300 ?m ) damage when the islets are rewarmed to 37 ℃ . These novel findings may help to understand the pathophysiology of early loss of islet tissue after transplantation,and may provide a new strategy to improve graft function in the clinical setting of islet transplantation.

Objective To study the expression of elastic fibers,Collagen type Ⅳ and CD44v6 in the metastasis of the pulmonary adenocarcinoma.Methods In paraffin-embedded specimens from 56 cases of pulmonary adenocarcinoma,the elastic fibers were stained with histochemical method and the expressions of collagen type Ⅳ and CD44v6 were detected with immunohistochemical method.Results The positive expression rates of elastic fibers,collagen type Ⅳ and CD44v6 were 11.5%(3/26),11.5%(3/26) and 80.8%(21/26)in the group with lymph node metastasis,and were 69.0%(20/29),55.2%(16/29) and 24.1%(7/29) in the group without lymph node metastasis,respectively.The expression of elastic fibers,collagen type Ⅳ and CD44v6 were significant difference in the two groups with and without lymph node metastasis(P=0.000).There was statistically significant correlation among elastic fibers,collagen type Ⅳ,CD44v6 and lymph node metastasis(all P

Objective To explore the constituent ratio and clinical characteristics of multifocal thyroid papillary carcinoma (MPTC).Methods The clinical data of 1616 cases of papillary thyroid carcinoma(PTC) were retrospectively analyzed from January 2002 to December 2011 of the First Affiliate Hospital of Dalian Medical University,which operated at the first time and confirmed by pathology.The change of constituent ratio of MPTC in PTC was analyzed and the differences of the clinical characteristics of the multifocal group and single focal group were analyzed.Results The constituent ratio of MPTC in PTC was increasing from 8.33％ (4/48) in 2002 to 30.38％ (96/316) in 2011 gradually.Compared to the single focal group,MPTC group had higher rate of neck lymph node metastasis(45.09％ vs 25.02％ ; P =0.000) and extrathyroidal invasion (20.95％ vs 9.04％ ;P =0.000).Compared with pure microcarcinoma,none pure microcarcinoma had higher rate of neck lymph node metastasis (P =0.000).More than two focuses has higher rate of neck lymph node metastasis than two focuses (P =0.000).The rate of recurrence with lymph node metastasis was higher than that without lymph node metastasis (24.05％ vs 8.98％ ;P =0.000) conformed by postoperative pathology.Conclusions The number and constituent ratio of MPTC in PTC is increasing gradually.MPTC group has high proportion of lymph node metastasis and extrathyroidal invasion than single focal group.None pure microcarcinoma has higher rate of neck lymph node metastasis than pure microcarcinoma;more than two focuses has higher rate of neck lymph node metastasis than two focuses.The recurrence rate is correlated with the rate of lymph node metastasis.

The actual incidence of gastrointestinal stromal tumor (GIST) is underestimated.With the progression of awareness and development of examination methods,the detection rate of small GIST (diameter ＜ 5 cm) is increasing year by year.These patients always had no obvious clinical symptoms,and were often detected with small GIST in physical examination unexpectedly.Combination of endoscopic ultrasound and radiographic examination is helpful in detecting small GIST.Aggressive surgical complete resection should be considered in case of a definitive diagnosis.Laparoscopic resection is becoming the standard surgical treatment currently.For micro GIST (diameter ＜2 cm),especially micro gastric stromal tumor,current guidelines recommend close observation.Some scholars advocate that endoscopic resection is feasible for the treatment of micro GIST,while we think that the efficacy of individualized treatment is better after identifying the potential malignancy of micro GIST.

Objective To investigate the clinical significance of CA242 combined with TGF-? to diagnose adenocarcinoma of pancreas.Methods Thirty patients were involved in this study,who were hospitalized from Dec.2004 to Sept.2005.ELISA was used both to investigate the expression of CA242 in 30 cases and TGF-? in 20 cases.Twenty healthy volunteers were as controls.Results CA242 was increased in adenocarcinoma of pancreas compared with controls[(312?5)kU/L vs(56?2)kU/L,P0.05.Conclusion The specificity of each of CA242 and TGF-? to diagnose adenocarcinoma of pancreas is high.The sensitivity of TGF-? is higher than that of CA242.CA242 combined with TGF-? can increase the diagnosis rate of adenocarcinoma of pancreas.

Purpose:To evaluate the results of combination chemotherapy with MxFL[mitoxantrone(MIT),Fluaroracil (5 FU),Leucovorin (CF)]in the treatment of metastatic breast cancer.Methods:From 1993 through 1998,41 patients with metastatic breast cancer were enrolled in this study, Twenty six patients had no prior chemotherapy and 15 were had prior chemotherapy in nineteen patients estrogen receptor (ER) was positive. MIT 12 mg/m 2 by was given intravenous titrate the first day; continuous 5 FU 320 mg/m 2 by intravenous titrate the first day;continuous 5 FU 320 mg/m 2 by intravenous titrate was given for one hundred and twenty hours during the first day to the fifth day; at the same time, CF 50 mg/m 2 by intravenous titrate, once every twelve hours for five days. Repeated every three weeks. Results:Complete response was observed in 11 patients and partial response was observed in 19 patients with an overall response rate of 73.2%. The median response duration was 17 months and the median survival period was 23 months. The dose limiting toxicity was neutropenia which was seen in 85.4% of the treated cases (19.5% in grades Ⅲ and Ⅳ). Stomatitis was observed in 9.8% of the patients and local venous toxicity was observed in 12.2% of the patients. Conclusions:A high response rate is obtained in metastatic breast cancer treated by MxFL. Such treatment may be used as first line chemotherapy for metastatic breast cancer.

Objective To investigate improvements in the diagnosis and treatment of primary malignant tumor of the duodenum. Methods The clinical data of 54 patients with primary malignant tumor of the duodenum treated during a period of 6 years were analysed retrospectively. Results Tumors located in the first, second, third and fourth parts accounted for 6 cases(11.1%), 44 cases(81.5%), 2 cases(3.7%), and 2 cases(3.7%) respectively; and among them, ampullary tumor accounted for 38 cases(86.4%) of tumor of descending portion of duodenum and 70.4% of the total number of duodenal tumors. The main clinical presentation included jaundice, upper abdominal pain, weight loss, abdominal distention, and gastrointestinal obstruction. Upper abdominal pain, no positive signs and abdominal mass were found in 72.0%, 20.0% and 8.0% respectively on abdominal examination. Preoperative associated cholecystopathy accounted for 37.0%. The accuracy rate of duodenoscopy and ERCP in preoperative diagnosis was 94.4%, and 77.8% respectively. Preoperative diagnostic accuracy rate was 27.8%. Panceaticoduodenectomy was performed in 38 cases, duodenectonmy in 1 case, palliative resection of tumor in 9 cases, and tumor was inoperable in 6 cases. Radical resection rate was 72.2%. The postoperative 3- and 5-year survival rate was 40.6% and 21.9%, respectively. After palliative resection, death occurred from 1month to 24months. Conclusions The tumors in the ampullary region account for the majority of primary malignant tumors of the duodenum and are mainly adenocarcinoma. The symptoms of advanced stage are complicated, and specific signs on abdominal examination are few. Associated cholecystopathy is relatively ferquent and preoperative accurate diagnostic rate is low. The examinations of first choice are duodenoscopy and ERCP, and radical panceaticoduodenectomy can extend survival time.

Objective To report the treatment outcome of nonunion of tibial fractures with local muscle flap transfer and injection of autogenous bone marrow. Methods 15 patients who had suffered from nonunion of tibial fracture 10 to 42 (mean 22) months after the initial injury underwent open reduction, internal fixation with locking intramedullary nail, wound coverage with locally transferred muscle flap and injection of autogenous bone marrow into the fracture site 12 to 15 days after operation. Results The follow-ups revealed bone union in all the cases of this series with a mean healing time of 22 (3 to 11) months. Except for limited necrosis of the skin edge in 2 cases which healed after dressing changes, the wounds healed primarily in all the cases without infection and implant failure. Conclusion Besides stable internal fixation and bone graft, coverage of fracture site with locally transferred muscle flap and injection of autogenous bone marrow can be used to treat nonunion of tibial fractures with satisfactory results.

Objective To determine the renal function compromised in patients after ST-segment elevation myocardial infarction (STEMI) with left ventricular aneurysms (LVA) by measurement of serum cystatin C (Cy-C) concentrations and Cy-C-based eGFR.Methods A total of 355 patients admitted from January 2011 to December 2012 could be categorized into group A (STEMI without LVA,n =183) and group B (STEMI with LVA,n =172) confirmed by echocardiography in 24 hour after admission.Of them,273 patients were treated with primary percutaneous coronary intervention (PCI) after admission and included in the analysis.Cy-C-based estimated glomerular filtration rate (eGFR) and creatinine (Cr)-based eGFR were calculated for evaluating cardiac function in tern to assess the magnitude of compromised renal function.The correlation between magnitude of compromised renal function and in-hospital mortality was analyzed.Distributions of categorical variables were compared using the chi-square test.Continuous variables were compared by one-way ANOVA with the Bonferroni test.Results The in-hospital mortality rate of whole patient cohort was 14.0％.Mortality in the group B was 18.6％ and in the group A was 9.8％ (P ＜ 0.01).With multivariable regression analysis,the compromised renal function was found when the Cr-based eGFR was ＜60 mL/ (min · 1.73 m2) or Cy-C-based eGFR was ＜ 60 mL/min/1.73m2 which were independently associated with in-hospital mortality (OR 0.13,95％ CI 0.02-0.7,P =0.02 ; OR 0.01,95％CI 0.003-0.05,P ＜ 0.01).Compared with the acute myocardium infarction (AMI) patients with chronic kidney disease (CKD) stage 2,the Cy-C based eGFR was greater in the AMI patients with LVA group (P ＜ 0.05),and compared with AMI with CKD stages 3 or CKD 3-5,this difference was also significant (P ＜ 0.01).Conclusions Renal dysfunction was an independent predictor of in-hospital mortality in patients with STEMI,especially in patients with LVA.Cy-C and Cy-C based eGFR were more sensitive to judge renal dysfunction in STEMI patients with LVA.

During medical rescue for nuclear and radiation accidents, triage of potential victims could contribute to better use of medical resources currently and higher efficiency of the rescue.Biological dose estimation techniques ( estimated biodosimetry) are effective for assessing the degree of external radiation injury.The application of estimated biodosimetry to triage is important for effective nuclear accident medical rescue.In this paper, the characteristics of the estimated biodosimetry and its application to triage during medical rescue for nuclear accident and radiation were discussed.