Comparative study on computed tomography features of gastrointestinal schwannomas and gastrointestinal stromal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the CT image of gastrointestinal schwannomas (GIS) and gastrointestinal stromal tumors(GIST), and to find the CT features to be helpful for differentiation of GIS from GIST.</p><p><b>METHODS</b>Clinical and iconography data of 15 GIS patients and 50 GIST patients who underwent stomach CT scan with postoperatively confirmed histopathology between January 2000 and July 2014 in our department were collected retrospectively. CT findings of these two tumors were compared. Then the ROC curve was drawn based on the significant CT findings and area under the curve (AUC) was calculated to assess the sensibility and specificity for the differential diagnosis of GIS and GIST.</p><p><b>RESULT</b>CT findings, such as the tumor size, shape, cystic change, perilesional lymph nodes, vessel seeding, enhancement pattern and degree, absolute and standardized CT value were significantly different between GIS and GIST(all P<0.05). Among the CT findings, tumor size, cystic change, perilesional lymph nodes, enhancement pattern and arterial phase standardized CT value (Sa) were better differential than others (all AUC>0.7). Tumor size showed the highest sensibility(90%), and cystic change and Sa showed the highest specificity(87%).</p><p><b>CONCLUSIONS</b>GIS seems to show a homogeneous tumor more frequently, presenting light and moderate enhancement pattern and obvious enhancement of perilesional lymph nodes, while GIST seems to reveal malignant features, such as abundant blood supply, larger volume, frequent necrosis and cystic change. Cystic change and Sa value possess the better differential ability in diagnosis of these two tumors.</p>

Effect of low dose heavy ion irradiation on subset percentage and cytokines expression of peripheral blood lymphocytes in patients with pancreatic cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>The aim of this study was to examine the effect of low dose heavy ion irradiation on the subset percentage and expression of cytokines of peripheral blood lymphocytes(PBL) in patients with pancreatic cancer.</p><p><b>METHODS</b>PBL from 21 patients with pancreatic cancer were divided into three groups: sham, X-ray and ¹²C⁶⁺ irradiation groups, and the cell responses were measured at 24 hours after radiation exposure. The percentages of T and NK cell subsets were detected by flow cytometry. The mRNA expression of interleukin (IL)-2, tumor necrosis factor (TNF)-α and interferon (IFN)-γ were examined by real-time quantitative RT-PCR (qRT-PCR). The cytokine protein levels in supernatant of cultured cells were assayed by enzyme-linked immunosorbent assays (ELISA).</p><p><b>RESULTS</b>The percentage of T lymphocyte subsets was significantly increased at 24 hours after exposure to low dose radiation, and the effect was more pronounced in the group receiving 0.05 Gy ¹²C⁶⁺ ion irradiation than that in the group receiving X-ray irradiation [CD3⁺ T cells: (67.15 ± 4.36)% vs. (60.81 ± 8.35)%; CD3⁺ CD4⁺ T cells: (19.02 ± 2.35)% vs. (17.21 ± 2.86)%; CD3⁺ CD8⁺ T cells: (46.59 ± 6.07)% vs. (41.18 ± 6.35)%. (P < 0.05 for all)]. However, there were no significant changes in the CD3⁺ CD4⁺/CD3⁺ CD8⁺ ratio (0.67 for sham, 0.65 for X-ray, and 0.68 for ¹²C⁶⁺ groups) and percentage of NK cell subsets (P > 0.05 for all). Expression levels of IFN-γ mRNA (cycle threshold/CT value was 23.35 ± 3.16 for ¹²C⁶⁺, CT value was 27.25 ± 2.15 for X-ray) and IL-2 (CT value was 24.19 ± 3.56 for ¹²C⁶⁺, CT value was 27.85 ± 4.08 for X-ray) in PBL, and their protein levels in the supernatant were significantly increased at 24 hours after exposure to the low dose radiation (P < 0.05). The effects were more pronounced in the group receiving 0.05 Gy ¹²C⁶⁺ ion irradiation than that in the group receiving X-ray irradiation. However, there was no significant change in the TNF-α production of PBL.</p><p><b>CONCLUSIONS</b>Low dose irradiation may alleviate the immune suppression caused by tumor burden and that the effect is more pronounced for 0.05 Gy high linear energy transfer (LET) ¹²C⁶⁺ irradiation. The percentage of T cell subsets and cytokines production could be used as sensitive indicators of acute response to low dose irradiation.</p>

Imaging features of radiation-induced sarcoma in patients with nasopharyngeal carcinoma / 中华放射学杂志

Objective To summarize the CT and MRI features of radiation-induced sarcoma (RIS) after radiotherapy in patients with nasopharyngeal carcinoma (NPC).Methods From January 1997 to October 2012,a total of 73 NPC patients with RIS after radiotherapy were confirmed by pathology.The clinical data and imaging findings (CT and MRI findings) were retrospectively reviewed.Of the 73 patients,43 underwent CT examination,24 underwent MRI,and the remaining 6 underwent both CT and MRI scans.Results Fibrosarcoma [45.3％ (33/73)] was the most frequently histologic type,followed by osteosarcoma[31.5％ (23/73)] and malignant fibrous histiocytoma [9.6％ (7/73)].The top three common sites were maxillary sinus [26.7％ (20/73)],followed by the neck soft tissue [17.8％ (13/73)] and mandible[13.7％ (10/73)].The main characteristics of the RIS on CT and MRI were soft tissue masses[78.1％ (57/73)] with an irregular shape and ill-defined margin,or rounded masses with welldefined margin [21.9％ (16/73)].CT of 49 patients showed masses with isodensity or mixed density on precontrast CT.MRI of 30 patients showed lesions with isointensity signal on T1WI and intermediate signal intensity on T2WI.On post-contrast images,65.8％ (48/73) tumors showed markedly homogeneous or inhomogeneous enhancement,23.2％ (17/73) lesions showed moderate enhancement,and 11.0％ (8/73) masses showed mild enhancement.Among the 23 patients with radiation-induced osteosarcomas,78.3％ (18/23) presented tumor bone formation.Conclusions RIS has a characteristic imaging features.Clinical history,tumor sites and serial imaging follow-up are necessary for early detection of RIS in patients with NPC.

The safety study of low central venous pressure used in the elderly under hepatic resections / 中国医师杂志

Objective To observe the change of early postoperative cognition in the elderly under low central venous pressure (LCVP) after lobe resection to investigate the safety and feasibility of LCVP in Geriatrics.Methods A total of 45 ASA class Ⅰ ～ Ⅱ old patients (60 ～ 75 y)with elective liver resection were divided into L group and C group.In the LCVP group (L group),CVP was maintained below 5 cmH2O during liver resection until the lobe was done.The patients in the control group (C group) received standard care (The CVP was controlled between 6 cmH2O to 12 cmH2O).To compare the anesthesia recovery after surgery,all patients were tested with a battery of neuropsychologic assessment of cognitive function preoperatively and on the 7th day postoperatively.Results During liver resection,the MAP [(75.8 ±7.9)mmHg] and CVP [(3.1 ±0.4)cmH2O] of experimental group were lower than the control group [MAP (92.3 ± 10.6)mmHg,CVP(9.3 ± 1.4)cmH2O].The difference was statistically significant (t' =20.08,P ＜0.05,t =5.89,P ＜0.01) ;There was no statistically significant difference in postoperative recovery of spontaneous breathing,respiratory,eye opening time,extubation time and leave the operating room time between two groups[(18.1 ±6.7)min,(25.4±8.3)min,(31.9±11.7)min,(42.8±17.8)minvs (15.3 ± 7.0)min,(22.6 ±9.4)min,(30.2 ± 10.8) min,(45.4 ± 13.6) min,P ＞ 0.05].The incidence of POCD was 30.0％ in the experimental group and 27.3％ in the control group.The difference was no statistical significance between two groups(P ＞0.05).Conclusious There was no significant influence of low central venous pressure on anesthesia recovery time and early postoperative cognition in the elderly under hepatic resections.

ERCP, laparoscopy and choledochoscopy for Mirizzi syndrome / 中华普通外科杂志

ObjectiveTo investigate the treatment of Mirizzi syndrome (MS) by ERCP、laparoscopy and choledochoscopy. MethodsIn this study 12 cases were confirmed intraoperatively as with MS from July 2005 to June 2009. Patients were treated by ERCP,laparoscopy and choledochoscopy according to the Csendes Classification. ResultThere were 7 MS patients complicating common bile duct stones among all 12 MS cases.There were 8 cases of Type Ⅰ Csendes MS,3 cases of Type Ⅱ and 1case of Type Ⅲ.11cases were treated by the ERCP、laparoscopy and choledochoscope.4 cases was treated by primary closure of common bile duct in laparoscopy,all the patients were cured.The case of type Ⅲ with T tube placed for stone caused bile duct injury had no stricture of the common bile duct as demonstrated by postoperative follow-up cholangiography.ConclusionsERCP,laparoscopy and choledochoscopy are effective for the treatment of Mirizzi syndrome.

Combined application of laparoscope and multiple endoscopes for the treatment of extra-hepatic bile duct stones:a report of 3780 eases / 中华消化外科杂志

Objective To investigate the efficacy of combined application of laparoscope and multiple endoscopes for the treatment of extra-hepatic bile duct stones.Methods The clinical data of 3780 patients with extra-hepatic bile duct stones who were admitted to the First Hospital of Lanzhou University from March 1998 to June 2010 were retrospectively analyzed.According to the condition of bile duct stones,laparoscope,choledochoscope and duodenoscope were applied separately or combinately.All patients were divided into A,B and C groups.Patients in group A were treated by laparoseopy,choledochoscopy or duodenoscopy;patients in group B were treated by choledochoscopy+duodenoscopy.duodenoscopy+laparoscopy or laparoscopy+choledochoscopy;patients in group C were treated by laparoscopy+duodenoscopy+choledochoscopy.The efficacies of different treatment approaches were analyzed by comparing the results of imaging examination and follow-up.Results The curative rate and complication rate of the group A were 89.54%(1276/1425)and 6.73%(86/1276),respectively.Of the 149 patients in the group A who were failed in the treatment,83 patients were transferred to the group B,and 66 patients were transferred to the group C.The curative rate and complication rate of the group B(including 83 patients transferred from the group A)were 95.93%(1719/1792)and 4.07%(70/1719),respectively,and 73 patients who were failed in the treatment were transferred to the group C.The curative rate and complication rate of the group C(including 139 patients transferred from the group C)were 99.75%(783/785)and 0.26% (2/783),respectively,and 2 patients who were failed in the treatment received open surgery.Conclusion Combined application of laparoscope and endoscopes could raise the success rate of stone clearance and decrease the postoperative complications.

Effects of cyclooxygenase-2 on immunologic function of rats with sepsis / 中华消化外科杂志

Objective To study the expression of cyclooxygenase-2(COX-2)in hepatic inflammatory reaction and the effects of COX-2 on immunologic function of rats with sepsis.Methods Fifty-four Wistar rats were divided into sham group(n=6),sepsis group(n=24),and NS-398 intervention group(n=24).All rats were subjected to cecal ligation and puncture or sham operation.The expression of COX-2 mRNA in rat hepatic tissue was determined by RT-PCR,serum levels of IL-6,IL-10 and TNF-α were detected by ELISA,and percentage changes of CD4+,CD8+ cells by flow eytometry.The pathological changes of liver were observed at the same time.Results (1)Severe pathologic injuries of liver were observed in sepsis group,while not in NS-398 intervention group.(2)The expression of COX-2 mRNA was up-regulated in sepsis group and NS-398 intervention group,and the expression value was higher in sepsis group than that in NS-398 intervention group.The expression of COX-2 mRNA was the lowest in sham group.(3)The level of IL-6 was higher in sepsis group than that in sham group and NS-398 intervention group(F=125.582,134.712,54.760,121.441,P＜0.05).(4)The level of IL-10 was higher in NS-398 intervention group than that in sham group and sepsis group(F=39.064,34.382,51.115,8.174,P＜0.05).(5)The levels of TNF-α in sepsis group and NS-398 intervention group were increased,and the difference between the 2 groups had no statistical significance(x2=5.600,6.162,7.136,7.200,P＞0.05).(6)The ratio of CD4+to CD8+ was higher in NS-398 group than that in sepsis group(F=17.448,15.055,30.068,64.210,P＜0.05).Conclusions COX-2 plays an important role in the development of sepsis by changing the dynamic equilibrium between pro-inflammatory and anti-inflammatory cytokine and that between CD4+and CD8+.