RÉSUMÉ
Objective:The paper seeks to explore the characteristics of myeloid tumors with genetic DDX41 gene mutations,especially focusing on the understanding and treatment of acute myeloid leukemia with germline/somatic DDX41 mutation. Methods:One AML patient with germline/somatic DDX41 mutation who was diagnosed by using morphology,immunology,cytogenetics and molecular biology in Shanghai Shidong Hospital was retrospectively analyzed,and the patient was treated with lenalidomide combined with decitabine,and the literatures were reviewed. Results:The patient obtained complete remission after the therapy and there were no relevant adverse reactions to the treatment. Conclusion:The DDX41 gene mutations have effects on the prognosis and treatment of myeloid malignancies,and lenalidomide combined with decitabine is effective in acute myeloid leukemia with germline/somatic DDX41 mutation.The germline mutation status should be identified and confirmed early.
RÉSUMÉ
Liver is the most common metastatic organ in patients with advanced colorectal cancer. Once colorectal cancer liver metastasis (CRLM) occurs, the prognosis will be poor. Therefore early detection of CRLM has a great clinical significance for improving the prognosis of CRLM patients. Surgical resection of primary and metastatic lesion is the only possible curable option for CRLM, translational therapy, interventional therapy and multidisciplinary team also provide more treatment ideas. Long non-coding RNA, cancer stem cells and phosphatidylinositide-3-kinases/protein kinase B signaling pathway reveal the main mechanism of CRLM from different aspects. This article reviews the recent advances in the early diagnosis, treatments and main mechanisms of CRLM.
RÉSUMÉ
Objective:To study the survival outcomes in patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC) treated with sorafenib combined with transcatheter arterial chemoembolization (TACE) versus sorafenib alone.Methods:The data of 92 patients with BCLC stage C HCC at Tianjin Medical University Cancer Institute& Hospital from January 2008 to December 2015 were retrospectively studied. There were 82 males and 10 females. The average age was 56.3 years. Classified according to whether there were vascular invasion and/or distant metastasis, patients were divided into the vascular invasion group ( n=24), the metastasis group ( n=48), and the vascular invasion combined with metastasis group ( n=20). All patients were treated with sorafenib, but some patients received combined treatment with TACE. The survival data of these patients on follow-up was collected. The Kaplan-Meier method was used for survival analysis, and the survival rates were compared by the log-rank test. Univariate and multivariate Cox analyses were used to determine the prognostic factors of patients’ survival. Results:There were no significant differences in the baseline clinical data among the three groups (all P>0.05). Multivariate Cox regression analysis showed that pre-treatment alpha fetal protein >20 μg/L ( HR=1.90, 95% CI: 1.13-3.12), alkaline phosphatase >125 U/L ( HR=1.60, 95% CI: 1.03-2.49) and sorafenib alone ( HR=2.11, 95% CI: 1.23-3.54) were independent risk factors of survival for these patients. There were no significant differences in the cumulative survival rates among the three groups ( P>0.05). In the vascular invasion group, the cumulative survival rates of patients treated with combined sorafenib and TACE ( n=4) were significantly higher than those treated with sorafenib alone ( n=20) ( P<0.05). Conclusion:Compared with sorafenib alone, sorafenib combined with TACE resulted in better prognosis for patients with BCLC stage C HCC. Subgroup analysis showed that patients with vascular invasion had significantly better survival treated with combined sorafenib and TACE than sorafenib alone.
RÉSUMÉ
Objective To compare the efficacy of radiofrequency ablation versus surgical resection in treatment of colorectal liver metastases with a maximum diameter ≤ 3 cm and a number ≤ 3, and to analyze the risk factors of recurrence. Methods The data of 97 patients with colorectal liver metastases from January 2012 to June 2016 treated at Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively. There were 66 males and 31 females. The patients were divided into the radiofre-quency ablation group (23 patients) and the surgical resection group ( 74 patients). The patients were followed up. The clinicopathological features of the two groups before treatment were compared. Kaplan-Meier curves were drawn, and the recurrence-free survival curve and overall survival curve of the two groups were compared by log-rank test. Univariate and multivariate Cox regression analysis was used to analyze the risk factors of recurrence. Results There were no significant differences in age, location of primary tumor, number and size of liver metastases, and preoperative carcinoembryonic antigen level between the two groups (P＞0. 05). On the date this study was censored, there were 50 patients who had developed recurrence in the surgical resection group and 22 patients in the ablation group, (67. 6% vs. 95. 7% ). The difference was significant (P＜0. 05). The 1-and 2-year recurrence-free survival rates were 54. 6% and 39. 0% in the surgical resection group and 39. 1% and 8. 7% in the radiofrequency ablation group, respectively. The difference was significant (P＜0. 05). There was no local recurrence in either of the two groups. There was no significant difference in the overall survival curves between the two groups (P＞0. 05). Univariate and multivariate analysis showed that N 1 ～2 staging (HR=1. 908, 95% CI: 1. 094～3. 325), simultaneous liver metastasis (HR=1. 662, 95% CI: 1. 024～2. 695) and radiofrequency ablation (HR=2. 708, 95% CI: 1. 589～4. 617) were independent risk factors of recurrence for colorectal liver metastasis. Conclusions Radiofrequency ablation can achieve complete ablation in patients with colorectal liver metastases with maximum diameter ≤3 cm and number≤3, but the recurrence rate of radiofrequency ablation is significantly higher than that of surgical resection. N 1 ～2 staging, simultaneous liver metastasis and radiofrequency ablation were independent risk factors for recurrence of colorectal liver metastasis.
RÉSUMÉ
·AIM: To investigate the prevalence of myopia among primary and middle school students aged 7 to 18 in Longkou City, Shandong Province, and to provide a scientific basis for prevention and control of myopia. ·METHODS: The students aged 7 to 18 were enrolled through the method of stratified random and cluster sampling by the unit of schools and were investigated in Longkou, Shandong Province in 2015. A total of 58 schools were selected and 61 036 students were effectively sampled. All the subjects were divided into three- tiers based on geographical location: urban, rural-urban continuum, and rural areas. All the subjects were examined with the visual acuity and non -cycloplegic objective fraction. Microsoft Excel worksheet was used to establish a database, and SPSS 21. 0 software was used for statistical analysis. ·RESULTS: The prevalence of total myopia in the sample population of students of Longkou in 2015 was 49. 81% from 7 to 18 years old. The overall prevalence of myopia increased fastest from 11 to 12 years old. And the prevalence of mild myopia of students aged 13 was highest. The prevalence of total myopia were 46. 41% for boys and 53. 39% for girls, which showed the prevalence of girls was higher than the boys'. The prevalence of myopia in urban, rural- urban continuum, and rural areas were 55. 18% , 49. 75% , 44. 47% , respectively, and the prevalence of myopia in urban areas was the higher than the rural-urban continuum and the rural areas. The prevalence of total myopia gradually increased with age (rs=0. 943, P<0. 05). ·CONCLUSION: The results of the investigation showed a high prevalence of myopia among primary and middle school students in the city of Longkou, and gradually increased with age. The overall myopia prevalence for girls was higher than boys, and the prevalence was highest in urban areas.
RÉSUMÉ
Objective@#To investigate the effect of hypoxia inducible factor 2α (HIF-2α) on regulating CUB domain-containing protein 1 (CDCP1) and its role in hepatocellular carcinoma metastasis.@*Methods@#HIF-2α-knocked down and HIF-2α-stably overexpressing cells (MHCC97H) were prepared by small interfering RNA (siRNA) and lentivirus transfection, respectively. The expression of CDCP1 protein and mRNA in the above cells was detected by western blot and real-time PCR. The effect of HIF-2α on cell invasion ability was determined by Transwell assay. Furthermore, immunohistochemical staining was performed to detect the expression of CDCP1 in human HCC tissue samples.@*Results@#Both HIF-2α and CDCP1 were induced under hypoxic conditions. The activation of CDCP1 under hypoxic conditions was dependent on the expression of HIF-2α.When HIF-2α was overexpressed, the mRNA level of CDCP1 was greatly upregulated (5.92±0.28, P<0.05). When HIF-2α was knocked down by siRNA for 48 h and 72 h, the expression of CDCP1 was significantly downregulated (48 h: 0.25±0.04; 72 h: 0.18±0.02, all P<0.05). Moreover, analysis of human HCC samples showed that CDCP1 expression was correlated with tumor-free survival (P<0.05).@*Conclusions@#The results of this study indicate that the expression of CDCP1 is regulated by HIF-2α and is correlated with the progression of HCC. Inhibition of HIF-2α/CDCP1 may play certain inhibitory role in the metastasis of HCC.
RÉSUMÉ
Objectives To analyze prognosis and risk factors of Barcelona Clinical Liver Cancer (BCLC) stage B hepatocellular carcinoma patients treated with hepatectomy.Methods Clinical data of 162 BCLC stage B patients who underwent hepatectomy at Tianjin Medical University Cancer Institute & Hospital and the Second Hospital of Tianjin Medical University from June 2007 to December 2013 were retrospectively studied.The correlations between factors (age,gender) and long-term outcome were analyzed to determine independent risk factors.Subsequently,subgroup analysis of BCLC stage B hepatocellular carcinoma was performed.Results Multiple tumors,maximum tumor diameter ＞ 10 cm and AFP ＞ 100 μg/L were con firmed as independent risk factors of overall survival in postoperative BCLC B patients.Based on the risk factors,patients were divided into two groups,namely low-risk subgroup (≤ 1 risk factor) and high-risk subgroup (≥ 2 risk factors).In low-risk subgroup,1,3 and 5-year overall survival (OS) rates were 91.6％,65.5％,61.9％ respectively,and mean OS was 72 months.By contrast,1,3 and 5-year OS rates in high-risk subgroup were 67.4％,25.6％,10.8％ respectively,and mean OS was 29 months.Further more,1,3 and 5-year OS rates of all patients were 85.2％,54.9％,48.0％ respectively,and mean OS was 61 months.Conclusions Relatively favorable long-term outcomes could be yielded in BCLC stage B hepatocellular carcinoma patients treated with liver resection.The independent risk factors including multiple tumors,maximum tumor diameter ＞ 10 cm and AFP ＞ 100 μg/L were closely correlated with overall survival.BCLC stage B hepatocellular carcinoma patients could be divided into low-risk and high-risk subgroups based on the risk factors mentioned above.Survival rates in low-risk subgroup are remarkably superior to those in high-risk subgroup.
RÉSUMÉ
Studies show that metformin inhibits the proliferation of several types of cancer cells.All evidences,therefore propose the anti-tumor effect of metformin.Metformin can repress the oxygen consumption of tumor cells,and suppress hypoxia-inducible factor-1α (HIF-1ct) accumulation through the translational and posttranslational mechanisms,and suppress the expression of HIF-1α by activating AMP-activated protein kinase (AMPK).
RÉSUMÉ
Objective:To investigate the effect of pancreaticojejunostomy on the occurrence of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. Methods:Data from 145 patients with periampullary tumor who underwent pancreaticoduode-nectomy in Tianjin Medical University Cancer Institute and Hospital between October 2008 and August 2013 were reviewed. Factors potentially associated with POPF were analyzed by Pearson chi-square test and Logistic regression analysis. Results:Among the 145 patients, 27 were diagnosed with POPF, including 5 grade A, 17 grade B and 5 grade C. Neither duct to mucosa nor Blumgart pancreati-cojejunostomy was correlated with POPF in grade C. The univariate analysis showed that gender, pancreatic cancer, portal vein involve-ment, type of pancreaticojejunostomy, texture of pancreas, and diameter of the main pancreatic duct were closely correlated with POPF. The multivariate analysis using Logistic regression showed that different pancreaticojejunal anastomoses and genders were independent predictors of POPF. Conclusion:Different types of pancreatic anastomoses are a risk factor for POPF after pancreaticoduodenectomy.
RÉSUMÉ
Objective To identify the prognostic factors for patients with intrahepatic cholangiocarcinoma.Methods The clinical data of 99 patients with intrahepatic cholangiocarcinoma who received surgical treatment at the Cancer Hospital of Tianjin Medical University from January 2000 to January 2010 were analyzed retrospectively.Lymph nodes at the hepatic portal and group 12,13 and 8 lymph nodes were resected.The range of hepatectomy was decided according to the size,location,number of tumor and the hepatic function.Patients were followed up every month within the first 6 months after operation,every 3 months at 6 months later,and they were followed up every half year at 2 years later.Patients who were suspected as with tumor recurrence or progression were followed up every month.All the patients were followed up till death or March of 2013.The survival was analyzed using the Log-rank test,and multivariate analysis was done using the COX regression model.Results Forty patients received hemi-hepatectomy,27 received extended hemi-hepatectomy,20 received segmentectomy,and 12 received hemi-hepatectomy + wedge resection.All the patients were followed up and the median time of follow-up was 33 months (range 21.1-44.9 months).The 1-,3-,5-year recurrence-free survival rates and total survival rates of the 99 patients were 64.6％,29.2％,22.7％ and 78.8％,46.4％ and 30.3％,respectively.The results of univariate analysis showed that hepatitis B or C virus infection,preoperative CA19-9 level,TNM staging,lymph node metastasis,microvascular invasion,number of nodules and Ro resection were risk factors influencing the recurrence-free survival time (Log-rank value =5.048,5.982,20.128,13.148,29.632,32.488,50.574,P ＜0.05).The peroperative CA19-9 level,TNM staging,lymph node metastasis,microvascular invasion,number of nodules and R0 resection were risk factors influencing the total survival rate (Log-rank value =4.302,17.267,11.756,23.840,36.411,47.126,P ＜0.05).There were significant differences in the recurrence-free survival time and total survival time between patients in different TNM stages (20 patients in stage Ⅰ,44 in stage Ⅱ,8 in stage Ⅲ and 27 in stage Ⅳ) (Log-rank value =20.128,17.267,P ＜0.05).There were significant difference in the recurrence-free survival time between patients in stage Ⅰ and Ⅲ,patients in stage Ⅰ and Ⅳ,and between patients in stage Ⅱ and Ⅳ (Log-rank value =10.807,19.368,6.347,P ＜ 0.05).There were significant difference in the total survival time between patients in stage Ⅰ and Ⅱ,patients in stage Ⅰ and Ⅲ,patients in stage Ⅰ and Ⅳ and between patients in stage Ⅱ and Ⅳ (Log-rank value =6.119,4.015,16.282,4.929,P＜0.05).There was no significant difference in the survival time between patients in other TNM stages (P ＞ 0.05).The results of multivariate analysis showed that TNM stage Ⅲ and Ⅳ,microvascular invasion,multiple nodules and R0 resection were independent risk factors influencing the recurrence-free survival time (RR =1.413,3.073,2.737,3.916,95％ confidence interval:1.119-1.784,1.837-5.140,1.338-4.207,1.849-8.291,P＜0.05) ; lymph node metastasis,microvascular invasion,multiple tumors and R0 resection were the independent risk factors influencing the total survival time (RR =2.025,2.948,0.327,3.494,95％ confidence interval:1.215-3.374,1.774-4.900,0.183-0.583,1.670-7.310,P ＜ 0.05).Conclusions TNM stage Ⅲ and Ⅳ,lymph node metastasis,microvascular invasion,multiple nodules,non-R0 resection shorten the recurrence-free survival time and total survival time of patients who received surgical resection for intrahepatic cholangiocarcinoma,and they are the main factors influencing the prognosis.R0 resection could improve the survival of patients with intrahepatic cholangiocarcinoma.
RÉSUMÉ
Asaresult,establishinganimalmodelsoflivercancerisofhighvalue.Therearetwoparts of the establishment of animal models-the selection of laboratory animals and the source of tumors.The animal models could be classified into different patterns due to difference sources of tumor,and these different patterns possess distinctive characters and limitations.The ideally animal models should satisfy the general requirements of biological habits,biochemical properties,and pathological features which are similar with human hepatocel-lular and easy to establish.
RÉSUMÉ
Objective:To discusse the clinical features of sarcomatoid hepatocellular carcinoma to improve the understanding of diagnosis and treatment for sarcomatoid hepatocellular carcinoma. Methods:Data including clinical features and follow-up from 8 pa-tients admitted in Tianjin Medical University Cancer Institute and Hospital from January 2009 to April 2014 were retrospectively ana-lyzed. Results: The average age of all patients was 56.6 years old, and the male-to-female ratio was 3:1. Preoperative CT or MRI showed specific characteristics but it was difficult to confirm diagnosis. Pathological and immunohistochemical examination revealed an expressed epithelial-like phenotype. All 8 patients had advanced local tumor invasion and high lymph node metastasis rates. These patients received surgery, and the median survival time was 10.8 months (3 months to 35 months). Conclusion:Diagnosis of sarcoma-toid hepatocellular carcinoma mainly depended on postoperative pathological examination. Immunohistochemistry was beneficial for sarcomatoid hepatocellular carcinoma diagnosis and differential diagnosis. Surgical treatment prolonged survival time, but the overall prognosis remained poor.
RÉSUMÉ
Objective To explore the expression and clinical significance of chemokine receptor 6 (CCR6)/chemokine ligand 20(CCL20) axis in hepatocellular carcinoma (HCC).Methods From March 2003 to December 2005,48 patients with HCC were selected,and one specimen of HCC tissue and one of corresponding adjacent tissue were taken from every patient.Another eight patients with benign liver lesions were selected,and one specimen of surgical sectioned normal liver tissue of each was taken.The relative expression quantity of CCR6 and CCL20 at mRNA level was detected by real-time fluorescence quantitative polymerase chain reaction (qRT-PCR).And the expression of CCR6 and CCL20 at protein level was determined by immunohistochemisty methods.One-way analysis of variance (ANOVA) was performed for comparison among groups of measurement data.Chi-square test was used for rate comparison.The correlation coefficient was calculated by Spearman's method.Survival curves were plotted by Kaplan-Meier method and the survival rate was compared by Log-rank test.Results The relative expression quantity of CCR6/CCL20 at mRNA level in HCC tissues (0.99±0.21 and 0.46± 0.11) were significantly higher than those of para carcinoma tissues (0.33 ± 0.09 and 0.31 ± 0.07) and normal liver tissues (0.22±0.06 and 0.28±0.05),and the differences were statistically significant (F=127.43 and 21.10,both P＜0.05).The positive percentage of CCR6 protein expression in HCC tissues (54.17％,26/48) was significantly higher than that in para carcinoma tissues (16.67％,8/48) and normal liver tissues (0/8),and the difference was statistically significant (x2 =19.55,P＜0.05).There was no statistically significant difference in the positive percentage of CCL20 protein expression among HCC tissues (50.00％,24/48),paracarcinoma tissues (33.33％,16/48),normal liver tissues (2/8) (all P＜0.05).There was correlation between the positive percentage of CCR6 protein expression and that of CCL20 protein expression in HCC tissues (r=0.42,P＜0.05).The positive percentage of CCR6 protein expression was correlated with the pTNM stage of HCC,vascular tumor thrombosis,intrahepatic metastasis and lung metastasis (x2 =5.48,4.02,5.07 and 5.19,all P＜0.05).The positive percentage of CCL20 expression was significantly correlated to tumor maximum diameter and pTNM stage (x2 =4.09 and 4.00,both P＜0.05).Both the disease-free survival (DFS) rate and overall survival (OS) rate of CCR6-positive group were significantly lower than those of negative group (x2 =4.57 and 6.57,both P＜ 0.05).There were no significant differences in DFS rate and OS rate between CCL20-positive group and negative group (both P＞0.05).Conclusion CCR6/CCL20 axis may be related with the malignant behavior and the prognosis of HCC.
RÉSUMÉ
Post-operative pancreatic fistula(POPF)is the most common and severe complication after pancreaticoduodenectomy,which may have significant impacts on curative effects and prognosis.It has been shown that POPF is not only closely associated with texture of pancreatic parenchyma,diameter of pancreatic duct and tumor site,but also affected by surgeon's experience and surgical techniques.Double layer pancreaticojejunostomy and external pancreatic duct stent may be beneficial to decrease POPF.
RÉSUMÉ
Objective:The present study discussed the clinical diagnosis and treatment of pancreatic body and tail carcinoma. Methods:The data of 52 patients with pancreatic body and tail carcinoma treated in Tianjin Medical University Cancer Institute and Hospital from January 2008 to December 2012 were reviewed retrospectively. The data included historical materials of perioperative examination and therapy. The data of 49 cases were reviewed retrospectively, and the median survival was calculated by the Kaplan-Meier method. The effects of the clinicopathologic parameters on the prognosis of patients with pancreatic body and tail carcinoma were examined by the log rank test. Results:Thirty-eight patients underwent exploratory surgery among which 24 had surgical resection, and the standard procedure was distal pancreatectomy plus splenectomy. The tumor staging was stage I in five patients (13.16%), stage II in nineteen patients (50%), stage III in five patients (13.16%), and stage IV in nine patients (23.67%). The median survival time was 18.0 ± 1.23 months for patients who received radical resection and 10.0 ± 2.71 months for patients who underwent nonspecific treatment or palliative therapy. The radical resection was associated with a longer survival period than the nonspecific treatment or palliative therapy (P<0.01). Conclusion:Early diagnosis is the key to achieving long-term survival. The radical resection plays an important role in improving the surgical treatment.
RÉSUMÉ
Objective To investigate the clinical and pathological prognostic factors of the carcinoma of the body and tail of the pancreas.Methods The clinical data of 64 patients with the carcinoma of the body and tail of the pancreas who received radical resection at the Cancer Hospital of Tianjin Medical University from January 1998 to December 2008 were retrospectively analyzed.Abdominal ultrasound,computed tomography and tumor markers detection were carried out preoperatively to learn the condition of the patients.No patient received neoadjuvant therapy before operation,and chemotherapy,biotherapy and radiotherapy were applied to all the patients after radical resection.Indicators including the gender,age,onset of back pain,site,diameter and differentiation of tumors,operative procedure,lymph node metastasis,metastatic rate of lymph nodes,extra-and intra-pancreatic neural invasion,splenic artery invasion,splenic vein invasion,retroperitoneal soft tissue infiltration,venulae infiltration and TNM staging were collected.The survival curve was drawn by Kaplan-Meier method,and the survival was analyzed by Log-rank test.Univariate and multivariate analysis were carried out by chi-square test and COX proportional hazards model,respectively.Results All patients received R0 resection,and the mean number of lymph node resected was 15 (range,12-22).There were 5 patients with pancreatic leakage,3 with delayed gastric emptying,1 with peritoneal infection,and 1 with deep venous thrombosis,no perioperative mortality was detected.All the 64 patients were with ductal adenocarcinoma and cystadenocarcinoma,and 9 patients were with high differentiated tumor,35 with moderate differentiated tumor and 20 with low differentiated tumor.There were 4 patients with tumor in the TNM IA stage,9 in the TNM IB stage,17 in the TNM Ⅱ A stage and 34 in the TNM Ⅱ B stage.Twenty-six patients died of tumor local recurrence and 18 died of tumor distal metastasis.The 1-,3-,5-year survival rates were 42.2％,17.2％ and 15.6％,respectively,and the median survival time was 19.0 months.The result of univariate analysis showed that back pain,maximum tumor diameter,differentiation,lymph node metastasis,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion and TNM staging were factors affecting prognosis (x2=10.658,8.371,18.910,6.605,28.382,14.571,19.476,32.155,P ＜0.05).The result of multivariate analysis showed that tumor differentiation,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion,TNM staging were the independent factors affecting prognosis (RR =2.509,2.107,6.692,5.109,4.784,P ＜ 0.05).Conclusion Tumor differentiation,metastatic rate of lymph nodes,extra-pancreatic neural invasion,splenic artery invasion and TNM staging are the risk factors affecting the prognosis of carcinoma of the body and tail of the pancreas.
RÉSUMÉ
Objective To investigate the clinical value of a preoperative predictive scoring system established by National Cancer Center Hospital (NCCH) for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).Methods The clinical data of 100 patients with periampullary tumor who underwent PD in the Cancer Hospital of Tianjin Medical University from October 2008 to January 2012 were retrospectively analyzed.Five indexes including gender,pancreatic cancer,main pancreatic duct index,portal invasion and intra-abdominal fat thickness were in the NCCH preoperative predictive scoring system.Patients with score ＞ 4 were defined as with high risk of POPF,and those with score≤4 were defined as with low risk of POPF.Factors associated with POPF were analyzed using the Pearson chi-square test.The sensitivity and specificity of the predictive scoring system were determined by receiver operating characteristic (ROC) curve analysis.Results Of the 100 patients,20 had POPF,including 9 in grade A,6 in grade B and 5 in grade C.Gender,pancreatic cancer,portal invasion,texture of pancreas and method of pancreaticojejunostomy were closely correlated with POPF (x2=5.613,4.785,15.479,7.145,7.050,P ＜ 0.05).The incidence of POPF was 86.4％ (19/22) for patients with high risk of POPF,and 1.3％ (1/78) for patients with low risk of POPF,with significant difference (x2=77.637,P ＜ 0.05).The results of ROC curve analysis showed that the sensitivity and specificity of the predictive scoring system were 95.0％ and 96.3％,respectively.The nomogram showed an area under the curve of 99.0％ (P ＜ 0.05).Conclusion The NCCH preoperative predictive scoring system could accurately predict the occurrence of POPF.
RÉSUMÉ
Objective To evaluate the impact of the Blumgart anastomosis in pancreaticojejunostomy on the incidence of postoperative pancreatic fistula (POPF) after pancreaticoduodeneetomy (PD),and to study its safety and efficacy.Methods A total of 205 patients who underwent PD between January 2011 and February 2013 were retrospectively studied.The patients were divided into three groups depending on the pancreaticoenteric reconstruction:the Blumgart anastomosis group (n=37),the duct-to-mucosa anastomosis group (n =39) and the traditional invagination group (n=129).Postoperative morbidity were analyzed.Results The incidences of POPF after the Blumgart anastomosis (8.1％) was significantly lower than the duct-to-mucosa anastomosis group (23.1％ ; P=0.037) and the traditional invagination anastomosis group (30.2％ ; P=0.012).Multivariate analysis revealed soft pancreatic texture,pancreatic duct diameter ＜3 mm and non-Blumgart anastomosis were independent risk factors of POPF.On subgroup analysis,the Blumgart anastomosis was superior to the duct-to-mucosa anastomosis in patients with pancreatic duct diameter ＜ 3 mm (P=0.038),and showed advantages over the traditional invagination anastomosis in patients with soft pancreatic texture (P =0.001),as well as in patients with pancreatic duct diameter ＜ 3 mm (P=0.011).Conclusions The Blumgart anastomosis is a safe technique,and it could significantly reduced the rate of POPF.It should be routinely used for pancreatoenteric reconstruction after PD.
RÉSUMÉ
Objective To investigate the clinical and pathological characteristics,surgical treatment strategy and prognosis of primary malignant neoplasms of the appendix.Methods The clinical data of 74 patients with primary malignant neoplasms of the appendix in our hospital from January 1982 to December 2012 were retrospectively studied.Results Among the 74 cases of primary malignant neoplasms of the appendix,carcinoids were the most common accounting for approximately 70％,adenocarcinoma accounting for 22％ and lymphoma accounting for 8％.The prognosis of primary malignant neoplasms of the appendix is rather poor,nainly because of patients' later presentetion.The overall 1,3,5-year survival rate is respectively 95％,74％,60％,the prognosis of carcinoid is good,while that of adenocarcinoma is poor.Conclusions The incidence of primary malignant neoplasms of the appendix is relatively low.It is difficult to diagnose preoperatively,and the diagnosis relies mainly on rapid intraoperative frozen section and postoperative pathology.
RÉSUMÉ
<p><b>BACKGROUND</b>Astragalus polysaccharides (APS), the main active extract from Astragalus membranaceus (a traditional Chinese medicinal herb), is associated with a variety of immunomodulatory activities. The purpose of the present study was to examine the effect of APS on the function of Treg cells in the tumor microenvironment of human hepatocellular carcinoma (HCC) and to identify the pharmacologic mechanism of APS responsible for the anti-chemotactic activity in CD4+CD25highTreg cells in tumor site of HCC.</p><p><b>METHODS</b>The prevalence of Treg in fresh tissue samples from 31 patients with HCC after radicalhepatectomy was detected. CD4, CD25 and CD127 were selected as Treg cell makers to phenotype cell populations. The expression of FOXp3 mRNA was also analyzed. The migration and proliferation of Treg cells were observed. Interleukin (IL)-4, IL-10, IFN-γ and SDF-1 in cell supernatant were detected. For all tests, functions of Treg cells were evaluated after treatment with APS.</p><p><b>RESULTS</b>APS can inhibit the growth and proliferation of CD4+CD25+Treg cells in vitro in a dose- and time-dependent manner. APS may inhibit CD4+CD25+Treg cells through restoring the cytokine imbalance and reducing the expression of FOXp3 in local HCC microenvironments. SDF-1 played an important role in there recruitment of Treg cells into the tumor microenvironment of HCC. APS might have inhibiting effects on Treg cell migration by blocking SDF-1 or its receptor through the CXCR4/CXCL12 pathway.</p><p><b>CONCLUSIONS</b>The increase in numbers of tumor associated Treg cells might play a role in modulation of the immune response against HCC. APS can restore the cytokine balance in the tumor micro environment and suppress the expression of FOXp3 mRNA to inhibit the immune suppressive effects of Treg cells. The application of APS in the tumor microenvironment might act to enhance the anti-tumor effects of the immunotherapy-based methods, and consequently to increase the survival rate in HCC.</p>