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Objective To detect circulating tumor cells (CTCs) in the peripheral blood of patients with pancreatic cancer using a new nano microfluidic chip and to explore the relationship between CTCs and clinicopathological feature,postoperative recurrence and prognosis of pancreatic cancer.Methods The peripheral blood samples of 53 patients with pancreatic cancer who underwent curative resection in the second affiliated hospital of Jiaxing college of medicine were collected from January 2015 to January 2017.The CTCs from peripheral blood were detected by novel nano microfluidic chip.The cut-off value for CTCs-positive and negative groups was 1 CTC.The relationship between CTCs positive and postoperative recurrence and prognosis of pancreatic cancer were evaluated.Results The number of CTCs for 23 pancreatic cancer of 53 patients ranged from 5 to 196 per ml,and the mean number was 78.5 ± 44.7 per ml;the rate of CTCs-positive patients was 43.4％ (23/53).There were significant correlation between CTCs with vascular invasion (P =0.001),but but CTCs was not correlated with the gender,age,the presence of clinical symptoms,tumor size,pathological type,lymph metastasis and TNM stage.31 patients had tumor recurrence,and the rate of tumor recurrence was 58.5％.Among them,there were 13 cases with tumor local recurrence,10 cases with tumor distant metastasis (including liver,lung,kidney,etc.) and 8 cases with both tumor local recurrence and distant metastasis.The median recurrence free survival time of all patients was 14.0 months (13.0-17.0) and the median overall survival time was 19.0 months (15.5-24.0).The cumulative one-year and two-year recurrence free survival rate were 66.9％,12.2％ for patients with CTCs-positive and 88.3％,42.2％ for CTCs-negative patients,and the differences were statistically significant (both P ＜ 0.05).The cumulative one-year and two-year overall survival rate were 85.4％,33.6％ for patients with CTCs-positive and 96.3％,62.2％ for CTCs-negative.There was no difference in statistics in cumulative one-year overall survival rate and with a statistically significant difference in cumulative two-year overall survival rate (P =0.028).Conclusions Peripheral blood CTCs of pancreatic cancer can be effectively detected by a novel nano microfluidic chip.There were significant correlation between CTCs with vascular invasion and survival time after surgery.CTCs may be a potential prognostic indicator of the postoperative recurrence and prognosis of pancreatic cancer.
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Objective To establish a novel method using a nano microfluidic chip to detect circulating tumor cells (CTCs) in peripheral blood in gallbladder carcinoma,and to study the relationship between CTCs with clinicopathology and prognosis in these patients.Methods The peripheral blood samples of 51 patients with gallbladder carcinoma were collected from June 2014 to January 2017.The CTCs from peripheral blood samples were detected by a novel nano microfluidic chip.This study aimed to study the correlation between CTCs with the clinical and pathological features.The significance of CTCs on prognosis in patients with gallbladder carcinoma was also analyzed.Results The positive rate of CTCs in the peripheral blood of gallbladder carcinoma patients was 43.1％ (22/51).There were significant correlations between CTCs with liver metastasis (P ＜ 0.05) and Nevin staging (P ＜ 0.05).The 1-and 2-year overall survival (OS) in patients with CTCs were 70.7％ and 35.3％,and the 1-and 2-year OS in patients without CTCs were 92.0％ and 56.1％.There was a significant difference in the 2-year OS (P ＜ 0.05) but no significant difference in the 1-year OS between the 2 groups of patients (P ＞ 0.05).Conclusions Peripheral blood CTCs in patients with gallbladder carcinoma were efficaciously detected by a novel nano microfluidic chip.Peripheral blood CTCs was closely related to the Nevin staging and liver metastasis.CTCs could serve as a potential prognostic indicator in patients with gallbladder carcinoma.
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Objective@#To detect the expression of B cell transposition gene 3(BTG3) in pancreatic ductal adenocarcinoma(PDAC), and explore its relationship with postoperative recurrence and metastasis of tumor.@*Methods@#Six self-paired frozen PDAC specimens and 3 normal pancreatic tissues from the Second Hospital of Jiaxing Affiliated to Jiaxing University were collected and the expression of BTG3 was detected by qPCR. Ten normal pancreatic tissues and 52 cases of PDAC tumor and paracarcinomatous tissues from the Second Hospital of Jiaxing Affiliated to Jiaxing University were collected from June 2009 to December 2016. The expression of BTG3 and relationship among BTG3 and clinicopathological characteristics of PDAC and patients′ prognosis were detected and analyzed using immunohistochemistry.χ2 test, Kaplan-Meier method and Cox regression model were used to analyzed the data.@*Results@#The results of qPCR showed that expression level of BTG3 in PDAC (0.63±0.17) was lower significantly than that in paracarcinomatous (0.96±0.04) and normal tissues (1.00)(t=4.673, 5.502; both P<0.05). Immunohistochemistrv showed that BTG3 mainly expressed in the cytoplasm.The high expression rate of BTG3 in PDAC tumor tissues was 25.0%(13/52), which was remarkably lower than that in paracarcinomatous tissues(65.4%) and normal liver tissues(7/10)(χ2=17.120 and 5.849, both P<0.05). The low expression of BTG3 in PDAC was correlated with primary tumor, and TNM stage(χ2=7.704, P=0.006; U=154.000, P=0.018, respectively). Survival analysis showed that disease free survival rate of patients with low expression of BTG3 was significantly less than that with high expression(χ2=192.493, P<0.01). The Cox multivariate analysis demonstrated that low expression of BTG3 was independent risk factors for disease free survival in patients with PDAC after a curative resection(RR=3.366, 95%CI: 1.040-10.889, P=0.043).@*Conclusion@#BTG3 may be involved in the occurence and development of tumor, and its low expression may be associated with poor prognosis in patients with PDAC.
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Objective To investigate the application of damage control surgery (DCS) concept in treatment of pancreas trauma. Methods The clinical data of 22 cases of pancreas trauma from January 2009 to June 2016 were analyzed retrospectively, including degree of injury, therapies and effect. Results Following DCS concept, 3 cases were given conservative treatment, and 19 cases were treated by operation, including debridement, hemostasis, suture, simple drainage and preserved pancreas function;21 cases were cured and 1 died;pancrestic fistula occurred in 11 cases, abdominal infection occurred in 6 cases and injured pancreatitis occurred in 1 cases by conservative treatment;false cyst occurred in 1 cases 6 weeks after operation. All patients were followed up for 12-36 months, with an average of (25.1 ± 1.7) months, and No significant impact was seen on the lives or work of 21 patients after surgery. Conclusions Pancreas trauma needs early-stage diagnosis and active treatment. Rational application of dcs concept can reduce the mortality and improve the outcome effectively.
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Objective To investigate the application of damage control surgery (DCS) concept in treatment of pancreas trauma. Methods The clinical data of 22 cases of pancreas trauma from January 2009 to June 2016 were analyzed retrospectively, including degree of injury, therapies and effect. Results Following DCS concept, 3 cases were given conservative treatment, and 19 cases were treated by operation, including debridement, hemostasis, suture, simple drainage and preserved pancreas function;21 cases were cured and 1 died;pancrestic fistula occurred in 11 cases, abdominal infection occurred in 6 cases and injured pancreatitis occurred in 1 cases by conservative treatment;false cyst occurred in 1 cases 6 weeks after operation. All patients were followed up for 12-36 months, with an average of (25.1 ± 1.7) months, and No significant impact was seen on the lives or work of 21 patients after surgery. Conclusions Pancreas trauma needs early-stage diagnosis and active treatment. Rational application of dcs concept can reduce the mortality and improve the outcome effectively.
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Objective To explore the diagnostic value of k ras mutation detection of specimen obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA)for pancreatic cancer.Methods Seventy-eight patients with pancreatic carcinoma and 49 patients with pancreatic benign diseases were collected from January 2013 to December 2015.All the patients underwent EUS-FNA and cell or tissue samples were collected.DNA was extracted from the samples,and the codon 12 and 13 mutation of K-ras gene was detected by specific nano capture probe.Liquid cytology was also conducted.The sensitivity and specificity of the two methods were compared.Results The K-ras mutation rate was 92.3％ (72/78) in 78 patients with pancreatic carcinoma,which was obviously higher than the mutation rate of 20.4％ (10/49) in 49 patients with pancreatic benign tumors,and the difference was statistically significant (x2 =68.002,P =0.000).The sensitivity of the cytology examination of EUS-FNA specimens in the diagnosis of pancreatic carcinoma was 75.6％,the specificity was 87.8％,Youden index was 0.634,the positive and negative predictive value was 6.196 and 0.227.The detection of K-ras mutations had a sensitivity of 92.3％ and a specificity of 79.6％ in the diagnosis of pancreatic carcinoma,the Youden index was 0.719,the positive and negative predictive value was 4.524 and 0.096.K-ras mutation detection had a higher sensitivity compared with cytology,and the difference was statistically significant (x2 =8.47,P =0.004).The sensitivity was 94.9％ and specificity of 95.9％ using the combination of K-ras mutations and cytology for diagnosing pancreatic cancer,and the specificity was obviously increased compared with only k ras mutation detection and the difference was statistically significant (x2 =6.13,P =0.013).Conclusions K-ras mutation detection of EUS-FNA specimen using nano capture probe system can significantly improve the sensitivity of diagnosing pancreatic cancer,and the sensitivity and specificity could be further improved when combined with cytology.
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Objective To detect K-ras mutations in plasma by a nano capture probe system , and to explore the diagnostic and prognostic value of this method for patients with pancreatic cancer .Methods The clinical data of 62 patients with pancreatic cancer , 38 patients with benign pancreatic diseases and 31 healthy controls admitted in the Second Affiliated Hospital of Jiaxing Medical College from June 2013 to June 2015 were collected.The diagnosis of all the patients were confirmed by pathology .The DNA were extracted from all plasma samples and were detected for the codon 12 and 13 mutation of K-ras gene by nano capture probe and conventional PCR plus direct sequencing .The correlation of K-ras gene mutation with certain clinical data and the diagnostic and prognostic value in pancreatic cancer were analyzed .Results The K-ras mutation were detected by nano capture probe in 27 pancreatic cancer patients , and the mutation rate was 43.5%(27/62), including 25 cases with codon 12 mutation and 2 cases with codon 13 mutation .The K-ras mutation rate in patients with benign pancreatic diseases was 7.9%(3/38), which were all in codon 12.K-ras mutation was detected in only 17 pancreatic cancer patients by conventional PCR plus direct sequencing , and the mutation rate was 27.4%(17/62), The K-ras mutation rate of benign pancreatic diseases was 5.3%(2/38).The mutation rate detected by nano capture probe was higher than that by conventional PCR , and the difference was statistically significant (P=0.006).K-ras mutation in the plasma of patients with pancreatic cancer was related to TMN stage and liver metastasis , but there was no correlation of the factors such as sex , age, clinical symptoms, tumor size, serum CA19-9 and CEA levels with K-ras mutation.The sensitivity of K-ras gene mutation for diagnosing pancreatic cancer was 43.5%, the specificity was 92.1%, the positive predictive value was 90%, the negative predictive value was 50%, Youden index was 0.356.The 1-year survival rate of patients with K-ras mutation was 44.4%, which was lower than that (71.4%) of patients with wild-type K-ras, and the difference was statistically significant (P<0.05).Conclusions The nano capture probe system could certainly detect K-ras mutation in a small quantity of plasma DNA , and its diagnosis sensitivity for pancreatic cancer is low , but the specificity is relatively high .K-ras mutation in plasma is closely related to the TMN stage and prognosis of pancreatic cancer .
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For human solid tumors,the preferred treatment is surgery.However most patients with clinical diagnosis of tumor is already in advanced,and lost the chance of operation.Cleavage and polyadenylation specific factor is involved in mRNA 3' end cleavage and polyadenine (A) tail,and plays an important role in mRNA maturation and intracellular singal transduction.Under certain conditions,cleavage and polyademletion specific factor can lead to abnormal activation of cancer genes,and then cause tumors.Progress in the relation between cleavage and polyademletion specific factor and tumor was reviewed in the paper.
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Objective To explore the value of endoscopic nasopancreatic drainage (NPD) in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) in a high-risk population.Methods From April 2009 to February 2012,a total of 105 cases of PEP high risk population were collected and divided into non NPD group (n=58) and NPD group (n=47) according to the situation during the endoscopic retrograde cholangiopancreatography(ERCP) operation.NPD was placed in NPD group,the head of the drainage passed the neck of pancreas under X-ray.Nasobiliary drainage or no drainage was assigned to the group of non NPD group according to the situation during operation.x2 test and t-test were performed for comparing and analyzing the clinical data before and post operation,the incidence and risk ratio of PEP between the two groups.Results Twenty-four hours after ERCP,the mean level of serum amylase at 24 h (t=2.419),the degree of abdominal pain (t3h=2.585,t24h=7.236) and relief time (t=4.996) of NPD group were better than those of non NPD group (all P＜0.05).The incidence of PEP in NPD group was 6.7％(3/45) and non NPD group was 29.3 ％ (17/58),the incidence of PEP in the NPD group was significantly lower than that in the non NPD group (x2 =8.304,P＜0.01),and the relative risk was 0.172 (95％CI:0.047 to 0.632,P＜0.01).Conclusion The regular placement of endoscopic NPD is a practical,effective and easy way to prevent PEP in high risk population.
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Objective To study the expressions of metadherin (MTDH),E-cadherin and β-catenin in the tissues of hepatocellular carcinoma (HCC),to investigate the relationship between them and the clinical-pathological features,and to evaluate the prognostic values after surgical resection for hepatocellular carcinoma.Methods The protein expressions of MTDH,E-cadherin and β-catenin were studied by immunohistochemistry in tumor tissues of 107 HCC patients who underwent curative surgical resection.The data were correlated with the clinical-pathological data,tumor free time and recurrence rate.Results Positive expression of MTDH and nuclear β-catenin accumulation were correlated with the Edmondson grade (P＜0.05) and decreased E-cadherin expression was correlated with the preoperative serum level of α-fetoprotein (AFP) (P＜0.05).All these expressions were associated with a shorter tumor-free survival and a higher recurrence rate (P＜0.05).Positive MTDH expression was correlated with decreased E-cadherin expression and nuclear β-catenin accumulation (P＜0.05).On Cox regression analysis,MTDH was an independent risk factor of tumour recurrence (RR=3.431,CI=1.254～ 7.318).Conclusions Positive MTDH expression,decreased E-cadherin expression,and nuclear β-catenin accumulation indicated a higher recurrence rate after curative surgical resection for HCC.MTDH was an independent risk factor of recurrence.
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Objective To investigate the incidence of occult pancreatobiliary reflux and to evaluate its relation to gallbladder epithelial dysplasia and cancer. Methods From July 2006 to Feb 2008,956 cases underwent selective biliary procedure or preoperative endoscopic retrograde cholangiopanereatography (ERCP), bile was collected and amylase was measured. All removed gallbladders were pathologically examined for dysplasia and cancer. Results Occult pancreatobihary reflux was found in 75 of 754 patients in this study, with an incidence of 9. 9%. The biliary amylase values in the patients with occult pancreatobiliary reflux and in controls were 7701±20 378 IU/L and 16±51 IU/L, respectively ( P <0. 01 ).Gallbladder dysplasia and cancer were found in 31.0% and 3.4% of the patients with occult pancreatobiliaryreflux, respectively, and both were higher than those in the patients without pancreatobiliary reflux ( P <0. 05). In the patients with occult pancreatobiliary reflux, the biliary amylase level with gallbladder dysplasia or cancer was 2388 ± 2745 IU/L and was higher than those without gallbladder dysplasia or cancer (P < 0. 01 ). Conclusions With an incidence of 9.9% in patients of normal pancreatobiliary junction,the occult pancreatobihary reflux may contribute to the pathogenesis of gallbladder epithelial dysplasia and cancer.
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Objective To explore how to improve the curative effects and reduce the complications of duodenoscopy in the treatment of bile duct diseases. Methods Clinical data of 292 cases of endoscopic sphincterotomy (EST) and 104 cases of endoscopic nose biliary drainage (ENBD, including 9 post-EST cases) from February 1995 to February 2003 were retrospectively reviewed. Results The success rate of EST was 92.1% (269/292). Among 272 cases of common bile duct calculus, stones were completely taken out in 235 cases (86.4%). Among 15 cases of intrahepatic duct calculus, stones were completely removed in 4 cases. Biliary duct foreign bodies were removed at once in 3 out of 5 cases. EST related complications were found in 16 cases (7 cases of acute pancreatitis, 5 cases of bleeding at the site of incision, 2 cases of severe cholangitis, 1 case of duodenal perforation and 1 case of instrumental break-off), with an incidence rate of 5.5% (16/292). Satisfactory outcomes were achieved in 92 cases receiving ENBD. No death occurred in the study. Conclusions Proper selection of patients and skillful performance of EST is the key to improve its curative effects and reduce its complications.