Objective To investigate the effects of different surgical modalities on primary anorectal malignant melanoma. Methods Clinical data of 60 primary anorectal malignant melanoma cases who were admitted between 1965 and 2007 were collected, summarized and analyzed. Multivariate analysis was performed using the COX proportional hazards regression method. Results Tumors located in the rectum in 50 cases, in the anal canal in 10 cases. The overall survival rates were not significantly different between the 23 cases who received tumor resection only and those 30 cases receiving postoperative adjuvant therapy (X2=0. 078, P>0.05). Among these 53 surgical cases of anorectal malignant melanoma, 37underwent abdominoperineal resection, 16 underwent wide local excisions, There was no significant difference of the survival rates between the two groups (X2=1.464,P>0.05). Risk factors analysis revealed that the depth of tumor invasion is a risk factor (P<0.05), the modality of treatment is a protective factor (P<0.05). Conclusions Surgical operation is the principal effective management for anorectal malignant melanoma, Wide local excision is the principal therapeutic choice for localized well-circumferential anorectal malignant melanomas.

BACKGROUND:For the sacroiliac joint has complex structure and locates deep,its biomechanical properties have not been fully understood,even less about the study of reconstruction.OBJECTIVE:To construct a finite element model of pelvis after subtotal sacrectomy,and validate its effectiveness,which is supposed to be useful for evaluating reconstructions of sacroiliac joint.TIME AND SETTING:The establishment and validation of three-dimensional finite element model was performed in the Orthopaedic Laboratory of Changhai Hospital,Second Military Medical University between January and March 2008.MATERIALS:The CT scan images of adult males who had no pathological changes in lumber and pelvis were downloaded from CT work station in Changhai hospital.The CT scan included low lumber and whole pelvis,and got 132 DICOM images in all.METHODS:Two three-dimensional finite element pelvis models were established:① an intact pelvis model,② a defective pelvis model on which subtotal sacrectomy was performed cephalic to the S1 neural foramina.According to the biomechanical experiment of Hugate RR Jr,axial loads of 3 000 N and 1 000 N were applied on intact and defective pelvis models,respectively.The max axial displacements and stiffness on the L5 of two models were calculated and following comparison with the result in the literature.MAIN OUTCOME MEASURES:The max axial displacements and stiffness on the L5 were observed and considered as the index reflecting sacroiliac joint stability.RESULTS:The max axial displacements of the L5 on intact and defective pelvis models were 7.99 mm and 7.68 mm,respectively.The stiffness of the L5 on intact and defective pelvis models were 375 N/mm and 130 N/mm,respectively.The max axial displacements of the L5 on intact and defective pelvis models in the literature were(10.73?5.10) mm and(11.71?5.74) mm,and the stiffness were(353?231) N/mm and(101?49) N/mm,respectivly .CONCLUSION:In this experiment,we were successful to establish the finite element model of pelvis after subtotal sacrectomy.The calculated result was similar with the reference.The model could be used to evaluate different ways to reconstruct the sacroiliac joint.

Objective To investigate the diagnosis and treatment of functional pancreatic endocrine tumors (PETs). Methods The clinical data of 45 patients with functional PETs who were admitted to the Southwest Hospital from January 1998 to December 2008 were retrospectively analyzed. Etiologic and localization diagnosis were made preoperatively according to the manifestation and the results of color doppler ultrasound and computed tomography, respectively. Eight patients received resection of the body and tail of the pancreas and spleen, 32 received tumor enucleation, one received resection of the pancreaticobiliary junction and four received pancreaticoduodenectomy. All patients received chemotherapy after the operation. Results Thirty-four cases of the PETs were benign and the rest eleven cases were malignant. Eight cases of the PETs were in the head of the pancreas,26 in the tail of the pancreas, seven in the body of the pancreas and four cases were with multiple PETs. The diameters of the PETs were 0. 3-5.0 cm, and the diameters of the PETs in 19 cases were above 2.0 cm. Eight patients were complicated with pancreatic leakage, two with incision infection and one with abdominal infection. Of the 33 patients with insulinoma, the blood glucose of five patients with multiple PETs was still abnormal after the operation, three patients underwent reoperation and the other two were treated by diazoxide to control the blood glucose in the normal range. The clinical symptoms of the seven patients with gastrinoma disappeared after the operation, and the gastric ulcer was healed, the 12-hour gastric juice volume and the level of the gastric acid were in the normal range after a continuous treatment with proton pump inhibition agents for 6 months. Necrotizing or migratory rash and diabetes of the four patients with glucagonoma were cured three weeks later, and the level of the amino acid was back to normal. Diarrhea and electronic disturbance of one patient with vasoactive intestinal peptide tumor were alleviated after the operation. Thirty-nine patients were followed up for 20-120 months. Of the 32 patients with benign PETs, two patients had tumor recurrence, and three patients died of other diseases. Of the seven patients with malignant PETs, two patients survived, and three patients died of hepatic metastasis or tumor recurrence, two patients died of other diseases. Conclusions Surgical treatment is effective for the treatment of functional PETs. Palliative resection of the tumor also can obviously improve the life quality of patients with fuctional PETs.

Objective:To establish a method for the determination of omeprazole delayed release capsules and investigate the be-havior of reference preparations to provide experimental basis for generic drugs quality consistency evaluation. Methods:According to the first dissolution method (basket method) stated in 0. 931 of Chinese Pharmacopeia (2015 edition), the type of release media, solu-bility and stability of omeprazole in different media, effect of different treatment methods on the drug adsorption in the solution, differ-ent rotation speed and the methodology of ultraviolet spectrophotometry were investigated. Results:The rotation speed was 75 r·min-1 with the dissolution medium volume of 900 ml. The dissolution profiles of omeprazole delayed release capsules in three different media ( pH 6. 0 phosphate buffer, pH 6. 8 phosphate buffer and water containing 3% Tween-80) were determined with online filteration. The solubility of omeprazole in the different media was 0. 123, 0. 078 and 0. 275 mg·ml-1 , respectively. The results showed that ome-prazole was degraded 44%, 8% and 14% in 2 h in the above three release media, and degraded up to 43% in 6 h in water containing 3% Tween-80. The linear of omeprazole was 0. 209 4-20. 94, 0. 204 8-20. 48 and 0. 2016-20. 16 μg·ml-1 with the average recovery of 99.3% (RSD=0.7%,n=12), 99.7% (RSD=0.9%,n=12) and 99.5% (RSD=0.6%,n=12) respectively in the three media. Conclusion:The method is accurate and reliable, which can be used to study the quality consistency of omeprazole delayed re-lease capsules.

Aim To explore the growth inhibition effects of jasmonates on human neuroblastoma SH-SY5Y cell line,and to investigate its mechanisms.Methods After administration of 0.5~2.5 mmol?L-1 jasmonates for 6~24 hrs, the growth inhibition rates of SH-SY5Y cells were studied by MTT colorimetry.Cell cycle phases were assayed by propidium iodide staining flow cytometry. Cellular apoptosis was inspected by Hoechst 33258 fluorescent staining and Annexin V-FITC and propidium iodide staining flow cytometry.Gene expressions of PCNA, cyclin D1 and N-myc were determined by reverse transcription polymerase chain reaction.Results Jasmonates inhibited the growth of SH-SY5Y cells in a dose-and time-dependent manner,while the methyl jasmonate was the most efficient. After administration of 0.5 to 2.5 mmol?L-1 of methyl jasmonate for 24 hrs,the growth inhibition rates of cells reached 5.75%~88.7%(P

Objective To evaluate the transmural myocardial strain in three specific layers of the left ventricle at the papillary muscle level in short-axis view in SD rats before and after doxorubicin administration usmg myocardial layer-specific strain imaging based on two-dimensional ultrasound speckle tracking imaging (2D-STI),and to demonstrate the myocardial mechanical characteristics of doxorubicininduced early-stage acute cardiac toxicity in rats.Methods Thirty-two SD male rats weighing 300-350 g were randomly divided into a doxorubicin group (DOX group,n=16) and a control group (n=16).In the doxorubicin group,doxorubicin hydrochloride (concentration,2 mg/ml) was injected intraperitoneally at a single dose of 12 mg/kg,while the control group was given equal volume of 0.9％ sodium chloride solution.LVEDD,LVESD,IVSd,LVPWd,FS,and LVEF were measured and derived using two-dimensional gray-scale echocardiography at the left ventricular papillary muscle level in short-axis view at three time points (before administration and 24 and 48 hours after administration).The circumferential strain in the subendocardium,medium,and subepicardium at the left ventricular papillary muscle level in short-axis view were obtained using ultrasonic 2D-STI.The values of FS,LVEF,and the global myocardial circumferential strain in different layers of the left ventricular wall at the papillary muscle level in short axis view at three time points were compared between the two groups.After echocardiographic examinations at 48 h and 72 h,the hearts of three rats in each group were randomly selected,sliced,and HE-stained for myocardial pathological observation.Results In both groups,there was a circumferential strain gradient of the left ventricular wall at the papillary muscle level in the short-axis view:subendocardium ＞ medium ＞ epicardial myocardium.In the DOX group,the circumferential strain in the subendocardial myocardium decreased at 48 hours after DOX administration;the difference was statistically significant between the two groups (-25.13± 10.6 vs -17.04± 2.89,t=2.3,P ＜ 0.05).There was no significant difference in myocardial circumference strain in the three layers,as well as LVEDD,LVESD,IVS,LVPW,FS,or LVEF at three time points between the control group and DOX group (P ＞ 0.05).The pathological changes were mainly myocardial cell edema,vascular degeneration,myocardial nucleus atrophy,dissolution,interstitial edema,and capillary dilatation in the doxorubicin group,which were especially obvious in subendocardial cardiomyocytes.Conclusion 2D-STI technology based layer-specific strain imaging could be used to detect and quantitatively evaluate the deformation damage of the transmural left ventricular wall in SD rats.

Objective To determine the age-specific normal ranges of serum prostate-specific antigen (PSA) levels in Dalian,China.Methods Serum samples were collected from 8 453 asymptomatic men who underwent health examinations at the Second Affiliated Hospital of Dalian Medical University.Results The median PSA level was 0.93 μg/L,and the interquartile level was 0.81 μg/L.The 95th percentile level was 3.49 μg/L.The 95th percentile levels according to age group were:20 to ＜30 years,0 to 1.67 μg/L;30 to ＜40 years,0 to 2.01 μg/L;40 to ＜50 years,0 to 2.41 μg/L;50 to ＜60 years,0 to 3.25 μg/L;60 to ＜70 years,0 to 3.92 μg/L;70 to ＜80 years,0 to 5.48 μg/L;and older than 80 years,0 to 9.35 μg/L.The differences between the different age groups were statistically significant (P ＜ 0.01).The serum PSA value was positively correlated with age (r =0.251,P ＜ 0.001).Conclusion There were clear differences in age-specific PSA levels in Dalian,and these were lower than the standard OESTERLING.Screening for prostate cancer according to age-specific PSA reference values may be useful in the early detection of prostate cancer and may also reduce the risk of over-diagnosis.

OBJECTIVETo explore the clinicopathological features and prognostic factors of three rare and poor-prognostic pathological subtypes of primary liver carcinoma, and improve the clinical diagnosis and surgical treatment.

METHODSA retrospective analysis of clinicopathological data of 69 patients with rare pathological subtypes of primary liver carcinoma, diagnosed by postoperative pathology in our hospital from October 1998 to June 2013 was carried out. The data of 80 cases of common poorly differentiated hepatocellular carcinoma treated in the same period were collected as control group. Kaplan-Meier method was used to analyze the survival rate, and Cox proportional hazards model was used for prognostic analysis in the patients.

RESULTSThirty-four cases were combined hepatocellular carcinoma and cholangiocarcinoma (CCC, 28 males, 6 females), with a median age of 52 years (range, 33 to 73). Ninteen cases were giant cell carcinoma (GCC, 16 males and 3 females), with a median age of 59 years (range, 38 to 66). Sixteen cases were sarcomatoid carcinoma (SC, 14 males and 2 females), with a median age of 57 years (range, 46 to 70). The survival analysis revealed that median survival time and the 1-, 3-, 5-year survival rates for these 3 groups were 20 months, 61.8%, 29.4%, and 20.6% in the CCC patients, 13 months, 52.6%, 31.6%, and 0% in the GCC patients, and 8 months, 31.3%, 0%, 0% in the SC patients, respectively. The median survival time and survival rate of the SC group were significantly lower than those of the other three groups (P < 0.05). However, in the SC group, the incidences of hilar lymph nodes metastasis, vascular tumor emboli and invasion of adjacent organs were significantly higher than those in the other three groups (P < 0.05). There were no statistically significant differences among the other three groups (P > 0.05). The levels of carcino-embryonic antigen were higher in the three rare subtype groups than that of the control group. The incidences of multiple tumors of the three rare subtype groups were higher than that of the control group (P < 0.05). Positive surgical margin was an independent unfavorable prognostic factor.

CONCLUSIONSThe combined hepatocellular carcinoma and cholangiocarcinoma, giant cell carcinoma and sarcomatoid carcinoma have a poor prognosis. Among them sarcomatoid carcinoma is the most malignant and poor prognostic one. Radical resection is recommended.

Adult ; Aged ; Carcinoembryonic Antigen ; metabolism ; Carcinoma, Giant Cell ; metabolism ; pathology ; surgery ; Carcinoma, Hepatocellular ; metabolism ; pathology ; surgery ; Carcinosarcoma ; metabolism ; pathology ; surgery ; Cholangiocarcinoma ; metabolism ; pathology ; surgery ; Female ; Follow-Up Studies ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; metabolism ; pathology ; surgery ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplastic Cells, Circulating ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Survival Rate

OBJECTIVETo investigate the clinicopathological features and prognosis of clear cell carcinoma (CCC), giant cell carcinoma (GCC) and sarcomatoid carcinoma (SC), the 3 rare cellular morphological subtypes of hepatocellular carcinoma (HCC).

METHODSThe clinic data of 78 rare pathological subtype HCC cases, which were diagnosed by postoperative pathological examination during October 1998 and June 2013 was analyzed retrospectively. CCC group involved 43 patients (33 male and 10 female), with a median age of 56 years (ranging from 25 to 80 years). GCC group involved 19 patients (16 male and 3 female), with a median age of 59 years (ranging from 38 to 66 years). SC group involved 16 patients (14 male and 2 female), with a median age of 57 years (ranging from 46 to 70 years). Characteristic differences were analyzed by χ(2) test and Fisher exact test. Survival analysis was estimated by Kaplan-Meier method. Cox proportional hazards model was used in survival multivariate analysis.

RESULTSThe proportion of multiple lesions in CCC group (4.7%) was significantly lower than those in GCC group (21%) or SC group (25%) (P = 0.034). The histologic grade of CCC group was the best, whereas SC group was the worst (P = 0.000). The survival analysis revealed that median survival time and the 1-, 3-, 5-year survival rates for the 3 groups are CCC group (45 months, 92%, 65%, 45%) > GCC group (13 months, 55%, 30%, 0) > SC group (8 months, 31%, 0, 0), respectively (χ(2) = 4.473 to 26.981, P < 0.05, between each 2 groups). Two cases in CCC group underwent abdominal metastasectomy 18 and 32 months after hepatectomy, and they still achieved long-term survival time. The histologic grade of tumor cell and the TNM staging were 2 independent unfavorable prognostic factors (regression coefficient: 4.038 and 1.354, P < 0.05).

CONCLUSIONCCC is a rare low degree malignancy pathological subtype of HCC and may achieve a relatively optimistic prognosis. However, the GCC, especially SC are 2 rare high degree malignancy pathological subtypes of HCC with highly aggressive and poor prognosis.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; classification ; pathology ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; classification ; pathology ; Male ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Survival Analysis

Objective: To investigate the clinical value of intraoperative radiofrequency ablation (RFA) in the treatment of colorectal liver metastasis (CLM). Methods: A retrospectively analysis of 187 patients with CLM who underwent liver resection with or without RFA from January 2009 to August 2016 in Department of Hepatobiliary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences was performed. According to whether RFA was used intraoperatively, patients were divided into resection only group and combined treatment group. The clinical and pathological characteristics of the two groups were compared to explore factors influencing survival and recurrence. Imbalance of background characteristics between the two groups was further overcome by propensity score matching method (PSM). Results: The number of liver metastases (267), simultaneous liver metastases (100%), bilobar involvement (73.3%) and preoperative chemotherapy (93.3%) rates were significantly higher in the combined treatment group than those in the resection only group(471, 74.7%, 42.0% and 63.1%)(all P<0.05). In the combined treatment group, median overall survival (OS) was 25.7 months; and 3-year and 5-year OS were 47.9% and 28.8%, respectively. In the resection only group, the median survival time was 46.9 months; and 3-year and 5-year OS rate was 59.1% and 42.4%, respectively (χ²=4.579, P=0.034). Median disease-free survival (DFS) was 5.4 months in the combined treatment group, and 10.1 months in the resection only group (χ²=5.399, P=0.023). In multivariate analysis, intraoperative RFA was not an independent prognostic factor for OS and DFS (HR=0.98, 95%CI: 0.47-2.08, P=0.965; HR=1.21, 95%CI: 0.71-2.07, P=0.465). After PSM, the median OS of the resection only and the combined treatment groups were 30.2 and 25.7 months (χ²=0.876, P=0.350). The median DFS in the two groups was 5.3 and 4.2 months, respectively (χ²=0.199, P=0.650). Conclusion In patients with similar tumor burden, liver resection combined with intraoperative RFA for unresectable CLM can achieve long-term outcomes similar to hepatectomy alone for resectable CLM.