Study on the preoperative clinical criteria for nerve-sparing radical prostatectomy / 肿瘤研究与临床

Objective@#To investigate the preoperative clinical criteria for nerve-sparing radical prostatectomy.@*Methods@#A retrospective analysis of 79 patients undergoing radical prostatectomy with complete clinical and pathological data in Jinhua Hospital of Zhejiang University from January 2012 to December 2016 was performed. The distance between the edge of the prostate tumor and the neurovascular bundle (NVB) was measured. When the distance between the edge of the tumor and the ipsilateral NVB was >2 mm, NVB retention surgery can be performed; when it was ≤2 mm, NVB retention surgery cannot be performed. The influencing factors of the distance between the tumor edge and NVB were analyzed by χ 2 test and logistic regression analysis.@*Results@#Univariate analysis showed that side-specific positive biopsy core ≥1/3, side-specific maximum tumor length in biopsy core ≥5 mm, side-specific tumor involvement rate in biopsy core ≥1/2 and extraprostatic cancer extension by preoperative magnetic resonance imaging (MRI) examination were associated with the distance between the tumor edge and NVB (all P < 0.01). Multivariate analysis showed that extraprostatic cancer extension by preoperative MRI examination (OR = 3.66, P = 0.006) and side-specific positive biopsy core ≥1/3 (OR = 3.39, P = 0.008) were the independent influence factors.@*Conclusion@#The clinical criteria for a nerve-sparing radical prostatectomy are side-specific positive biopsy core <1/3 and no extraprostatic extension by preoperative MRI examination.

Application of modified Veil nerve-sparing technique in laparoscopic radical prostatectomy / 中国医师进修杂志

Objective To explore the application and early efficacy of modified Veil nerve-sparing technique during laparoscopic radical prostatectomy(LRP).Methods Fifty-seven modified Veil nerve-sparing during LRP procedures were performed in patients with clinically localized prostate cancer between 2012 and 2016 by the same surgeon.Preoperative PSA level was 10.9 μg/ml,and Gleason score was 6.06(5-8).TNM clinical stage showed cT1 in 39 cases and cT2in 18 cases.All patients underwent transrectal ultrasonography before operation. Prostate volume was 40.2 (26- 99) ml. ECT bone scan excluded bone metastasis.MRI or CT examination showed no obvious prostate invasion and lymph node metastasis. The key technology was anatomical separation of detrusor apron, dorsal vascular complex (DVC) and the level between the prostate capsule, and a complete reservation was accomplished. Measurements: the rates and location of positive surgical margins (PSM) and tumor biochemical recurrence rate as well as functional outcomes were presented.Questionnaires were used to assess urine function and IIEF-5 score was used to estimate sexual function.Results Fifty-seven cases were followed up,and the average follow-up of 27.3(6-65)months.Five cases showed biochemical recurrence after 23 months.Five patients had a PSM(2 patients in apical margins,1 patient in left side,1 patient in right side and 1 patient in the bottom).At catheter removal,49 of 57 patients(86%)were dry(0 pads),and 8 of 57 patients(14%)needed one security pad.After 3 months and 6 months,42%(24 of 57 patients)and 60%(34 of 57 patients)presented an International Index of Erectile Function score>15(with or without phospho-diesterasetype-5inhibitors). Conclusions The modified Veil nerve-sparing technique during LRP can retain the fascia around the prostate more completely and restore postoperative urine and erectile function early.For selective cases, it will not increase the positive rate of surgical margins and biochemical recurrence rate.

Application of pubovesical complex preserving technique during laparoscopic radical prostatectomy / 中华泌尿外科杂志

Objective To describe a novel pubovesical complex preserving technique for laparoscopic radical prostatectomy and to evaluate its postoperative outcomes.Methods From January 2011 to May 2017,168 patients who underwent laparoscopic radical prostatectomy were enrolled and analyzed retrospectively.Their mean age were 62.8 (46-74) years,preoperative PSA 11.3ng/ml,Gleason score 6.7,preoperative prostate volume 46.5 ml.They all got preoperative potency (IIEF-5 score ≥ 15 score).TNM clinical stage:cT1 123 cases,45 cases cT2.There were 59 patients with pubovesical complex preserving technique for laparoscopic radical prostatectomy (group A):without pelvic fascia cut and deep vein complex suture.The preservation of the periprostatic anatomy was kept by preserving the pubovesical complex,including detrusor apron with pubovesical ligaments,DVC and NVB.There were 46 patients with conventional intrafascial laparoscopic radical prostatectomy (group B) and 63 patients with interfascial laparoscopic radical prostatectomy(group C).No differences were found between the three groups in terms of preoperative age,clinical staging,prostate-specific antigen (PSA) values,Gleason score at biopsy and preoperative good potency (IIEF-5 score)(P ＞0.05).Continence was defined as zero to one security pad per day.The three groups were compared for perioperative variables,PSM (positive surgical margin,PSM)rate,postoperative urinary continence functional and potency (IIEF-5 score).Biochemical recurrence-free survival was by Kaplan-Meier and log-rank.Results No differences were found in the three groups in terms of operative times,blood loss,catheterization time and postoperative stay and histologic status (PSM was similar to that of the groups (8.5％ in group A,13.0％ in group B vs.11.1％ in group C).Urinary incontinence:group A,the continence rate was 71％,82％,92％ and 100％ at 1,3 and 6 months after catheter removal,respectively;group B,the continence rate was 63％,80％,89％ and 96％ respectively;group C,it was 24％,54％,79％ and 86％ respectively.The group A showed a significantly earlier recovery from incontinence compared with that in the group C at immediately after catheter removal and 1 month after catheter remove (x2 =27.47,P ＜ 0.001;x2 =15.20,P ＜ 0.01).The group B showed a significantly earlier recovery from incontinence compared with that in the group C at immediately after catheter removal and 1 month,(x2 =17.00,P ＜ 0.01;x2 =8.20,P ＜ 0.05).No differences were found between the A and B groups at immediately after catheter removal and 1 month,(P ＞ 0.05).Regarding sexual function,at the postoperative 1,3,6 months,median IIEF-score was 10,11,16 in the group A,respectively,8,9,13 in the group B respectively,and 7,8,12 in the group C respectively.No differences were found in the three groups in potency (IIEF-5 score).Baseline IIEF-score was reached by 53％,35％ and 21％ at postoperative 6 months.There were significant differences between the A and the C groups.(x2 =13.45,P ＜0.01).There were no significant differences between the A and the B groups.(x2 =3.30,P ＞ 0.05).Follow-up was 31.6 (6-69) months.Biochemical recurrence-free survival at 3 years was 79.3％,76.3％ and 76.4％ by A,B and C group,respectively.Conclusions The pubovesical complex preserving technique for laparoscopic radical prostatectomy provides early recovery from incontinence,faster recovery of sexual function preoperative levels.

Variation in activity concentration of 210Pb in atmospheric aerosol and its radiation dose assessment in Qingdao / 中华放射医学与防护杂志

Objective To investigate the variation patterm in activity concentration of 210Pb in atmospheric aerosol in Qindao and evaluate its internal radiation effect to human body.Methods 210Pb activity concentration of aerosol samples was measured by high purity germanium(HPGe) γ spectrometer for purpose of ascertaining its variation in aerosol in Qingdao from April 2015 to March 2016.Results 210Pb activity concentration in aerosol varied from 0.06 to 1.61 mBq/m3 and the mean of (0.70 ± 0.50) mBq/m3,slightly higher than the UNSECAR 1988 report recommended value of O.50 mBq/m3.In this study,210Pb activity concentration in aerosol was high from December 2015 to February 2016 and low from August to November.Radiation dose assessment revealed that the annual committed effective dose to adults delivered by 210Pb was 6.35 × 10-6 Sv.The monthly variation in activity concentration variation of 210Pb in atmospheric aerosol in Qingdao was similar as in Xiamen.Conclusions Activity concentration of 210Pb in atmospheric aerosols in Qingdao varied largely dependent on atmospheric environmental pollution.210Pb contributed less to the adult annual committed effective dose.However,more attention should be drawn to the long-term radiation effects to aduhs due to the 210Pb potentially deposited in lungs.

Hypoxia-inducible factor-1α and CD133 predicts pathological complete response and survival for locally advanced rectal cancer patients after neoadjuvant chemoradiotherapy / 浙江大学学报·医学版

To investigate the expression of hypoxia-inducible factor 1α (HIF-1α) and CD133 in predicting pathologic remission and survival of patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy.One hundred and fourteen patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy from January 2010 to December 2015 in Jinhua Municipal Central Hospital were enrolled in the study. RT-PCR and immunohistochemistry methods were used to detect the mRNA and protein expression of HIF-1α and CD133 before and after chemoradiotherapy. Spearman rank correlation was used to analyze the correlation between HIF-1α and CD133 mRNA expression. Univariate and logistic multivariate analyses were used to determine the factors related to pathological complete response (pCR). Logistic regression analysis and Cox's proportional hazard model were used to determine factors related to overall survival and recurrence-free survival.The expression of HIF-1α and CD133 mRNA was correlated with pT, ypTNM, pCR, recurrence and metastasis of rectal cancer, while not correlated with sex, age and BMI of patients. HIF-1α mRNA expression was positively correlated with CD133 mRNA expression (=0.579,=0.000). Immunohistochemistry analysis showed that residual cancer cells strongly expressing HIF-1α also expressed CD133 strongly. Univariate analysis showed that HIF-1α mRNA and CD133 mRNA were significantly correlated with pCR (=0.001,=0.022, respectively). Multivariate analysis showed that HIF-1α and CD133 mRNA expression were independent prognostic factors of pCR (=0.012,=0.047, respectively). Cox regression analysis showed that the expression of HIF-1α mRNA and CD133 mRNA were independent predictors of recurrence-free survival and overall survival (=0.025,=0.033, respectively).The study indicates that HIF-1α and CD133 can predict pathological complete remission and survival of patients with locally advanced rectal cancer.

A randomized controlled trial comparing the efficacy and toxicities between neoadjuvant concomitant boost intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal radiotherapy (3-DCRT) for locally advanced rectal cancer / 中华放射医学与防护杂志

Objective To compare the efficacy and toxicities between preoperative concomitant boost intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal RT (3-DCRT) for locally advanced rectal cancer.Methods A prospective study from May 2010 to May 2015.A total of 130 patients with histologically confirmed,newly diagnosed,locally advanced rectal adenocarcinoma (cT3-T4 and/or cN +) located within 10 cm from the anal verge were included in this study.The patients were divided into IMRT and 3D-CRT groups by random number table method.Sixty-six patients were treated with IMRT,and the other sixty-four patients were treated with 3-DCRT.In the IMRT group,the prescription dose was 1.8 Gy/fraction to 45 Gy to the pelvis and 2.2 Gy/fraction to 55 Gy to the gross tumor volume simultaneously.The 3D-CRT prescription was 45 Gy in 25 fractions to the pelvis.Capecitabine (1 650 mg· m 2 · d-1) was given twice daily from days 1 to 14 and days 22 to 35 during RT in both arms.Total mesorectal excision (TME) was scheduled 6-8 weeks after the completion of chemoradiation.Results There were no significant differences in age,gender,tumor location,pathological differentiation degree and clinical stage between the two groups.Two patients withdrew from the study:one for grade 3 radiation dermatitis in IMRT group and the other for grade 3 fatigue in 3D-CRT.There was no significant difference in hematologic or nonhematologic toxicities between the two groups.No grade 4 or 5 toxicity was observed in either group.Compared with conformal radiotherapy,IMRT did not increase the difficulty of surgery.No significant difference was found in type of surgery or postoperative complications between the two groups.The rate of tumor regression grade (TRG) 4 (pathologic complete response,pCR) was 22.7％ for IMRT and 15.6％ for 3D-CRT,respectively(P ＞ 0.05).The rate of both TRG4 and 3 was 42.4％ for IMRT and 25.0％ for 3D-CRT,respectively (x2 =4.406,P=0.036).Conclusions Neoadjuvant concomitant boost IMRT is feasible and has a higher histopathological regression for patients with locally advanced rectal cancer.Trial registration Chinese clinical trial registry,ChiCTR-IN R-16008004.

Study of molecular genetic on diffuse large B -cell lymphoma / 中国基层医药

Objective To study the molecular genetic characteristics and immunophenotype of diffuse large B -cell lymphoma (DLBCL),thus to provide evidence in further research.Methods 92 patients with DLBCL were selected.Immunophenotype was classified by Hans method,bcl -2 and bcl -6 were detected by fluorescence in situ hybridization(FISH).The relationship between immunophenotype and genes expression was analyzed by SPSS 19.0. Results There were GCB with 28 cases(30.43%)and non GCB with 64 cases(69.57%).Bcl -2 gene abnormality was more found in GCB(χ2 =38.39,P 0.05).There was no correlation between bcl -2 translocation and bcl -6 translocation(r =0.095,P >0.05),but there was significant correlation between bcl -2 amplification and bcl -6 translocation(r =0.750,P 0.05 ).Conclusion Bcl -2 gene abnormality was more found in GCB,but the relationship between bcl -2 and bcl -6 is not clear.There may be no correlation between location and molecular genetic.

The clinical pathological analysis of intestinal neuronal dysplasia type B / 中国小儿急救医学

Objective To investigate the clinicopathological features and diagnosis of intestinal neu-ronal dysplasia type B.Methods Between January 2004 and August 2014 , 9 patients ( 5 males and 4 females) were treated for constipation and abdominal distention,and in all of them an intestinal neuronal dys-plasia type B was confirmed histopta holoig cally.The age of 9 patients ranged from 3 months to 1 year old ( mean 7.8 months) .The specimen of 9 patients was routinely takne by paraffin-embedded full-circumference sections of lesional bowel,hematoxylin and eosin and immunohits ochemical stainign were carried out on the specimen.The patholgo ical morphology and quantitative of inet stinal en urons and ganglia were retrospectively analyzed.Results Total of the 9 patients,the number and density of myenteric ganglia increased significant-ly increased in the lesional bowel,the pathological findings included giant nerve plexus,isolated and ectopic ganglia.In the proximal bowel,the number and density of myenteric ganglia were observed abnormal on giant nerev plexus, isoal ted and ectopci ganglia was osb erved.Combinated these pathological findings and symp-toms,intestinal neuronal dysplasia type B was diagnosed.Conclusion The diagnosis of ni testinal neuronal dysplasia type B relies on typical presentations of allied disorders of Hirschsprung′s disease,giant ganglia, isolated and ectopic ganglia,and increasing the density of giant submucosal ganglia of pathologic morpholo-gy,meanwhile,excludingo thers prima ry etiologies.

Clinicopathologic analysis of 254 cases of papillary thyroid microcarcinoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To evaluate the prognostic impact of tumor size, ultrasonography, central neck lymph node involvement, and age of patients in papillary thyroid microcarcinoma (PTMC).</p><p><b>METHODS</b>Two hundred and fifty-four patients who underwent total thyroidectomy and central neck dissection for PTMC between 2012 and 2014 were included in this retrospective study. Statistical correlation between tumor size and various clinicopathological parameters was assessed by univariate and multivariate analyses. The ultrasound findings were also evaluated.</p><p><b>RESULTS</b>A total of 254 patients (199 females and 55 males) were included in this study. PTMC showed a predilection for female patients, 41-50 years of age (43.3% of all cases, 110/254), and ultrasound showed hypoechoic nodules. Statistically significant correlation was demonstrated between central neck lymph node involvement and the following factors: age and tumor size. A tumor diameter greater than 0.5 mm (67.3% of all cases) most commonly occurred in patients older than 41 years, and was associated with a higher risk of metastatic central neck lymph node involvement (P<0.05). Hashimoto's thyroiditis was noted in the background in 39.4%(100/254) of cases.</p><p><b>CONCLUSIONS</b>Tumor size appears to have a prognostic impact in PTMC, and larger size is more likely to be associated with a higher risk of central neck lymph node involvement. It is controversial whether the etiology of papillary thyroid carcinoma is related to Hashimoto's thyroiditis.</p>

Significance of P504s in distinction between solid pseudopapillary tumor of pancreas and pancreatic neuroendocrine tumors / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the significance of P504s in differential diagnosis between solid pseudopapillary tumor of the pancreas (SPTP) and pancreatic neuroendocrine tumors (PanNET).</p><p><b>METHODS</b>Forty-three patients with SPTP and 41 patients with PanNET encountered during the period from 2007 to 2014 were recruited. Immunohistochemical study for vimentin, CD10, chromogranin A, synaptophysin, beta-catenin, CD99 and P504s in SPTP and PanNET was performed. The diagnostic value of P504s in differentiating SPTP from PanNET was analyzed.</p><p><b>RESULTS</b>Immunohistochemical study showed that vimentin, CD10, chromogranin A, synaptophysin and CD99 were expressed both in SPTP and PanNET. All cases of SPTP showed granular cytoplasmic expression of P504s, whereas those of PanNET were negative.</p><p><b>CONCLUSION</b>P504s is a sensitive and useful marker for SPTP and can be used in the distinction between SPTP and PanNET.</p>

Expressions and significances of TBX2 and MDM2 protein in urothelial carcinoma of bladder / 中国医师进修杂志

Objective To evaluate the expressions of TBX2 and MDM2 protein in urothelial carcinoma of bladder.Methods The expressions of TBX2 and MDM2 protein were examined by immunohistochemistry EnvisionTM Plus method in 90 cases of urothelial carcinoma of bladder and 20 cases of normal bladder mucosa tissue.Results The positive rate of TBX2 and MDM2 protein was 0 in normal bladder mucosa tissues.The positive rate of TBX2 in urothelial carcinoma of bladder was 65.6％ (59/90).With the increased of TBX2 expression degree,the carcinoma tissue was worse cell differentiation,later clinical stage,more prone to recurrence (P ＜ 0.01).The positive rate of MDM2 in urothelial carcinoma of bladder was 31.1％(28/90).With the decreased of carcinoma tissue differentiation degree,the positive rate of MDM2 was increased (P ＜ 0.01).The positive rate of MDM2 in recurrence patients was 57.5％ (23/40),in non-recurrence patients was 10.0％ (5/50),there was statistical difference (P ＜ 0.01).The positive rate of MDM2 in pTNM stage Ta-T1 was 0,in pTNM stage T2-T3 was 73.7％ (28/38),there was statistical difference (P ＜0.01).There was positive correlation between the expression of TBX2 and MDM2 in carcinoma tissue (r =0.487,P ＜ 0.05).Conclusions The over expression of TBX2 and MDM2 protein may closely associated with aggressive biological behavior and recurrence in urothelial carcinoma of bladder.Combined analysis of TBX2 and MDM2 may provide a theoretical basis for prognostic information and treatment of patients with urothelial carcinoma of bladder.

Sclerosing polycystic adenosis of salivary gland:a clinicopathologic analysis of 2 cases and review of literature / 中国基层医药

Objective To investigate the clinicopathologic features of sclerosing polycystic adenosis(SPA)of salivary gland.Methods The clinical and pathologic profiles of 2 SPA cases were evaluated.Immunohistochemical study was performed on fixed tissues.The biologic behavior was analyzed with follow-up data.Results The main clinical manifestation of patients was parotid painless nodules.Histological features were embedded cystic dilatation of ducts and alveoli as hyaline sclerosis collagen tissue background,catheter see apocrine metaplasia,focal areas of ductal epithelial hyperplasia and dysplasia.Immunohistochemical staining for calponin and SMA staining showed that the catheter had a layer of myoepithelial cells.Conclusion Sclerosing polycystic sialadenopathy of parotid is a rare disease,the cause and course of the disease are not very clear,but the literature reports are atypical ductal epithelial remarkable phenomenon,thus strengthen the follow-up to patients.

Significance of expression and promoter methylation of LITAF gene in B-cell lymphoma / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate promoter methylation status of LITAF gene in B-cell lymphoma and to explore transcription regulation of 5-Aza-2'-deoxycytidine (5-Aza-CdR) on LITAF gene.</p><p><b>METHODS</b>One hundred and five paraffin specimens including 54 cases of diffuse large B cell lymphoma (DLBCL), 15 small lymphocytic lymphoma (SLL), 8 mucosa-associated lymphoid tissue lymphoma (MALT) and 6 follicular lymphoma (FL) were included. Five reactive lymphoid hyperplasia samples were collected as control. Methylation status of CpG island in LITAF gene in the specimens and in Raji, Pfeiffer and Daudi cell lines were detected by methylation-specific PCR (MSP). LITAF expression in Raji, Pfeiffer and Daudi cell lines with or without 5-Aza-CdR treatment was detected by Western blot and immunohistochemistry. The inhibitory ratio in the three cell lines was measured by MTT assay.</p><p><b>RESULTS</b>The frequency of LITAF gene methylation in B-cell lymphoma was 89.5% (94/105) . Among them, 3.8% (4/105) showed complete hypermethylation. In control group, however, there was no methylation in CpG island of LITAF gene promoter. The expression of LITAF was recovered or increased along with the cell growth inhibition when the cells exposed to demethylating reagent.</p><p><b>CONCLUSIONS</b>LITAF gene silencing with aberrant CpG methylation is probably one of the critical events to the oncogenesis of B-cell lymphoma, which may have important implications as a candidate marker for diagnosis and target gene therapy.</p>

Selective decongestive devascularization shunt of gastrosplenic region for treatment of portal hypertension / 中华肝胆外科杂志

Objective To evaluate the curative effect of selective decongestive devascularization shunt of gastrosplenic region(SDDS-GSR) for the treatment of portal hypertension. Methods From September 2000 to June 2008, 44 patients with portal hypertension had received SDDS-GSR in our hospital. Twenty-nine of them had been followed up for 12-85 months (mean=44months). Results Operative mortality was 0 %. Mesenteric area pressure(33.82±5.12 cm H_2O) was higher than splenic area pressure(24.57±4.63 cm H_2O)soon after the operation finished(P<0.01). No re-bleeding ca-ses were found, and the encephalopathy occurred in 2.27% of the patients in the early stage of post-operation. However, the rates of 3.45% for re-bleeding and 3.45% for encephalopathy were noticed in long-term follow-up. The 1-, 3- and 5-year survival were 100%, 95% and 95%, respectively. Dur-ing the long-term follow-up, the platelet counts markedly increased from (49.2±21.8 × 10~9/L) of preoperative value to (77.2±29.5×10~9/L) (P<0.01), while spleen size was significantly reduced.Conclusion SDDS-GSR is a reliable and reasonable surgical procedure for the management of portal hypertension.

Hepatolithiasis concurrent with intrahepatic cholangiocarcinoma / 中华普通外科杂志

Objective To investigate the clinical features and management of hepatolithiasis associated with intrahepatic cholangiocarcinoma. Methods Data of 84 patients of hepatolithiasis associated with intrahepatic cholangiocarcinoma in our hospital from 1990 to 2009 were retrospectively analyzed.Results The incidence of intrahepatic cholangiocarcinoma in patients of hepatolithiasis was 4. 6%(84/1840), among them only 47 patients got a definite diagnosis before operation. All cancer located in the bile duct containing cholelith. In 20 patients intrahepatic cholangiocarcinoma was identified 6 - 16 years after lithotomy. The clinical manifestation of hepatolithiasis associated intrahepatic cholangiocarcinoma included:refractory hepatic abscess, incurable infection of intrahepatic biliary tract, and progressive obstructive jaundice. Only 35 patients received radical excision, 26 patients received palliative excision, 4 patients received radiofrequency ablation therapy, 19 patients received biopsy only. Conclusions There has been a considerable high coincidence between intrahepatic cholangiocarcinoma and hepatolithiasis. Resection of the lobe containing intrahepatic stones may help to prevent the development of intrahepatic cholangiocarcinoma.

Features and significance of lymph node metastasis patterns in radical cystectomy for the treatment of bladder cancer / 中华泌尿外科杂志

Objective To evaluate the features of pelvic lymph node metastasis and the significance of lymph node dissection in bladder cancer patients treated with radical cystcetomy. Methods The data of 77 bladder cancer patients(58 males and 19 females with mean age of 57 yrs)treated with radical eystectomy and pelvic lymph node dissection from Jan. 1990 to Dec.2008 were analyzed retrospectively.Preoperative TNM staging showed stage T1 tumor of 9 cases,stage T2 of 24 cases,stage T3 of 39 eases and stage T4 of 5 cases.The pelvic lymph nodes were divided into 5 groups according to the anatomic sites.The metastatic rate and dissected lymph node positive rate in these patients were compared. Results The metastatic rate and dissected lymph node positive rate were 27.3%(21/77)and 14.8%(233/1576),respectively.The metastatic rate in these patients from higher to lower were as follows:obturator group 19.5%(15/77),internal iliac group 19.3%(11/57),external iliac group 13.7%(10/73),common iliac group 5.3%(3/57)and presacral group 3.8%(1/26),with a significant difference in those groups,P<0.01.The dissected lymph node positive rates from higher to lower were as follows:external iliac group 23.0%(83/361),obturator group 22.1% (103/467),common iliac group 9.5%(17/179),internal iliac group 6.8%(28/411)and presacral group 1.3 % (2/158), with a significant difference in those groups, P<0.01. There was no metastasis in 9 eases with stage T, tumor. Conclusions In the radical cystectomy for the treatment of bladder cancer, it is suggested that the regional lymph nodes with higher metastatic rate should he resected accordingly, and the group with a higher metastatic rate should be dissected completely. The operation extent may be adjusted according to the result of sentinel lymph node biopsy in the obturator or presacral groups. The pelvic lymphadenectomy is not suggested in the cases of stage T1 tumor.

Effect of wild type parkin gene on growth of hepatocellular carcinoma cells / 中华肝胆外科杂志

Objective To explore the effect of wild type or mutant parkin gene expression on the growth of human hepatocellular carcinoma cell line Huh-7. Methods The parkin (wild type or mutant) expression vector and empty vector were transferred into Huh-7 cell lines with LipofectAMINE 2000 reagents. The positive clones that expressed parkin gene stably were chosen by G418 and checked by reverse transcription-polymerase chain reaction (RT-PCR) to check the DNA sequences. The cytobiological behaviors of those positive clones were analyzed by cell proliferation assay and tumorigenesis in nude mice. Results Huh-7 cell lines that expressed wild type or mutant parkin gene stably were successfully established. The growth of wild type parkin-expressed cells was obviously inhibited compared with the control cells transfected with empty vectors(t= 3. 875, P= 0. 031).The volume of tumor formed by wild type parkin-expressing cells in nude mice was also significantly reduced (t=8. 228,P=-0. 003). Mutant parkin gene expression had a slight effect on the growth of Huh-7 cells in vitro and in vivo (P＞0.05). Conclusion The re-expression of wild type parkin gene can favor the malignant phenotype revision of Huh-7 cells. Therefore, it might be a good candidate for tumor suppressor gene associated with HCC.

PI_3 K/Akt signal effects Ephrin-A1 mediated malignancy of HCC cells / 中华普通外科杂志

Objective To investigate the role of PI_3 K/Akt signal pathway in Ephrin-Al gene mediated invasion,metastasis of Huh-7 cells.Methods Western blot was used to test the protein expression of phosphatidylinositol 3-kinase(PI_3 K)and mitogen-activated protein kinase(MAPK)after Huh-7 cells were treated with Ephrin-A1/Fc fusion protein.According to the protein expression,LY294002 was used to block PI_3 K/Akt pathway specifically,then p-Akt protein expression,mobility and invasive ability of Huh-7 cells were examined.Results In Huh-7 cells actived by Ephrin-Al/Fc fusion protein,p-Akt expression was higher than that in control group(t=4.564,P＜0.05),but there was no difference of p-p38MAPK expression between Ephrin-Al/Fc fusion protein group and IgG/Fc fusion protein group(P＞0.05).PI_3 K/Akt pathway was specifically blocked by LY294002,the p-Akt protein expression decreased in Huh-7 cells,and the mobility and invasive ability mediated by Ephrin-Al in Huh-7 cells decreased(P＜0.05).Conclusions PI_3 K/Akt pathway effects an important role in mobility and invasive ability of Huh-7 cells mediated by Ephrin-A1.

Clinicopathological analysis of 58 cases of gastrointestinal stromal tumor / 肿瘤研究与临床

Objective To investigate the clinical presentation, morphological features, immunohistochemical staining of the gastrointestinal stromal tumor (GIST), and its histogenesis as well. Methods The morphologic characteristics of GISTs were studied in 58 cases using light microscopy. The expression of c-kit(CD117), CD34 and vimentin were detected in all of the cases with EnVision staining. Results Among 58 cases of GISTs, 41 were spindle cell type, 5 epithelioid cell type and 12 mixture type, equivalent to 86.6 %(58 of 67) of all of the mesenchymal tumors of gastrointestinal tract admitted in the same period. The epithelioid cell type tumors were mainly composed of the epitheloid cells, predominantly short spindle, oval or round in pattern, with an overall eosinophilic cytoplasm by hematoxylin-eosin stain. Focal cytoplasmic vacuolization was often seen. Sometimes signet-ring like cells and cells with a clear cytoplasm were seen in the epithelioid stromal tumor. The tumor cells arranged in interlacing fascicles forming whorls or sometimes cell clusters. All of the 58 stromal tumors were strongly positive for vimentin (100 %), 55 out of 58 tumors positive for CD117 (94.8 %) and 46 out of 58 positive for CD34(79.3 %). Some cases also expressed SMA, actin, S-100 and MBP. Conclusions GISTs were the most common mesenchymal tumor seen in the gastrointestinal tract. Under light microscope, the morphology of stromal tumors sometimes looks like a leiomyoma or Schwannoma. The application of immunohistochemical markers (particularly CD117 and CD34) is considered necessary for the differential diagnosis. GISTs may originate from the pluripotential precursor cells like the interstitial cells of Cajal.

Study of surgical style of treating acute mesenteric venous thrombosis / 中国实用外科杂志

Objective To explore the best therapeutic methods for acute mesenteric venous thromboses(AMVT)with different degrees of intestinal ischemic lesions. Methods 6 cases of acute abdomen were preoperatively diagnosed as AMVT with imaging. After laparotomy, patients were classified as congestive lesion(n=3)and necrotic lesion(n=3)according to the degree of intestinal sichemia and were treated with mesenteric thrombectomy and bowel resection, respeetively. All cases received heparin and urokinase perioperatively. Results Of the 3 patients receiving mesenteric thrombectomy, 2 were cured and the other one with ischemic ascending colon was cured after right hemicolectomy due to the complication of colic dynamic ileus and perforation 10 days after thrombectomy. The other 3 patients recovered after bowel resection. Follow-up from 8 months to 6 years showed no recurrence. Conclusion Combined with anti-coagulation therapy, thrombectomy and bowel resection are rational and effective protocol for congestive lesion and necrotic lesion, respectively in AMVT patients.