Volume 90  ·   Issue 16  ·  2010

The incidence of pancreatic cancer is increasing all over the world, and it has become a common malignant tumor of digestive system. The incidence rate in western countries is 10/100,000~11/100,000, and 40,000 people die of pancreatic cancer every year in the United States alone ~ ([1]).

Objective To analyze the diagnostic value of employing the parameters of glucose metabolism as screening tests for insulinoma.Methods Blood glucose profiles within 72 h were recorded by continuous glucose monitoring system(CGMS).Blood samples were collected to detect the Hbalc and GA levels.All subjects received a delayed 75g oral glucose tolerance test(OGTT)and a simultaneous insulin and C peptide releasing test.Results Levels of Hbalc[(4.49±0.63)%vs(5.60±0.25)%,(5.28±0.48)%],fasting blood glucose[(3.44±0.78)mmol/L vs(4.82±0.35)mol/L,(4.70±0.49)mmol/L] and the lowest blood glucose with CGMS[(2.31±0.24)mmol/L vs(3.28±0.45)mmol/L,(3.28±0.99)mmol/L]in insulinoma group were significantly lower than that in impaired glucose tolerance or diabetic patient group and functional hypoglycemia group(P value＜0.05).On the contrary,the levels of IRI(insulin release index)(0.38±0.07 vs 0.11±0.06,0.16±0.03),CPI(C-peptide index)(0.03±0.01 vs 0.02±0.01,0.02±0.01)in insulinoma group were higher than those of two other groups (P value＜0.05).Areas of ROC curve were 0.875,0.955,0.974,0,848,0.916 respectively as screening tests for insulinoma.Conclusion The measurements of Hbalc,fasting blood glucose,IRI,CPI and the lowest blood glucose with CGMS might be useful screening tools to identify insulinoma.

Objective To improve the diagnosis and treatment of non-ductal pancreatic adenocarcinoma-occupying lesions.Methods A retrospective analysis was made for 114 cases of pancreatic non-ductal adenocarcinoma-occupying pathologically confirmed lesions.Results ①There were 36 males (31.6%)and 78 females(68.42%);②presenting symptoms and signs were abdominal pain(n=56,49.1%),back pain(n=24,21.1%),weight loss(n=18,15.8%)and obstructive jaundice(n=8,0.07%);③the positive rates of Cal9-9,CA242 and CEA were 21.1%,19.7% and 5.6%respectively;④pancreaticoduodenectomy was performed in 26 patients,distal pancreatectomy in 53,tumor enucleation in 15,segmental pancreatectomy in 9,partial resection in 3,duodenum-preserving pancreatic head resection in 1 and palliative surgery(either cholecystojejunostomy anastomosis or gastrojejunostomy)in 7;⑤pathologic analysis revealed 35 solid pscudopapillary neoplasm of pancreas,28 pancreatic endocrine tumors,18 focal hronic pancreatitis,11 serous cystic neoplasms,9 mucinous cystic neoplasms,4 pancreatic cysts,3 acinar cell carcinomas,2 pancreatic cavernous hemangiomas,1 sarcoma of pancreas,1 sarcomatied carcinoma of pancreas.1 pancreatic schwannnoma and 1 pancreatic neuroblastoma.Conclusion The non-ductal pancreatic adenocarcinoma-occupying lesions have no specific clinical presentation or serum tumor marker.An understanding of the natural history of these lesions is important for optimal management.

Objective To investigate the expression of BRSK2(brain selective kinase 2)in pancreatic ductal adenocarcinoma and to understand its clinical implication.Methods Resected tumor specimens of 79 pancreatic ductal adenocarcinoma were collected and paraffin-embedded for prepare.0.5μm sections.Immunohistochemical staining was employed to examine the expression pattern of BRSK2 translated protein.Semi-quantitative analysis was used to evaluate the intensity and content of protein expression in tumor tissues.The expression outcome was compared in peri-tumorous tissues and normal pancreatic tissues.Meanwhile,tumor samples were grouped according to their differentiation,TNM stage,with or without vascular or neural invasion.Then the possible relationship was explored between clinical,pathological and survival data and the expression profile of BRSK2 in tumor tissues.Results BRSK2's expression was weak in normal pancreatic tissues,including islets and minor ducts such as intercalated ducts,intralobular ducts and interlobular ducts.BRSK2's expression was also weak in peri-tumorous tissues.BRSK2's expression was strong in pancreatic ductal adenocarcinomns.It had a close relationship with lymphatic metastasis,distant metastasis,TNM staging as well as peri-pancreatic neural invasion.Tumors with lymphatic metastasis,distant metastasis and peri-pancreatic neural invasion or at later stages showed a higher expression of BRSK2 than those without or those at early stages.However the expression had no correlmion with tumor size,differentiation and vascular invasion.The expression of BBSK2 in pancreatic ductal adenocarcinonms was correlated with the prognosis of patients.Those with a higher expression pattern showed a shorter survival period.Conclusion BRSK2 is up-regulated in pancreatic ductal adenocarcinoma.And its expression is correlated with tumor biological behaviors and patient prognosis.

Objective To investigate the clinical diagnosis,treatment and prognosis of melanoma adrenal metastasis.Methods A total of 48 cases of malignant melanoma from 1985 to 2007 were reviewed.And three cases of melanoma adrenal metastasis were,analyzed.There were 2 males and 1 female with an age of 57,70 and 83 years old respectively.Two cases had a history of cutaneous melanoma and another one suffered previously from anal melanoma.The disease-free interval to adrenal metastasis were 25,37,33months respectively.Two presented with flank or abdominal discomfort and another one had adrenal metastasis on routine examination.The maximal diameters of metastasis were 5,8 and 12 cm respectively.The CT value of adrenal metastasis had a range of 9-45 Hu in plain scan.And the maximal post-contrast value was 107.5 Hu. Results One patient,with concurrent lymph node metastasis received non-operative therapy with interleukin-2.The other two cases underwent complete resection of melanoma metastasis.One

Objective To compare the clinical efficacy and safety of nephrectomy versus radical nephrectomy for renal cell carcinoma(RCC).Methods A total of 134 patients with renal carcinoma without metastasis in lymphatic system and distant sites were recruited.In random.69 cases of renal cell carcinoma were elected for nephrectomy and the others radical nephrectomy.The operating time,blood loss,fasting time,postoperative hospital stay,information of tumor recurrence and metastasis,survival time without tumor,survival rate and perioperative complication were compared between two groups.Results In cases of nephrectomy,the operating time ranged from 60-135 minutes and blood loss 70-100 mL In 4 cases,membrana pleuroperitonealis was damaged. The fasting time ranged from 6-24 hours and postoperative hospital stay 5-8 days;the staging of all 69 cases was detected;follow-up studies ranged from 5-15 years,finding 1 case tumor metastasis in adrenal body and 1 case recurrent tumor in csaes of radical nephrectomy,operating time ranged from 105-185 minutes and blood loss 150-2000 ml.Membrana pleuroperitonealis was breached in 3 cases.The fasting time ranged from 12-90 hours and postoperative hospital stay 8-12 days.The staging of all 65 cases was detected.Follow-up studies of 5-15 years revealed 1 case of tumor metastasis in brain and 1 case of recurrent tumor.There was no significant difference in perioperative complication.tumor recurrence,tumor metastasis and survival time without tumor between those two groups(P＞0.05).The blood loss,operating time,fasting and postoperative hospital stay were less than that in radical nephrectomy group(P＜0.05).Conclusion In patients without metastasis in lymphatic system and distant sites,nephrectomy is both effective and safe.It has the advantages of a short operating time,a short postoperative hospital stay and less damage and blood loss than radical nephrectomy.

Objective To evaluate the effect of technical improvements of transperitoneal radical nephrectomy on the patients with large renal cell carcinoma.Methods From May 2002 until May 2009,45patients with large(＞12 cm)renal cell carcinoma underwent transperitonel radical nephrectomy.A subcostal incision was selected to expose the extraperitoneal area.The modified operative methods included exposing the operative field via a liver retractor and initially ligating renal artery to block the blood supply of kidney and tumor.The method of tumor-free tissue dissociation was applied.Hem-o-lock was employed for clipping so as to avoid hemorrhage.This modified technique was evaluated in respects of operating time,estimated blood loss,intra-operative complications,postoperative complications,length of hospital stay and pathological diagnoses.Results The tumor diameter was from 12.2 cm to 28.3 cm with a mean of 14.5 cm.The mean operative time was(150±58)min and the average estimated blood loss(350±180)mLThree cases received blood transfusion.The average length of hospital stay was (12±6)days.Three cases developed complications,including spleen injury in 2 and pancreatic injury in 1.The treatment modalities were splenectomy and resection of pancreatic tail respectively.The pathological diagnoses were all of renal cell carcinoma.The pathological stage included T_2N_(0～1)M_(0～1)(n=13),T_3N_(0～1)M_(0～1)(n=23),T_4N_(0～1)M_(0～1)(n=9).After a follow-up period of 3-63 months,3 cases of tumor recurrence were found in primary renal clutch.Conclusion Improved radical nephrectomy is feasible for large renal cell carcinoma.And it cam reduce tlle volume of blood loss and decrease the occurrence of complications.

Objective To explore the clinical characteristics,therapeutic responds and outcomes of pediatric Crohn's disease(CD).Methods From a hospital-derived incidence cohort,20 Crohn's disease patients(aged 0.5-15 years old at diagnosis),diagnosed from 2003 to 2009,received a follow-UP period of more than one year.The patients were phenotyped according to Montreal standards.PCDAl was introduced to assess the disease activity and the Hyams J rules adopted to evaluate the therapeutic efficacies.The treatment was individualized based on the overall evaluation of child Results Of these 20 patients.55% were 7-12 years old at the diagnosis time.The male:female ratio was.1.5:1.At the time of diagnosis,the common manifestations included abdomihal pain(95.0%),fever(80.0%)and diarrhea (80.0%).Growth retardation wag detected iu 50% of the cases.Complicated behavior was observed in 45% patients at diagnosis.The most frequent disease location at diagnosis was terminal ileum/colon (55%).Upper GI tract involvement was quite common in children(20%).Non-penetrating non-stricture (50%) behavior wag most frequent at diagnosis.Ultimately,corticosteroids plus 6-MP/AZA treatment was administrated in 11 cases.Of these,9(82%) successfully withdrew the corticosteroids and maintained a complete remission.Colonoscopy wag repeated in 6 complete remission cases and 4 of them achieved a complete mucosa healing.The mean follow-up period wag 23 months(range:12-59).At the endpoint of follow-up,15 cases achieved a complete remission,4 had a partial remission,1 underwent operation and none of them died.The children who successfully withdrew from corticosteroids and achieved a complete remission could catch uD the height of their age group.6-MP/AzA associated severe adverse effects were reported at 17%in this group.Condusion Growth retardation is predominant in pediatric CD and it may provide diagnostic clues.Immunosuppressant therapy may improve the natural history of this disease.It is safe under close monitoring.

Objective To evaluate the diagnostic yield of endobronchial ultrasound-guided transbronchiai needle aspiration(EBUS-TBNA)in cases of undiagnosed intrapulmonary lesions.Methods A total of 89 patients with intrathoracic lesions underwent EBUS-TBNA.including 56 pulmonary lesions,7 lymph node staging in lung cancer patients,21 unknown hilar and/or mediastinal lymphadenopathies and 5 mediastinal tumors.All samples were evaluated for cytological and pathological examinations.Results No complication of EBUS-TBNA was observed.Among 89 cases,76 had positive results,5 negative and 5 cases excluded as unsatisfied samples.In 56 patients with pulmonary lesions.EBUS-TBNA demonstrated 45 malignant tumors,5 benign diseases,3 suspicious cancers,1 negative and 2 unsatisfied samples.In 7 lung cancer patients staged by EBUS-TBNA.5 showed metastasis and 2 showed no metastasis.In 21 cases with mediastinal and/or hilar lymphadenopathy,EBUS-TBNA demonstrated 3 malignant tumors,13 benign diseases.2 negative and 3 unsatisfied samples.All 5 mediastinal lesions were malignant.Three suspicious cancers were confirmed.1 bv CT-guided percutaneous transthoracic needle biopsy and 2 by clinical followups.In 2 lung cancer patients EBUS-TBNA showed negative.1 surgical sample showed metastasis and another nometastasis by PET-CT.Three negative cases were diagnosed as benign by clinical follow-ups.The diagnostic sensitivity,specificity,positive predictive value and negative predictive value of EBUS-TBNA were 95%,100%,100%and 20%respectively.Conclusion EBUS-TBNA is both effective and safe in making a diagnosis of intrathoracic lesions.

Objective To summarize the chest high-resolution CT(HRCT) features of the patients with extrinsic allergic alveolitis (EAA). Methods We analyzed the images of chest HRCT of 34 patients diagnosed as EAA at our hospital from February 2001 to August 2009. Results All patients had a history of environmental exposure. The duration of intermittent or continuous antigen exposure was from 3 months to 13 years. Two patients showed acute clinical manifestations. There were 22 sub-acute and 10 chronic cases.Acute EAA was characterized by ground-glass opacities, air trapping and/or mosaic sign on HRCT. The HRCT features of subacute EAA included patchy ground-glass opacities with mosaic sign (n =11, 50. 0% )and diffusely distributed centrilobular nodules ( n = 7, 31.8% ) with mosaic sign ( n = 4, 18. 2% ). All patients with chronic EAA had reticular and honeycombing lesions on HRCT. There were 3 cases with ground-glass opacities, 3 with mosaic sign, and 3 with centrilobular nodules. Conclusion The typical findings of chest HRCT are helpful for making a diagnosis and differential diagnosis of EAA.

Objective To investigate the molecular mechanism of idiopathic atrial fibrillation(AF)associated with KCNA5 mutation.Methods The clinical data and blood samples from 130 unrelated subjects with idiopathic AF were collected and evaluated in contrast to 200 healthy individuals.The coding exons and the flanking introns of KCNA5 gene were amplified by polymerase chain reaction and sequenced using the di-deoxynucleotide chain termination approach to identify potential mutations.Multiple alignment of the KCNA5 encoded protein sequences across species Was performed.The KCNA5 gene wag cloned and the corresponding mutant was acquired by site directed mutagenesis.The recombinant plasmid expressing or tracing KCNA5 Was constructed and transfected into COS-7 cells with Lipofectamine,respectively.The effects of mutated KCNA5 gene on the electrophysiologieal characteristics and subcellular location of encoded ion channel were explored by patch-clamp and confocal microscope,respectively.Results A heterozygous missense KCNA5 mutation.C.1580C＞T was identified in 1 of 130 idiopathic AF patients.Namely,the triplet substitution of ATG for ACG at codon 527.predicting the conversion of threonine into methionine at amino acid residue 527(T527M),was detected.Functional analysis revealed that KCNA5 T527M mutation exerted predominant negative effect on the currents but no effect on the subcellular location of encoded ion channel.Conclusion The heterozygous KCNA5 T527M mutation identified in 1 idiopathic AF patient exerts predominant negative effect on the currents of encoded ion channel,thereby conducing to idiopathic A F.

Objective To investigate the clinicopathological features and the safety of surgical treatment of large hepatocellular carcinoma(HCC).Methods A total of 316 HCC patients undergoing hepatectomy at our hospital from December 2005 to December 2008 were divided into HCC＞10 cm(large HCC)group(n=119)and HCC≤10 cm group(n=197).The clinicopathological data and surgical outcomes were compared between two groups.Results The HCC＞10 cm group had a higher rate of symptoms and physical findings than the HCC≤10 cm group.Compared with HCC≤10 cm group,intrahepatic metastasis,vascular invasion,adjacent organ invasion and poorly differentiated tumor were more common in HCC＞10 cm group.The preoperative serum levels of α-fetoprotein,aspartate aminotransferase and alkaline phosphatase were higher in HCC＞10 cm group.The patients with HCC＞10 cm received more major hepatectomies,suffered more intraoperative blood loss,had greater blood transfusion requirements and needed a longer operative duration.However,the incidences of postoperative complications and mortality rate were similar in two groups.Conclusion Large HCC is characterized by more clinical manifestations,higher incidences of vascular invasion and adjacent organ invasion,and worse histological grades.Surgical resection for large HCC is both safe and feasible.

Objective To analyze the genetic and biological characters of a new isolate of coxsackievirus B3( CoxB3), i. e. FY-19 strain, and investigate its mechanistic role in causing different clinical symptoms of hand-foot-mouth disease (HFMD). Methods FY-19 strain, isolated from a patient with severe clinical symptoms from Fuyang, China in 2008, was identified by the serological parameters via the Lim Benyesh-Melnick (LBM) antiserum pools. Its genotype was further characterized by sequencing the whole genome. And its biological characters were also examined by proliferation kinetic and pathogenetic analysis. Results FY-19 strain was identified as CoxB3 showing 23.0%, 16. 5% and 32. 1% difference with Nancy strain in 3'-, 5'-nonconding and coding regions respectively. FY-19 also showed a high homology with other HFMD-related CoxB3 isolates in China. But its homology with non-HFMD-related CoxB3 isolates was lower (13. 5% and 25.0% difference in 3'-NCR and coding region respectively). The viral replication kinetic analysis suggested that the FY-19 proliferation increased rapidly and peaked at 14 hours postinfection. In pathological analysis, FY-19 strain induced mortal pathology in sucking mice. Conclusion Differences in genetic and biological characters exist between FY-19 and Nancy strains. Further analysis on the pathogenesis of this variant may aid in elucidating the mechanisms of HFMD.

Objective To investigate the association of gastric emptying with ghrelin,obestafin and GHSR,GPR-39 in hypothalamus of diabetic rats.Methods Sixty Wistar rats were randomly divided into three groups:a normal control group(NC,n=20),a diabetes mellitus group(DM,n=20)induced by intraperitoneal injection of streptozotocin(STZ)and an insulin treated group(INs,n=20).After two and six weeks of STZ injection,gastric emptying was measured by intragastric administration of phenol red,ghrelin and obestatin in hypothalamus measured by ELISA (enzyme-linked immunosorbent assay)and GHSR and GPR-39 by RT-PCR(reverse transcription-polymerase chain reaction).Results After two weeks of STZ injection,gastric emptying(%)(74±8,40±5),ghrelin level(ng/g)(52±9,51±7)and ratio of ghrelin/obestatin(3.8±1.0,2.8±1.0)increased significantly in DM and INS groups compared to those in NC group[32%±7%,(39±11)ng/g,2.1±0.8,all P＜0.05].Obestatin level(ng/g)(14.2±2.0) of hypothesis decreased significantly in DM group as compared to those in NC group(21.7±4.7)while GHSR/β-actin increased significantly(1.26±0.46 vs 0.77±0.21,P＜0.05).Gastric emptying was positively correlated with ghrelin.ghrelin/obestatin and GHSR/β-actin of hypothalamus(r=0.49;r=0.63;r=0.73;P＜0.01).But there was a negative correlation with obestatin of hypothalamus(r=-0.74,P＜0.01).After six weeks of STZ injection,gastric emptying(78.97%±8.13% vs 44.06% ±5.06%)increased significantly in DM and INS groups as compared to those in NC group(35.06%±3.91%,P＜0.01).Gastric emptying was positively correlated with ghrelin/obestatin of hypothalamus(r=0.40,P＜0.05).There was no detection of GPR-39 in hypothalamus.Conclusion The rapid gastric emptying may be due to the rising levels of ghrelin and GHSR in hypothalamus during early hyperglycemia.And the duration of hyperglycemia is affected by the rising ratio of ghrelin/obestatin.

Objective Epithelial-mesenchymal transition(EMT)is an important process in tumor development.Several studies suggest that the β-catenin signal pathway may play an important role in EMT.However,there is no direct evidence showing that this pathway actually determines the EMT induced by exogenous signal.Our previous study has successfully proved that over-expression of HIF-1α could induce EMT in LNCaP cells.but not in Pc-3.So the present study was intended to indicate that the signal of HIF1αfor inducing prostate cancer cell to undergo EMT mish pass through the β-catenin pathway.Methods Firstly,we analyzed the expression of HIF-1αand its target proteins in LNCaP/HIF1α and PC-3/HIF1α by Western blot.And then EMT-associated proteins were detected by Western blot. Furthermore the potency of invasiveness and proliferation of several cell lines were evaluated by transwell and MTT assay.Lastly the expressions of β-catenin and GSK-3βin these cells were analyzed by Western blot and RT-PCR. Results HIF-1α,Glut-1 and、VEGF were highly expressed in LNCaP/HIF1α and PC-3/HIF1α And PC-3,LNCaP and PC-3/HIF1αwere EMT-negative cell lines whereas LNCaP/HIF1α and IA8 had undergone EMT

Objective To investigate the roles of InnVit(FBX011)gene in melanocytes by detecting the expression of InnVit gene in vitiligo and analyzing the impact of IunVit gene on morphology of endoplasmic reticulum(ER)and the tyrosinase export from ER.Methods The lesion tissues and the donor tissues were collected from 10 vitiligo patients to examine the IunVit gene expression by immunohistochemistry.Synthesimt specific siRNA and constructed plasmid P3XF-P120 were separately transfected into cells for the silence and over-expression of InnVit gene with lipofectamine~(TM) 2000.The untreated cells were used as control. Morphology of ER of cells from the above three groups was observed under electron microscope.Co-localization of tyrosinase and calreticulin was identified by confocal laser scanning microscopy.InnVit,tyrosinase and calreticulin were examined by Western blot.Results In vitiligo patients,the expression of InnVit gene in the lesions was markedly lower than that in the donor tissues.The normal morphology of ER was found in the untreated and the plasmid groups whereas inilated ER was shown in siRNA group.And the relative inflation rate in siRNA group(1.97±0.48)was higher

A 46-year-old male was admitted to hospital on July 25, 2009 due to physical examination showing space-occupying lesions in the left kidney for 1 week, hematuria and abdominal pain for 1 day. A week ago, B-ultrasound showed multiple hypoechoic areas in the left kidney, with a maximum of 9.4 cm ×7.4 cm. Abdominal CT showed a mixed density mass of 8.8 cm ×7.5 cm in the left kidney, with mild enhancement in the parenchyma stage, no obvious tumor thrombus in the left renal vein and inferior vena cava, and close to the destruction of the renal pelvis and calyces, so renal cancer was considered.

Patients with critical illness cannot carry out oral care independently, their oral health is often very poor, and microbial pathogens deposit and spread in biofilm and oral secretion. Under mechanical ventilation, these pathogens are easier to enter the lower respiratory tract and colonize the lung, causing iatrogenic pneumonia infection. The ICU admission time is significantly prolonged, and the mortality rate is increased. Reducing the number of bacteria causing oropharyngeal contamination is one of the methods to prevent iatrogenic infection. Selective oropharyngeal decontamination (SOD) and oral nursing measures may reduce the infection rate of nosocomial pneumonia. This paper reviews the literature on the application of topical antibacterial drugs and disinfectants, the role of comprehensive oral nursing measures, and the problems existing in oral nursing, hoping to attract widespread attention to the oral nursing of critical patients.

Shock is a medical emergency, characterized by hypotension and decreased tissue perfusion. If not treated as soon as possible, it will cause irreversible cell damage and death. Hypotension accompanying shock can be caused by many reasons, such as myocardial failure, hypovolemia and vascular effects caused by inflammatory reactions. Vasopressin is mainly used for treatment and a series of measures taken for ventricular enlargement and multiple organ failure.

A 57-year-old male was admitted to the hospital on August 1, 2009 due to the rediscovery of a cyst in the left laryngeal ventricle for 1 year and 3 months. The patient was admitted to the hospital more than 2 years ago due to "laryngeal carcinoma (glottic type) T_ (1a) N_0M_0". On July 10, 2007, he underwent "left anterolateral vertical partial laryngectomy + tracheotomy" under general anesthesia.