Research progress and discussion on traditional Chinese medicine properties of Kaempferia parviflora / 中国中药杂志

Kaempferiae Parviflorae Rhizoma is the dried rhizome of Kaempferia parviflora in Zingiberaceae. It is originated and widely distributed in Thailand and other tropical and subtropical regions, where it has been used as food and medicine for thousands of years. K. parviflora is also planted in Yunnan and other places of China, but its traditional Chinese medicine properties are not clear, which greatly limits its compatibility with traditional Chinese medicines. In this article, the English and Chinese literatures of K. parviflora were searched from Web of Science, PubMed, Scopus, CNKI, Wanfang, and VIP databases for research and analysis. The medicinal properties of K. parviflora were preliminarily discussed based on the theory of traditional Chinese medicine under the guidance of clinical application and research literatures. The traditional Chinese medicine properties of K. parviflora were inferred as follows: flat, acrid, sweet. The channel tropisms of K. parviflora included kidney, spleen, stomach, and liver. The function of K. parviflora included tonifying kidney to strengthen essence, tonifying Qi and invigorating spleen, soothing liver and relieving depression. K. parviflora was clinically applied for the diseases such as syndrome of kidney essence deficiency, sex apathy, deficiency of spleen Qi, lassitude and asthenia, a weary spirit, obesity, diabetes, liver Qi stagnation, depression, and restless. The equivalent of dry power is 1.5 g·d~(-1) and the equivalent of decoction is 1.5-6 g·d~(-1). The determination of traditional Chinese medicine properties of K. parviflora has indeed laid a theoretical foundation for its application in the field of traditional Chinese medicine and enriched traditional Chinese medicine resources.

Discussion on traditional Chinese medicine properties of Myrtus communis leaves based on literature analysis and Chinese medicine theory / 中国中药杂志

Myrtus communis is a traditional medicinal aromatic plant in the Mediterranean. At present, the plant has been introduced and cultivated in the southern part of China, and it is mostly used for ornamental or cosmetic purposes. Based on literature analysis and the theory of Chinese medicine, we discussed the medicinal parts and properties of M. communis in this paper to provide a theoretical basis for exploring the medicinal value of M. communis and its compatibility with traditional Chinese medicines. Literatures were searched from Web of Science(core collection), PubMed, CNKI, VIP and Wanfang by using the set conditions as key words. Then the obtained literatures were screened and classified. Finally, a total of 376 articles were included, consisting of 44 reviews, 54 germplasm resources, 78 chemical researches, 48 studies on application, extraction, or quality, 18 human trials, 132 pharmacological studies, and 2 safety studies. Based on literature analysis and theories of Chinese medicine, the leaves of M. communis were finally selected as the medicinal part of Chinese medicine, and the traditional Chinese medicine properties of M. communis leaves were deduced as pungent, bitter, and cool. The channel tropisms of M. communis leaves included lung, liver, and large intestine, with functions of detoxifying, resolving a mass, and insecticide. It was used for mouth sores, vaginal itching, hemorrhoids and warts, etc.; appropriate amount shall be applied for external use, and the decoction form shall be used for washing the affected parts; 3-12 g equivalent product shall be used in decoction, and this herb shall be put into the decoction in a later stage. The clarification of the medicinal parts of M. communis, and the determination of the Chinese medicine properties of M. communis leaves would lay a theoretical foundation for its compatibility and application with Chinese medicines, and can do more contribution to the medical and healthcare industry in our country.

Surgical management and outcome of solid-pseudopapillary tumor of pancreas: a series of 58 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the surgical management of solid-pseudopapillary tumor of the pancreas (SPTP) and its characteristics of outcome.</p><p><b>METHODS</b>Fifty-eight patients with SPTP of the pancreas admitted from January 2001 to December 2010 were retrospectively analyzed. There were 7 male and 51 female patients, with an average age of 30 years (ranging 9 to 70 years). Most patients were symptomatic before admission; the most common symptom was abdominal pain. Of the 58 patients, 21 patients underwent pancreaticoduodenectomy, 30 patients underwent distal pancreatectomy, 6 patients underwent central pancreatectomy, 1 patient underwent simple tumor enucleation, and 1 patients underwent duodenum-preserving pancreatic head resection.</p><p><b>RESULTS</b>The average length of stay in hospital was 23.8 days (ranging 12 to 64 days). Thirteen patients (22.4%) developed postoperative complications, including grade A postoperative pancreatic fistula of 8 cases, gastrointestinal tract bleeding of 1 case, pleural effusion of 2 cases, wound infection and fat liquefaction of 2 cases. Two patients underwent reoperation due to gastrointestinal tract bleeding or wound infection. There was no hospital death. Forty-four patients were followed-up for 7 to 136 months with an average of 41 months. All the 44 patients were alive, while 8 patients developed dyspepsia and 4 patients developed diabetes mellitus. There were no tumor recurrences or metastasis.</p><p><b>CONCLUSIONS</b>SPTP is found primarily in young women. Excellent prognosis would be achieved with surgical resection.</p>

Effects of partial portal vein arterialization on liver regeneration after hepatectomy in minipigs with obstructive jaundice / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hilar cholangiocarcinoma is a malignant tumor that is difficult to cure. The aim of this study was to observe the effects of flow-controlled partial portal vein arterializations (PPVA) on liver regeneration after hepatectomy in minipigs with chronic obstructive jaundice.</p><p><b>METHODS</b>Eight minipigs were made into chronic obstructive jaundice models. United semi-hepatectomy, which imitates extended radical surgery for treatment of hilar cholangiocarcinoma, was then performed. The eight minipigs were randomly divided into groups A and B (n = 4 minipigs each). PPVA was performed in Group A but not in Group B. The effects of flow-controlled PPVA on live regeneration after hepatectomy were observed for 30 days after hepatectomy.</p><p><b>RESULTS</b>The portal vein PO(2) at the immediate time point and on postoperative day 30 was higher in Group A ((47.33 ± 2.43) and (48.50 ± 4.44) mmHg) than in Group B ((35.38 ± 4.06) and (35.55 ± 2.55) mmHg respectively, all P < 0.01). The mitotic index of liver cells on postoperative days 14 and 21 was higher in Group A (12.55% ± 2.85% and 15.25% ± 1.99% respectively) than in Group B (6.85% ± 2.10% and 11.88% ± 1.15% respectively, all P < 0.05). The regeneration rate of residual liver on postoperative days 14 and 21 was higher in Group A (24.56% ± 6.15% and 70.63% ± 9.83% respectively) than in Group B (11.96% ± 5.43% and 44.92% ± 7.42% respectively, P < 0.05 and P < 0.01 respectively).</p><p><b>CONCLUSION</b>Flow-controlled PPVA can promote liver regeneration after hepatectomy and prevent liver failure in minipigs with chronic obstructive jaundice.</p>

Influence of obstructive jaundice on postoperative complications and mortality after pancreaticoduodenectomy: analysis of the 25-year single-center data / 中华外科杂志

<p><b>OBJECTIVE</b>To study the influence of the depth of jaundice, the duration of jaundice and preoperative biliary drainage (PBD) on postoperative complications and mortality after pancreaticoduodenectomy (PD).</p><p><b>METHODS</b>A retrospective review was performed of the medical records of 1025 patients who underwent PD between June 1986 and December 2010. The patients comprised 659 men and 366 women, ranging from 4 to 81 years old with a mean age of (54 ± 12) years. The indications for PD were malignant disease in 869 patients (84.78%) and benign or borderline tumors in 156 patients (15.22%). The operative procedures performed were pylorus-preserving modification in 279 patients and conventional PD, i.e. Whipple's operation in 746 patients. Complications after PD were compared among the different groups which was classified according to the depth of obstructive jaundice, the duration of obstructive jaundice and whether undergoing preoperative biliary drain or not, and the analysis was made by variance analysis and χ(2) test respectively.</p><p><b>RESULTS</b>The depth of jaundice did not significantly affect the incidence of complications after PD except for the hemorrhage complication (χ(2) = 11.06, P = 0.03). The duration of jaundice had no much influence on the postoperative complications and mortality. PBD could not reduce the postoperative complications and mortality, however, it would increase the incidence of postoperative incision infection (χ(2) = 9.84, P = 0.01). No significant relationship was observed between the duration of PBD and the postoperative complications and mortality.</p><p><b>CONCLUSIONS</b>Either the depth or duration of obstructive jaundice has no relationship with the postoperative complications and mortality after PD but the postoperative hemorrhage. Patients undergoing PD can not be benefited from PBD. Consequently, PBD should not be performed routinely, but it can be used in some serious patients with severe depth of jaundice who can not received surgery at once.</p>

Absorbable bandage wrapping in treatment of severe blast liver injury: a miniature swine model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The aim of this research was to evaluate the feasibility and efficacy of absorbable bandage wrapping in the treatment of cases of severe liver trauma.</p><p><b>METHODS</b>Electric firecrackers were detonated in 16 miniature swine to produce a severe blast liver injury. After fluid resuscitation, the animals were randomly divided into two groups (n = 8 each) and were either treated with absorbable bandage wrapping of the injured lobe of liver (Group B) or hepatic lobectomy (Group H). Time to hemostasis, blood loss during the treatment period, and other parameters were compared, including postoperative serum total bilirubin (TB), alanine aminotransferase (ALT), and aspartate aminotransferase (AST).</p><p><b>RESULTS</b>Blood loss during the treatment period was significantly lower in Group B than that in Group H ((81.3 ± 26.0) ml vs. (130.8 ± 29.5) ml, P = 0.0031). Serum AST and ALT were transiently increased post-surgically. These transient increases were significantly higher in Group B. No difference in time to hemostasis was noted ((8.70 ± 2.27) minutes vs. (10.28 ± 1.93) minutes, P = 0.1559) in Groups B and H, respectively. Two pigs were humanely euthanized 28 days post-surgically and the wrapped liver lobes appeared atrophies. Microscopically, there was evidence of emerging and mature fibrous tissue.</p><p><b>CONCLUSION</b>Absorbable bandage wrapping is both feasible and effective in the treatment of severe blast liver injury.</p>

A study of recompression treatment schedule for treating type I decompression illness with medical hyperbaric chamber pressurized / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To observe the therapic effects of the recompression treatment schedule D2 (breathing 100% oxygen at 0.12 MPa gauge pressure) on the type I decompression illness (DCI) by hyperbaric chamber pressurized with air.</p><p><b>METHODS</b>The recompression treatment schedule D2 was from the decompression treatment tables of <Leaflet for the Treatment of Illness in Compressed Air> in Germany BGI690. Seven cases on work site group (work site group) and five cases in hospital (hospital group) were treated using recompression treatment. All cases suffered from type I DCI after normal decompression procedures from working in compressed air in tunnel construction. These patients were treated with basic schedule D2 or extended schedule D2 according to the symptoms of the cases responded to recompression therapy.</p><p><b>RESULTS</b>In the work site group, the pains of joints, arms and legs were released quickly, the therapic effects appeared at (8.1 +/- 8.1) min, the cases were cured with a recompression therapy of basic schedule D2, the total mean time of treatment was (150 +/- 0.0) min. In the hospital group, the pains of joints, arms and legs disappeared slowly, the therapic effects appeared at (115.0 +/- 60.0) min, the cases were cured with a recompression therapy of extended schedule D2, the total mean time of treatment was (270.0 +/- 0.0) min, which was significantly longer than that in the work site group (P<0.01).</p><p><b>CONCLUSIONS</b>The treatment pressure is 0.12 MPa(gauge pressure) in schedule D2 with medical hyperbaric chamber pressurized with air,which can be used for treatment of type I DCI, the curative effects in the work site group are better than those in the hospital group.</p>

Effect of arterioportal shunting in radical resection of hilar cholangiocarcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The resection and reconstruction of the hepatic artery is often required in radical surgery for hilar cholangiocarcinoma. In this study, we report our experience in performing arterioportal shunting as an alternative for the arterial reconstruction.</p><p><b>METHODS</b>Four patients with hilar cholangiocarcinoma underwent extended left hepatectomy and caudate lobectomy combined with en bloc resection of the hepatic artery and arterioportal shunting with restriction of the arterial caliber. The efficacy of arterioportal shunting was assessed by computed tomography angiography (CTA).</p><p><b>RESULTS</b>All the four patients recovered uneventfully without any complications. CTA showed a patent shunt and normal liver regeneration. No signs of portal hypertension were found at one year of follow-up.</p><p><b>CONCLUSIONS</b>Arterioportal shunting with restriction of the arterial caliber appears to be a feasible and safe alternative for the microvascular reconstruction after hepatic artery resection in radical surgery for hilar cholangiocarcinoma.</p>

Experience from surgical resection for 48 cases of hilar cholangiocarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the methods, safety and efficiency of surgical resection for hilar cholangiocarcinoma.</p><p><b>METHODS</b>The clinical and follow-up data of 48 patients with hilar cholangiocarcinoma underwent surgical resection from January 2003 to December 2007 were analyzed retrospectively. There were 26 male and 22 female, aged from 38 to 72 years old with a mean of 63.6 years old.</p><p><b>RESULTS</b>Perioperative management including percutaneous transhepatic biliary drainage applied in 19 cases and portal vein embolization applied in 2 cases. Eight patients were treated with extrahepatic bile duct resection with or without parital hepatic segment II resection, 10 cases with perihilar hepatic resection (segment IVB, partial V, partial VIII, I), 28 cases with extended hemihepatectomy and 2 cases with central hepatic resection (segment IVB, V, VIII, I). R0 resection rate was 89.5% and the operative mortality was 2.1%. The 1-, 3- and 5-year survival rate were 93.5%, 51.8% and 36.5%, respectively. Patients undergoing extended hepatic resection survived significantly longer than those undergoing partial hepatic resection (P = 0.034).</p><p><b>CONCLUSIONS</b>Extended hepatic resection for hilar cholangiocarcinoma offers good outcomes with an acceptable mortality rate.</p>

Hepatic resection: an analysis of the impact of operative and perioperative factors on morbidity and mortality rates in 2008 consecutive hepatectomy cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hepatectomy is a standard hepatic surgical technique. The safety of hepatectomy has been improved in line with improvements in surgical techniques. This study analyzed the operative and perioperative factors associated with hepatectomy.</p><p><b>METHODS</b>A total of 2008 patients who underwent consecutive hepatectomies between January 1986 and December 2005 were investigated retrospectively. Diagnoses were made based on pathological findings.</p><p><b>RESULTS</b>Malignant and benign liver diseases accounted for 58.5% and 41.2%, respectively, of the conditions requiring resections. Primary liver cancers accounted for 76.1% of the malignant tumors, while hilar cholangiocarcinomas accounted for 6.7%. Hemangiomas (41.7%) and hepatolithiasis (29.6%) were the most common of the benign conditions. Microwave in-line coagulation was used in 236 of our liver resection cases. The overall postoperative complication rate was 14.44%, of which 12.54% of resections were performed for primary liver cancer, 16.40% for secondary liver cancer, and 16.32% for hepatolithiasis. The overall hospital mortality was 0.55%, and that for malignant liver disease was 0.51%. A high mortality (2.53%) was associated with extensive liver resections for hilar cholangiocarcinomas (two deaths in 79 cases). Microwave in-line pre-coagulation resection, Child-Pugh grading, operating time, postoperative length of stay, and preoperative serum albumin level were independent predictors of morbidity. Blood loss, Child-Pugh grading, operating time and preoperative serum albumin level were independent predictors of mortality.</p><p><b>CONCLUSIONS</b>Hepatectomy can be performed safely with low morbidity and mortality, provided that it is carried out with optimal perioperative management and innovative surgical techniques.</p>

Clinical application of precise liver resection techniques in patients with complicated liver space-occupying lesions / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the early results of precise liver resection.</p><p><b>METHODS</b>Between May 2006 and June 2009, 65 patients with complicated liver space-occupying lesions were included in the study. Fifty-one patients underwent curative liver resection. Liver resections performed included 16 trisectionectomies, 11 hemihepatectomy, 5 meso hepatectomies, 3 combined segmentectomies, 5 caudate lobectomies and 11 irregular local resections.</p><p><b>RESULTS</b>Patients undergoing resection had no mortality with a major morbidity of 9.8%. Nineteen vascular repairs and reconstructions were patent at last follow-up. The postoperative 1-year survival rate was 100% in 10 patients with benign lesions and 92.7% in 41 patients with malignant tumors. The 1-year survival rate was zero in patients with malignant tumors, who underwent no liver resection.</p><p><b>CONCLUSIONS</b>Precise liver resection, as an aggressive surgical approach, offers hope for these patients, who would otherwise have a dismal prognosis.</p>

Liver resection: single center experiences of 2008 consecutive resections in 20 years / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze operative and perioperative factors associated with hepatectomy.</p><p><b>METHODS</b>2008 consecutive patients undergoing hepatectomy from January 1986 to December 2005 at Chinese People's Liberation Army General Hospital were investigated retrospectively according to their medical documentation. Diagnoses were made on basis of pathological results.</p><p><b>RESULTS</b>Malignant and benign liver diseases accounted for 58.5% and 41.2%, respectively. In the former, primary liver cancer accounted for 76.1% and hilar cholangiocarcinoma for 6.7%. Hemangioma (41.7%) and hepatolithiasis (29.6%) were listed in the first two in the latter group with relatively more patient ratios. Isolated caudate lobe resection was performed in 25 patients and micro-wave inline coagulation was induced in 236 cases of liver resection. In all cases, those with blood loss less than 200 ml accounted for 50.5% (1015/2008), whereas those with more than 400 ml accounted for 28.4% (570/2008). In patients performed micro-wave inline coagulation liver resection, those with blood loss less than 200 ml and more than 400 ml accounted for 60.6% (143/236) and 19.9% (47/236), respectively, which differed significantly from the average level (P < 0.05). The postoperative complication incidence was 14.44% for all cases, 12.54% for primary liver cancer, 16.40% for secondary liver cancer, and 16.32% for hepatolithiasis. Complication incidence of primary liver cancer with tumor size smaller than 5 cm was 11.65% and that with tumor larger than 10 cm was 14.69%. There was no significant difference between the two groups. All-case hospital mortality was 0.55% and that for liver malignant disease was 0.60%, hilar cholangiocarcinoma 2.53%.</p><p><b>CONCLUSION</b>Hepatectomy can be performed safely with low mortality and low complication incidence, provided that it is carried out with optimized perioperative management and innovative surgical technique.</p>

Liver resection in hepatolithiasis: 20-year's evolution / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze operative and perioperative factors associated with hepatectomy in hepatolithiasis.</p><p><b>METHODS</b>245 consecutive hepatolithiasis patients undergoing hepatectomy from January 1986 to December 2005 at Chinese People's Liberation Army General Hospital were investigated retrospectively according to medical documentation.</p><p><b>RESULTS</b>Hepatolithiasis accounted for 29.6% (245/827) in all benign liver diseases treated with hepatectomy during this time period. There were 88 cases in male and 157 cases in female, the average age was (46.9 +/- 11.3) years. Cases of right liver resection and hepatic segments resection were much more than that in 1963 - 1985. Blood transfusion during operation was given in 45.3% of cases. Complication incidence was 16.3%, with infection 3.3% and bile leakage 2.4%. Length of stay after operation was (15.7 +/- 9.2) days. Perioperative mortality rate was 0.4% (1/245).</p><p><b>CONCLUSIONS</b>Individualized hepatectomy is the important surgical treatment of hepatolithiasis. Hepatectomy can be performed safely with low mortality and low complication incidence, provided that it is carried out with optimized perioperative management and innovative surgical technique.</p>

Clinical related factors of portal vein tumor thrombosis in patients with hepatocellular carcinoma: a logistic regression analysis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the related factors of portal vein tumor thrombosis (PVTT) in patients with HCC.</p><p><b>METHODS</b>A total number of 234 patients with hepatocellular carcinoma (HCC) were included in this retrospective study. Uni-variate and multi-variate logistic regression analysis were employed to analyze the association between PVTT and 18 routine clinical parameters.</p><p><b>RESULTS</b>Among the 234 patients with HCC, 15% of patients (35/235) had PVTT. Univariate logistic regression analysis revealed significant association of age (P = 0.016), gamma glutamyl transferase (GGT, P = 0.003), number of segmental invasion (P = 0.007), microvascular invasion (P < 0.01), segment location of S2 (P = 0.001), S3 (P = 0.000), S4 (P = 0.004) and S6 (P = 0.016). Multivariate analysis shows potential significant predictors of PVTT in HCC were age (RR: 0.373; 95% CI: 0.146-0.954; P = 0.040), the tumor location of S3 (RR: 4.625; 95% CI: 1.916-11. 165;P = 0.001), GGT (RR: 4.091; 95% CI: 1.448-11.553; P = 0.008) and microvascular invasion (RR: 20.912; 95% CI: 4.745-92.172; P < 0.01).</p><p><b>CONCLUSIONS</b>PVTT occurred more commonly in the younger (< 50 years old), and those with high level of GGT, segment location of S3 and microvascular invasion.</p>

Effects of portal venous arterialization on acute occlusion of hepatic artery in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A fatal complication after liver transplantation is anastomotic embolization of the hepatic artery. In order to solve this problem, the portal venous arterialization (PVA) is used to reconstruct the hepatic arterial blood flow. The purpose of this study was to investigate the influence of PVA on rats with acute occlusion of hepatic artery.</p><p><b>METHODS</b>Rat PVA models were established and then randomly divided into Group 1 (control group), Group 2 (jaundice group), Group 3 (bile duct recanalization group), and Group 4 (portal vein arterilization group). Recanalization of the common bile duct and PVA were performed 5 days after bile duct ligation in the rats. The influence of the PVA on general conditions, hepatic changes of structure and function, portal vein pressure and hepatic micrangium were observed for one month.</p><p><b>RESULTS</b>Five days after common bile duct ligation the serum bilirubin, transaminase and alkaline phosphatase levels were significantly increased. Compared with group 1, there was a statistically significant difference (P < 0.01). These rats then underwent bile duct recanalization and PVA. After a month, the liver functions and microscopic structures completely returned to normal and, compared with group 1, there was no statistically significant difference in portal vein pressure (P > 0.05). Vascular casting samples showed that hepatic sinusoids were slightly thicker and more filled than normal ones and although they had some deformations, the hepatic sinusoids were still distributed around the central vein in radial form.</p><p><b>CONCLUSION</b>Within a month after operation, bile duct recanalization and PVA do not show obvious adverse effects on liver hemodynamics and hepatic micrangium, and the liver function and microscopic structure can return to normal.</p>

Clinical analysis of 110 patients with primary gallbladder carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics of primary gallbladder carcinoma.</p><p><b>METHODS</b>The data of clinical manifestations, image characteristics, diagnosis and treatment of 110 patients with primary gallbladder carcinoma were analyzed.</p><p><b>RESULTS</b>The rate of diagnosis as early primary gallbladder carcinoma was only 8.2% (9/110) in this series. The majority of the patients were females (63/110) with an age ranging from 31 to 80 years. Clinical manifestations were not specific, and diagnosis was made mainly on image examination. Radical resection was performed for 57 patients, palliative resection for 41, the rest 12 patients failed to receive operation on reasons of distant metastasis, age or other reasons. Only 88 patients were followed with a mean survival time of 196 days ranging from 15 days to 5 years and 11 months.</p><p><b>CONCLUSION</b>The primary gallbladder carcinoma is quite difficult to diagnose at the early stage, and its prognosis is usually poor. The diagnosis is made mainly depending on the medical history and image examinations.</p>

To inquiry into clinical-pathological factors influencing cytological accuracy of pancreatic head lesions / 中华外科杂志

<p><b>OBJECTIVE</b>To inquiry into clinical-pathological factors influencing cytological accuracy of pancreatic head lesions.</p><p><b>METHODS</b>Cytology was retrospectively evaluated in 94 inpatients with a mass in head of pancreas existing with chronic pancreatitis in the past decade, the results of cytology were compared with clinical pathology or clinical follow-up to estimate the value and accuracy of cytology in detecting pancreatic cancer. Pancreatic clinical-pathology includes size of mass and component of mass which was composed of cancerous mode of development including shape of conglomeration, nest and pervasion, and pancreatic ductal epithelium inside the vicinity of 1 cm around the mass. Pancreatic ductal epithelium were divided into PanIN1, PanIN2 and PanIN3 three types according to classified criterion of pancreatic intraepithelial neoplasia (PanIN).</p><p><b>RESULT</b>Forty-six patients were pathologically diagnosed as pancreatic cancer and five patients as chronic pancreatitis, accordingly, 29 malignant, 5 suspicious, 10 atypical hyperplasia among of them 5 malignant, 3 hyperplastic ductal epithelium, 1 nondiagnostic results due to interfered by blood and 3 insufficient specimens. 43 patients were clinically diagnosed as chronic pancreatitis. Cytologic evaluation of pancreatic cancer has an 84.2% accuracy less than or equal to 2.5 cm and 71.9% larger than 2.5 cm. Shape of conglomeration, and nest have more accurate than pervasion in cytological diagnosis.</p><p><b>CONCLUSIONS</b>Cancerous mode of development is a vital factor influencing accuracy of cytology, cytological estimation of atypical hyperplasia and is still waiting for further investigation.</p>

TGF-beta1/SMAD signaling pathway mediates p53-dependent apoptosis in hepatoma cell lines / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To determine whether transforming growth factor betal (TGF-beta1)/Smad signaling pathway mediates p53-dependent apoptosis in hepatoma cell lines.</p><p><b>METHODS</b>Three human hepatic carcinoma cell lines, HepG2, Huh-7, and Hep3B, were used in this study. TGF-beta1-induced apoptosis in hepatic carcinoma cell lines was analyzed using TUNEL assay. For identifying the mechanism of apoptosis induced by TGF-beta1, cell lines were transfected with a TGF-beta1-inducible luciferase reportor plasmid containing Smad4 binding elements. After transfection, cells were treated with TGF-beta1, then assayed for luciferase activity.</p><p><b>RESULTS</b>The apoptosis rate of HepG2 cell lines (48.51% +/- 8.21%) was significantly higher than control (12.72% +/- 2.18%, P <0.05). But TGF-beta1 was not able to induce apoptosis of Huh-7 and Hep3B cell lines. The relative luciferase activity of TGF-beta1-treated HepG2 cell lines (4.38) was significantly higher than control (1.00, P < 0.05). But the relative luciferase activity of TGF-beta1-treated Huh-7 and Hep3B cell lines less increased compared with control.</p><p><b>CONCLUSIONS</b>HepG2 cells seem to be highly susceptible to TGF-beta1-induced apoptosis compared with Hep3B and Huh-7 cell lines. Smad4 is a central mediator of TGF-beta1 signaling transdution pathway. TGF-beta1/Smad signaling pathway might mediate p53-dependent apoptosis in hepatoma cell lines.</p>

Surgical treatment of 402 consecutive cases for hilar cholangiocarcinoma: Chinese single center experience / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze clinical typing, pathologic characteristics of hilar cholangiocarcinoma (HCCA) and surgical strategies and their effects on HCCA, and to explore the factors that influence the surgical outcomes and long-term survival.</p><p><b>METHODS</b>The data of the 402 patients with HCCA admitted between January 1993 and December 2004 was investigated retrospectively. Primary outcomes examined included clinical typing, pathologic characteristics, surgical procedures and follow-up results. On the basis of Bismuth-Corlette typing, we defined the tumor originated from intrahepatic large bile duct (LBD) as type V (type Va and Vb).</p><p><b>RESULTS</b>Among the 402 patients with HCCA, 198 cases accepted curative resection, 102 (51.5%) for radical resection and 96 (48.5%) for palliative resection. Of the rest patients, 8 received orthotopic liver transplantation (OLT), 161 received simple drainage and 35 were not operated on. The resection rates for type I, II, IIIa, IIIb, IV, Va and Vb were 69.4%, 55.5%, 57.4%, 71.7%, 19.6%, 100% and 34.6%, respectively. The one-year survival rates for radical resection, palliative resection, simple drainage and untreated were 80.3%, 53.2%, 26.7% and 9.8%, respectively. And the three-year and five-year survival rates in the four groups were 41.9% and 33.3%, 19.6% and 14.7%, 3.3% and 0, 0 and 0, respectively. Significant difference was found in survival rates between the radical and palliative resection. In the patients who received tumor resection, the ones without lymph nodes metastasis (LNM) survived much longer than those with LNM (P < 0.05). Complications were found in 36.1% of the patients and the mortality rate was 0.3%.</p><p><b>CONCLUSIONS</b>HCCA type V originated from intrahepatic LBD has higher resection rate and better prognosis. The tumor differentiation is significantly correlated with the prognosis after operation. With HCCA, resection is still the major treatment selection. Curative resection carries the best effect. Extended radical resection of liver lobes, blood vessels, lymph nodes can prolong survive. The problem of high recurrence rate after OLT for HCCA has not been solved yet.</p>

Experience of diagnosis and treatment of carcinoma arising from congenital biliary duct cyst / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience in diagnosis, prevention and treatment of carcinoma arising from congenital biliary duct cyst.</p><p><b>METHODS</b>The clinical and pathological data of 185 patients with congenital biliary duct cyst admitted to Chinese PLA General Hospital were analyzed retrospectively.</p><p><b>RESULTS</b>Among 185 patients, twenty-seven cases had carcinomas arising from congenital biliary duct cyst, and the frequency of malignant transformation was 14.6%, which closely related to the age (P < 0.001). The incidences of malignancy for different age groups were: 0 for 0-9 age group, 5.1% for 0-19, 9.1% for 20-29, 16.2% for 30-39, 26.7% for 40-49, 33.3% for 50-59, and 50% for over 60, respectively. Six patients had the history of cyst-enterostomy. Abdominal pain, fever, jaundice and weight loss were the main clinical manifestations. Abdominal ultrasonography, CT, MRI or magnetic resonance cholangiopancreatography, MRCP and endoscopic retrograde choledochopancreatography (ERCP) were the main diagnostic methods. For twenty patients (74.1%), a definite diagnosis was made preoperatively, but it's hard to make an early diagnosis. Nine patients (33.3%) underwent curative resection.</p><p><b>CONCLUSIONS</b>Congenital biliary duct cyst is a premalignant lesion, and the incidence of carcinogenesis increases remarkably with age. The most effective method for prevention of carcinogenesis in choledochal cyst is complete excision of choledochal cyst during childhood, and the prognosis is poor for patients with biliary malignancy.</p>