0.05 ).Conclusion Our data suggest a considerably poor knowledge and prevention awareness of COPD in Ningxia Province.In spite of relatively lower cigarette smoking rate,the problem that Hui (Muslim) ethnic people are lack of COPD awareness should not to be neglected.

OBJECTIVETo scrutinize the immunohistochemical spectrum to differentiate hepatocellular carcinoma (HCC) from intrahepatic cholangiocarcinoma (ICC) and metastatic adenocarcinoma (MAC) in the liver.

METHODSSeven antibodies including AFP, Hep Par 1, CK18, CK19, CA19-9, CD34 and pCEA were immunohistochemically stained in resected specimens of 300 HCC, 35 ICC and 30 MAC. The specificity and sensitivity of the antibodies were evaluated by comprehensive capability score (CCS), with only those with CCS > or = 8 considered as having highly diagnostic value.

RESULTSAntibodies CCS > or = 8 were observed as Hep Par 1 and CD34 in HCC, and CK19 in ICC, but none in MAC. For HCC, CCS of Hep Par 1 was higher than that of AFP (9 vs. 7) with 83.7% in sensitivity and 96.7% in specificity.

CONCLUSIONFor HCC, Hep Par 1 and CD34 can be used as the first line antibodies, AFP and pCEA as the second line ones. CK19 is the first line antibody for ICC, and CA19-9 as the second. Hep Par 1, CD34 and CK19 are definitely helpful for the routine immunohistochemical stain to differentiate HCC from ICC and MAC.

Adenocarcinoma ; chemistry ; Antibodies ; immunology ; Carcinoma, Hepatocellular ; chemistry ; Cholangiocarcinoma ; chemistry ; Humans ; Immunohistochemistry ; Liver Neoplasms ; chemistry ; Tumor Cells, Cultured

Objective: To evaluate the role of multidisciplinary team (MDT) clinic in the diagnosis of pancreatic diseases and patient compliance with MDT advice in the current medical system. Methods: The study included 512 patients that had visited the pancreas-oriented MDT clinic of Zhongshan Hospital between May 2015 and May 2019.The clinical and pathological data were collected and analyzed retrospectively. Diseases were classified in accordance with 2010 WHO classification of tumors of the digestive system and usual clinical practices. Compliance was determined according to whether a patient received corresponding therapies or undergoing further checks or follow-ups. Results: Among the 512 patients that had visited the MDT clinic, 121 patients were referred due to undetermined diagnosis. Classified according to the final diagnosis, the rate of undetermined diagnosis in different disease categories from high to low in order was inflammatory diseases of the pancreas (75.0%, 24/32), other lesions of the pancreas (56.1%,23/41), pancreatic cystic lesions (19.1%,17/89), pancreatic carcinomas (18.3%,48/262) and pancreatic neuroendocrine neoplasms (pNEN)(10.2%,9/88). The MDT clinic made diagnosis to 68 patients directly with an accuracy of 89.7%. The rate of compliance in the entire cohort was 63.4%. The rate of compliance of patients from June 2017 to May 2019 (68.4%) was higher than that of patients from May 2015 to May 2017(59.6%). The compliance rate of patients in different disease categories from high to low in order was inflammatory diseases of the pancreas(84.4%, 27/32), pancreatic carcinomas (67.9%, 178/262), pNEN(60.2%,53/88), other lesions of the pancreas (56.1%,23/41), and pancreatic cystic lesions(49.4%, 44/89). The compliance rate of patients with different MDT advice from high to low in order was best supportive care(78.6%,22/28), antitumor approaches beyond surgery(71.6%,159/222), further tests(62.6%, 77/123), surgery(53.7%, 65/121) and follow-up(49.2%, 31/63). In patients suggested for surgery, the compliance rate of patients with carcinomas(67.4%, 33/49) was higher than patients with other kinds of neoplasms. Conclusions MDT clinic could facilitate the diagnosis of pancreatic diseases conveniently and inexpensively. The overall compliance rate of MDT clinic patients is rather low, and patients with carcinomas have a relative high rate of compliance with the suggestion of surgery.