Therapeutic effect of extralevator abdominoperineal excision in combination with conventional abdominoperineal excision on distal rectal cancer:A Meta-analysis / 西安交通大学学报(医学版)

Objective To explore the short and long-term efficacy of extralevator abdominoperineal excision (ELAPE)vs.conventional abdominoperineal excision (APE)on distal rectal cancer.Methods Relevant studies were identified by search of Medline,EMBASE,and Web of Science published between January 1,2008 and February 28,2015,and included in the systematic review and meta-analysis with Stata software (version 12.0). Results Our Meta-analysis included 14 studies involving 3278 patients,of whom 1843 (56.2%)underwent ELAPE and 1435 (43.8%)underwent APE.Compared with patients undergoing APE,those undergoing ELAPE had a significantly reduced risk of intraoperative bowel perforation (IBP)involvement (OR=0 .55 ,95% CI= 0 .37-0 .85 ),but no significant reduction in the occurrence of CRM positivity (OR=0 .81 ,95% CI=0 .52-1 .25 ), local recurrence (LR)(OR=0.49,95% CI=0.18-1.30),wound complications (WCs)(OR=0.93,95% CI=0.65-1.35)or in-hospital death (IHD)(OR=0.89,95% CI=0.47-1.71).Conclusion ELAPE can reduce the risk of IBP but not for CRM positivity or LR when compared with APE.Therefore,more higher-quality studies are needed to verify the short-and long-term effects of ELAPE procedure on distal rectal cancer.

Practice and Exploration on Hospital Management under the Overall Trusteeship Mode / 中国医学伦理学

Objective:To explore the rational mode of hospital management under the trusteeship mode through the case study of a county-level hospital entrusted by a large general public hospital.Methods:Based on the system construction,the complete sinking of quality medical resources,the cultivation of talents and cultural integration,this paper analyzed the current situation of medical technology and service quality in hospitals before and after trusteeship by a retrospective control study.Results:The medical technology,quality and patient satisfaction of the hospital were improved significantly after trusteeship.Conclusions:The effective measures in the process of trusteeship of county-level hospitals are conducive to improve the level of medical technology and service of county -level hospitals,which can ensure the quality and safety of medical treatment,provide valuable suggestions for decision-making,and promote the development of hierarchical diagnosis and treatment.

Meta-analysis of the risk factors for clinical anastomotic leakage after resection of rectal cancer in China / 西安交通大学学报(医学版)

Objective To explore the risk factors for clinical anastomotic leakage after resection of rectal cancer in China. Methods By meta-analysis we made a comprehensive analysis of the risk factors for clinical anastomotic leakage after resection of rectal cancer based on 19 articles published in China between January 1999 and January 2009. Results The anastomotic leakage rate was higher in the patients aged 60 years old and above than in those younger, with the combined odds ratio (OR) value being 0.50 (95% CI: 0.33-0.76) (P<0.01). The incidence rate was higher in the male patients than in the female ones, with the combined OR value being 2.17 (95% CI: 1.38-3.42) (P<0.01). The incidence rate in the patients with the distance of tumor from the lower margin to anal verge being 7cm and shorter was higher than that with longer distance, with the combined OR value being 1.79 (95% CI: 1.37-2.35) (P<0.01). The incidence rate in the patients who had received radiotherapy preoperatively was higher than that in those who had not, with the combined OR value of 3.66 (95% CI: 2.19-6.09) (P<0.01). The incidence rate in the patients who had received stapler anastomosis was higher than that in the patients who had received manual anastomosis, with the combined OR value being 0.70 (95% CI: 0.47-1.05), but there was no significant difference between them (P>0.05). The incidence rate was higher in the patients with diabetes mellitus than in the healthy ones, with the combined OR value being 3.16 (95% CI: 2.27-4.39) (P<0.01). The incidence rate was lower in the patients with Dukes A and B stages than in those with Dukes C and D stages, with the combined OR value being 0.61 (95% CI: 0.45-0.83) (P<0.01). The incidence rate in the patients with high malignance degree in clinicopathological types was higher than that with low malignance degree, with the combined OR value being 2.17 (95% CI: 1.38-3.42) (P<0.01). The incidence rate was lower in the patients who had received preventive colostomy than in those who had not, with the combined OR value being 0.39 (95% CI: 0.14-1.05), but there was no significant difference between them (P>0.05). The incidence rate was higher in the patients who had got selective operation than in those who had got emergency operation, with the combined OR value being 0.27 (95% CI: 0.13-0.56). Conclusion The risk factors of anastomotic leakage after resection of rectal cancer are as follows: 60 years old and above, male patients, diabetes mellitus, preoperative neo-adjuvant radiotherapy, the distance of tumor from the lower margin to the anal verge being shorter than 7cm, Dukes C and D stages, high malignance degree in clinicopathological types, and emergency operation.

Geldanamycin inhibits proliferation and motility of Her2/neu-overexpressing SK-Br3 breast cancer cells / 药物分析学报

Objective Benzoquinone ansamycin antibiotic, geldanamycin (GA), is a new anticancer agent that could inhibit Hsp90 by occupying its NH2-terminal ATP-binding site. This study was to investigate the antitumor efficacy of GA on Her2/neu tyrosine kinase overexpressing human breast cancer cell line SKBr3. Methods The degradation of Her2/neu tyrosine kinase was analyzed by Western blotting, the proliferation index was determined by MTT assay,cell cycle distribution was detected by flow cytometry, Cyclin D1 mRNA transcription was measured by RT-PCR and real-time PCR, and cell motility was evaluated by the cell culture insert model. Results GA induced a dose- and a time-dependent degradation of the Her2/neu tyrosine kinase protein and concurrently, the inhibition of cancer cell proliferation. The antitumor effects mediated by GA included: GA treatment decreased the survival rates of cancer cells,and led to a dase-dependent G1 arrest. Furthermore, this antitumor effect was proved to be related to declined transcription of Cyclin D1. Concurrently, the motility of cancer cells was reduced by GA. Conclusion GA treatment could induce the degradation of Her2/neu tyrnsine kinase efficiently, inhibit cancer cell proliferation and reduce motility in Her2/nen tyrosine kinase overexpressed human breast cancer cell line SKBr3.

siRNA directed against TrkA sensitizes human pancreatic cancer cells to apoptosis induced by gemcitabine through an inactivation of PI3K/Akt-dependent pathway / 药物分析学报

Objective To determine the effect of suppressing TrkA expression on pancreatic cancer chemosensitivity to gemcitabine and further disclose the role of PI3K/Akt signal transduction pathway in pancreatic cancer chemoresistance. Methods Human pancreatic cancer cell lines PANC-1, MIA-PaCa-2 and ASPC-1 were studied. The expression and kinase activity of TrkA were determined by Western blot analysis and in vitro kinase assay, respectively. RNA interference was used to suppress TrkA expression. Gemcitabine-induced cytotoxicity was determined by tetrazolium reduction assay and caspase profiling was performed. The effect of TrkA-specific siRNA on PI3K/Akt activity was also quantified. Results TrkA expression and kinase activity in cell lines were directly correlated with gemcitabine chemoresistance. TrkA-specific siRNA suppressed TrkA expression and kinase activity, and furthermore increased gemcitabine-induced, caspase-mediated apoptosis. PI3K/Akt activity was decreased by suppression of TrkA expression. Conclusion TrkA is a determinant of pancreatic adenocarcinoma chemoresistance and PI3K/Akt is a key signaling component by which NGF activation of the TrkA signal transduction pathway protects pancreatic cancer cells from chemotherapy-induced cell death.

Relationship between ectopic expression of Wnt/?-catenin signaling pathway and Her2 overexpression in human breast carcinoma / 西安交通大学学报(医学版)

Objective To investigate ectopic expression of key elements of Wnt/?-catenin signaling pathway,including E-cadherin,?-catenin and Cyclin D1,as well as the relationship between ectopic expression of ?-catenin and overexpression of Her2 in human breast carcinoma tissues.Methods Immunohistochemical technique(Elivision) was used to detect the expression of Her2 and three elements of Wnt/?-catenin signaling pathway(?-catenin,E-cadherin,Cyclin D1) in 90 samples of human breast carcinoma.Results In E-cadherin normally-expressed group,the ectopic expression rate of ?-catenin(27.3%) was significantly lower than that(75.0%) in E-cadherin negative breast carcinoma;in ?-catenin ectopic expression group,overexpression rate of Cyclin D1(83.3%) was significantly higher than that(40.7%) in the other group.In Her2 overexpressed-breast carcinoma tissue,the ectopic expression rate of ?-catenin(73.5%) was significantly higher than that(19.6%) in Her2 negative breast carcinoma.Her2 overexpression could coexist with ectopic expression of Wnt/?-catenin in promoting axillary lymph node metastasis in human breast carcinoma.Conclusion Ectopic expression of Wnt/?-catenin signaling pathway does exist in some human breast carcinoma tissues,and the abnormal expression correlates with overexpression of Her2.Furthermore,the instantaneous activation of them could present synergism in promoting metastasis of axillary lymph nodes.

Multivariate analysis by Cox Proportional Hazards Model on prognoses of patients with bile duct carcinoma after resection / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the influence of various clinicopathologic factors on the survival of patients with bile duct carcinoma after curative resection.</p><p><b>METHODS</b>A retrospective analysis was performed on 86 cases of bile duct carcinoma treated from January 1981 to September 1995. Fifteen clinicopathologic factors that could possibly influence survival were selected. A multivariate analysis of these individuals was performed using the Cox Proportional Hazards Model.</p><p><b>RESULTS</b>The overall cumulative survival rate was 73% for 1 year, 32% for 3 years and 19% for 5 years. The results of univariate analysis showed that the major significant prognostic factors for influencing survival of these patients were type of histological lesion, lymph node metastasis, pancreatic invasion, duodenal invasion, perineural invasion, macroscopic vessel involvement, resected surgical margin and depth of cancer invasion (P < 0.05). Pancreatic invasion, perineural invasion and lymph node metastases were the three most important prognostic factors determined by multivariate analysis using the Cox Proportional Hazards Model.</p><p><b>CONCLUSION</b>Pancreatic invasion, perineural invasion and lymph node metastases are the most important prognostic factors for bile duct carcinoma after curative resection.</p>

The diagnosis and treatment of primary carcinoma of the duodenum:a report of 45 cases / 中国普通外科杂志

ObjectiveTo improve the diagnosis and treatment of primary duodenal carcinoma.MethodThe clinical data of 45 patients with primary carcinoma of the duodenum from 1987 to 2000 were analyzed retrospectively.ResultAccording to the site of cancer, tumors around, below and above the duodenal papilla accounted for 64%, 22% and 13% of all cases. The diagnosis rate of duodenoscopy was 71%(15/21). Pancreatoduodenectomy was performed in 22 cases, segmental duodenectomy in 2 cases, simple tumor resection in 3 cases, gastroenterostomy or choledochojejunostomy in 12 cases and simple laparotomy in 4 cases. In patients of curative resection, the postoperative 3 and 5 years′ survival rate was 41 4% and 23 6%. In those with gastroenterostomy or choledochojejunostomy, the average survival time was 6～15 months. All cases undergoing biopsy only died within six months.ConclusionPrimary duodenal carcinoma mainly occurs around duodenal papilla. The long time survival of Whipple′s procedure is favourable.

RESEARCH OF NUTRITIONAL AND IMMUNE STATUS IN PATIENTS WITH GALLBLADDER CARCINOMA RADICAL CHOLECYSTECTOMY / 药物分析学报

Objective To inquire the nutritional and immune status in patients with gallbladder carcinoma before and after radical cholecystectomy.Methods The nutritional and immune status in patients with gallbladder carcinoma were assessed in 1 week before surgery, and on 3rd day, 7th day, 14th day and 21st day after operation, respectively.Results All of the nutritional parameters but the serum level of iron, TIBC and transferrin recovered within 3 week after operation. Remarkable decrease of serum IgG, IgA, IgM and C3, C4 complement, IL-2, CD4, CD4/CD8 ratio, and the remarkable increase of serum SIL-2R and CD8(P＜0.01) on 3rd day after operation.Conclusion Adequate iron should be supplemented after the radical cholecystectomy for gallbladder carcinoma in the third postoperative week. Radical cholecystectomy with complete resection of the tumor and removal of lymph nodes played the important roles in the recovery of immune function.

SENTINEL NODE BIOPSY BY TWO KINDS OF BLUE DYES IN PATIENTS WITH BREAST CANCER / 药物分析学报

Objective To evaluate the identification successful rate of sentinel lymph node (SLN) with breast cancer and the accuracy to predict axillary lymph node status in different vital blue dyes.Methods 94 patients with breast cancer were recruited for the study between Oct. 1999 and Apr. 2001, of whom 32 and 62, respectively, were injected 0.028mmol*L-1 Methylene blue and 0.018mmol*L-1 Patent blue violet in breast parenchyma surrounding the primary tumor to identify SLN.All 94 patients underwent the axillary lymph node dissection.Results For Methylene blue group and Patent blue violet group, SLN identification successful rates were 65.6% (21/32) and 88.7% (55/62) (P=0.012) and accuracy rate to predict axillary lymph node status were 90.5% (19/21) and 98.2% (54/55) (P=0.183), respectively.Conclusion In identifying SLN,Patent blue violet is more ideal vital blue dye than Methylene blue, whereas the accuracy rate to predict axillary lymph node status had no significant difference.

HIGN LEVEL EXPRESSION OF HEPATITIS C VIRUS CORE GENE IN E. COLI / 药物分析学报

ObjectiveTo express the hepatitis C virus (HCV) core gene in E . coli on a high level. Methods　The cDNA coding for HCV core protein was amplified by polymerase chain reaction (PCR). The PCR product was　purified and digested with restriction enzymes and inserted into the downstream of PRPL promoter of a high-level ex- pression vector pBV220. HCV core gene was expressed in E. coli in a non-fused form. The expression protein was analysed by SDS-PAGE , and its immunoactivity was tested by ELISA. Results Sequence analysis of the amplified PCR products confirmed that we have successfully cloned and expresssed the intact core protein of HCV. SDS-PAGE showed that a specific protein with a molecular weight of 21kDa at a level of 14. 0％ of the total bacterial proteins ap- peared in bacteria harboring pBV/HCVCore, while this protein was absent in the control bacteria harboring pBV220. The results of enzyme immunoassay analysis showed that this protein could be specifically recognized by the HCV pos- itive sera from patients with hepatitis C . Conclusion The intact HCV core protein was successfully expressed in E . coli in a non-fused form on a high level, and its immunoactivity was high.

Significance of determination of glycosaminoglycan and its complements in pancreatic carcinoma / 中国普通外科杂志

Objective To investigate the clinical significance of the change in content of glycosaminoglycan and its composition in pancreatic carcinoma. Methods The content of glycosaminoglycan and its complements in 30 cases of pancreatic carcinoma and 2 cases of normal pancreatic tissue were determinated with biochemistrical and immuohistological methods. Results The content of glycosaminoglycan in pancreatic carcinoma (3.05 mg?0.75 mg/g wet tissue) was much higher than that in normal pancreatic tissue(1.39 mg?0.01 mg/g wet tissue) (P

Study of sentinel node biopsy with methylene blue and patent blue violet injection in patients with breast cancer / 中国普通外科杂志

Objective To study the identification rate of sentinel lymph node (SLN) in patients with breast cancer (BC) and the accuracy in predicting axillary lymph node(ALN) metastasis using methylene blue (MB) and patent blue violet (PBV) injection. Methods From October, 1999 to April, 2001, 94 patients with BC were selected for this study. Of them, 32 patients were injected with 1% MB and 62 patients with 1% PBV to identify SLN. All 94 patients underwent the axillary lymph node dissection. Results In MB group and PBV group , the SLN identification rate were 65.6% (21/32), 88.7% (55/62); the accuracy rate to predict axillary lymph node status were 90.5% (19/21), 98.2% (54/55) respectively. Conclusion Compared with MB ,PVB is the more ideal vital blue dye in identification of SNB.