Abstract:Abstract:Objective：To investigate the shortterm effect of anthracycline(pirarubicin)based combination regimen as neoadjuvant chemotherapy for stage III primary breast cancer. Methods：For 138 patients with stage III primary breast cancer , one to four cycles of anthracyclinebased combination chemotherapy as CTF regimen were given. The clinical results, the feasibility rate of conservative breast surgery and toxic and side reaction were observed. Results：The overall response rate was 75.4%(104/138), including one case with clinical complete response(cCR), and 102 cases with clinial partial response(cPR),no change rate 23.2%, and progressive disease rate(PD) 1.4%(2/138). Seven cases received conservative breast surgery(5.1%,7/138). The cardiotoxicity was light without congestive heart failure, and the incidence of premature ventricular extrasystole(PVE) was 1.4%. The regimen resulted in mild alopecia and serious myelosuppression. The incidence of grade II myelosuppression was 27.5%, grade III 21.0%, and grade IV 7.2%.Conclusions：the shortterm effect of anthracyclinebased combination neoadjuvant chemotherapy as CTF regimen for primary breast cancer was satisfactory with little cardiotoxic effects.

Abstract:Abstract:Objective：To investigate the correlative factors of sentinel lymph node(SN) metastasis status in breast cancer. Methods：The clinical data of 115 patients with breast cancer who underwent sentinel lymph node biopsy(SLNB) and axillary lymph node dissection(ALND) during June 2004 through April 2006 were retrospectively analysed. The SN metastasis were evaluated with regard to tumor size(≤2cm, 2.1cm~4cm)and CerbB2、p53、nm23、ER、PR status. Results：Of the 115 patients SN was identified in 110(95.65％).An average of 1.97 SNs were examined per patient. Ninetyfive(86.37％)of 110 patients were correctiy diagnosed in SN and AN.Thirtysix(37.89％)of 95 patients were SN positive, and 59(62.11％)were SN negative. Among the patients, SN metastasis rate in tumors 2.1cm~4cm(50.94％) in diameter was highter compared with those ≤2cm (23.43％) in size(P＜0.01). Among the patients with CerbB2 expression, SN metastasis rate was 24.32％(9/37) in negative cases and 46.55％(27/58) in positive cases, which difference was significant(P＜0.05).However,the relation of negative or positive expression of p53, nm23 , EP and PR, to SN metastasis rate was not statistically different when compared(P＞0.05). Conclusions：Tumor size and CerbB2 status were significantly associated with SN metastasis and may be used to predict SN metastasis in invasive breast cancer.

Abstract:Abstract:Objective：To construct the small interfering RNA (siRNA) eukaryotic expression vector specific for human CXCR4 gene and to observe its silencing effects on CXCR4 gene. Methods：The expression vectors of pSUPER/ CXCR4siRNA1 and the control group pSUPER/ CXCR4siRNA0 were constructed by gene recombination, and then were transfected by liposome mediated into the MDAMB231 breast cancer cells with high metastasis potential . The expression of CXCR4 mRNA and protein was detected. Results：The eukaryotic expression vectors of pSUPER/ CXCR4siRNA1 ,which downregulated mRNA and protein of CXCR4 at 72 h after transfection, were successfully constructed. The inhibitory effects of pSUPER/CXCR4 siRNA1 was obvious stastictically. Conclusions：Eukaryotic expression vector of siRNA specific for CXCR4 is successfully constructed and has inhibitory effects obviously, which can provide the experimental basis for its application in the treatment of breast cancer.

Abstract:Abstract:Objective：To explore the contribution of ultrasonic examination and localization in early breast cancer screening of chinese women with dense breast. Methods：From February, 2002 to April, 2006, the breasts of 5 000 women were examined using ultrasonic examination,and in about 4,000 women a mass was detected, which included 142 cases of breast cancer proved by pathology with diameter ≤2cm occurred in patients with dense breast. In these parients, ultrasonic visualization and molybdenum target mammographic were performed. Results：In these with breast cancer and dense breast,there were 47 cases(33.10％) with microcalcification detected by ultrasonography, the sensitivity rate was 74.60％ and the accuracy rate was 88.73％. Only 38 (26.76％) cases were detected by mammography, the sensitivity rate was 60.32％ and the accuracy was 82.39％.About 44.37％ breast cancer with dense brast display as the microcalcification. There were 110 cases（77.46％） of the small breast cancer detected by ultrasonography, the sensitivity was 88.71％ and the accuracy rate was 90.14％.There were 100 cases（70.42％） detected by mammography, the sensitivity rate was 80.65％ and the accuracy rate was 83.10％. Also, in 12 patients an unpalpation breast lesion was correctly excised by the use of ultrasonic localization.
Conclusions：（1）For the small breast cancer in dense breast the sensitivity and the accuracy of ultrasonography surpassed those of mammography. （2）The ultrasonic examination is an effective way for early breast cancer screening in young women with dense breast and flat breast. Ultrasonography can improve the rate of dignosis in early breast cancer, and also improve the breastconserving surgical rate. Ultrasonography is worth of widespread use spreading.

Abstract:Abstract:Objective：To study the expression of estrogen receptor beta mRNA(ERβmRNA)and vascular endothelial growth factor mRNA（VEGFmRNA） in breast cancer (BC) and the interrelationship of their expression. Methods：Semiquantitive reverse transcriptase polymerase chain reaction was conducted to dectect the expression of ERβmRNA and VEGFmRNA in 35 BC samples. The correlation between the expression of ERβmRNA and VEGFmRNA was analyzed, and the relationship between their expression and clinicalpathological parameters was also analyzed. Results：The expression of VEGF121，VEGF 165mRNA in BC with lymph node metastasis was significantly higher than that in BC without lymph node metastasis（P=0.033,0.004）. The expression of ERβmRNA was well correlated with the expression of VEGF121,165mRNA in BC patients（all p =0.000）.Conclusions：ERβmight modulate the expression of VEGFmRNA in BC. The expression of VEGFmRNA with high level in BC patient can indicate that lymph node metastasis might occur.

Abstract:Abstract:Objective：To study the effect of cryopresevation of vitrified microencapsul in preserving the rat hepatocytes, and to select the best cryopreservation condition of hepatocytes. Methods：33%,37%,40% ethyl hydroxide was respectively used as the cryopreserving agent of hepatocytes, and the effect of different speeds of cryopreservation on hepatocytes conservation was tested. Results：The best cryopreseration agent of hepatocytes was 40% ethyl hydroxide; the effect of different speeds of cryopreservation on hepatocytes preservation was the same. The P450 activation and urea synthesis function of cryopreserved hepatocytes were as same as before and after cryopresevation. Conclusions：Vitrification can presere the microencapsuled rats hepatocytes effectively.

Abstract:Abstract:Objective：To investigate the gene expression of nuclear factor-kappa B (NF-κB) and its biological significance in liver cancer tissue. Methods：The samples from hepatic cancer tissue and corresponding adjacent tissues were collected in thirty-two patients with primary liver cancer. The mRNA and protein levels of NF-κB were determined by reverse-transcription PCR and Western bolt, respectively. Immunochemistry was employed to determine the localization of NF-κB protein in liver tissues. Results：As shown by RT-PCR and Western blot, both mRNA and protein expressions of NF-κB in liver cancer tissues were significantly higher than those in corresponding adjacent liver tissues(P<0.05). In liver cancer tissues, NF-κB was shown to be expressed in both cellular nucleus and cytosol, whereas its expression was only detected in cellular cytosol of tissues adhacent to cancer. The difference of the intracellular localization of NF-κB between liver cancer and tissues adjacent to cancer implies that NF-κB is activated in liver cancer tissue. Conclusions：NF-κB gene is significantly overexpressed and activated in liver cancer tissue. The different location of NF-κB gene in cancer cell and adjacent liver cell may suggest that after NF-κB actived and entered to nucleus, which may consequently modulate transcription of some related downstream-gene, and promote the initiation and development of liver cancer.

Abstract:Abstract:Objective：To investigate the effect of expression of pituitary tumor transforming gene(PTTG) on the expression of inhibitory of vascular endothelial growth factor(VEGF). Methods：The constructed recomibinant vector, pcDNA3.1-PTTGas that contained full-length antisense PTTG,was transfected into the cholangiocarcinoma cell line QBC939 in different quantity. After 48h incubation, the variation of expressions of PTTG and VEGF mRNAs and proteins were observed by RT-PCP and Western-blot method. Results：After successful transfecting the recomibinant vector into QBC939, the mRNAs and proteins of PTTG and VEGF were all inhibited. Linear correlation analysis showed positive correlation between descendent extents of PTTG and VEGF（P <0.05）. Conclusions：Antisense blocking PTTG gene can inhibit the expression of VEGF in both mRNA and protein levels, and a positive correlation between descendent extents of PTTG and VEGF was observed.

Abstract:Abstract:Objective：To establish cholangiocarcinoma cell lines that could stably express exogenous tumor suppressor gene PTEN in order to study its effects on the biological behavior of cholangiocarcinoma cell lines. Methods：Three different plasmids including a wild type PTEN, a mutant type PTEN or an empty pBP plasmid were prepared by transformation of bacterium and purification of plasmids. Then three plasmids were separatedly transferred into cholangiocarcinoma cell line QBC939 cultured in vitro by using lipfectamine. After transfection, cells were selected by puromycin and the positive cell clones were chosen . The expression of the HA-tag protein was detected by Western blot. The expression of the tumor suppressor gene PTEN was separatedly determined by RT-PCR, Western blot and immunocytochemical staining. Results：All of the cell lines transfected by wild-type PTEN, mumant-type PTEN or empty plasmid acquired resistance to puromycin; HA-tag protein was detected by Western blot in cell lines transfected by wild type or mutant type PTEN, whereas, it did not show in cell lines un-transfected or transfected by an empty vector. RT-PCR, Western blot and immunocytochemical staining showed respectively that the tumor suppressor gene PTEN was expressed higher in cell lines transfected by wild type or mutant type PTEN than in cell lines un-transfected or transfected by an empty vector, both on mRNA lever and on protein lever. Conclusions：Successful establishment of cholangiocarcinoma cells that could stably express the exogenous gene wild-type PTEN, mumant-type PTEN or empty plasmid pBP respectively was obtained.

Abstract:Abstract:Objective：To observe the effect of kansui root on the change of nuclear factor-κB activity in pancreas in rats with severe acute pancreatitis(SAP)，and to explore the mechanism of kansui root in treating SAP. Methods：SD rats were randomly divided into 3 groups:sham group (S group),severe acute pancreatitis group (SAP group)and kansui root therapy group (K group).40 rats were in each group.The blood samples and tissue samples of each group were obtained at 2h,6h,12h and 24h after the operation respectively for the following tests: serum amylase,expression of NF-κB/p65 protein in pancreatic tissue nucleus by Western blot,morphological examination of pancreas, and 72h mortality after operation. Results：(1)serum amylase:the levels in SAP group were obviously higher than those in S group at 2h,6h,12h and 24h (P<0.01).The levels in K group were significantly lower than those in SAP group (P<0.01) at each time point except at 2h, but were significantly higher than those in S group (P<0.01).(2) Expression of NF-κB/p65 protein in nucleus: the expressions were extremely weak in S group; but the expressions in SAP group were obviously stronger than those in S group at 2h,6h and 12h (P<0.01); the expression in K group was significantly lower at 6h,12h than those in SAP group(P<0.01). (3)Microscopy: structures of pancreas were normal in S group;hemorrhage, necrosis and infiltration of inflammatory cells were observed in pancreatic tissue in SAP group; the injury in K group was milder than that in SAP group. (4)72h mortality: In S group mortality was 0%;in K group was 12.5%,both were significantly lower than that in SAP group(62.5%)(P<0.05). Conclusions：There was activation of NF-κB during the development of SAP, and kansui root can inhibit the activity of NF -κB in pancreas .It might be one of the mechanisms of kansui root in treating SAP.

Abstract:Abstract:Objective：To study the optimal procedure of digestive tract reconstruction after total gastrectomy. Methods：The clinical data of 122 patients who underwent total gastrectomy in the recent 6 years were analyzed retrospectively. Three types of reconstruction procedures, including Orr-type Roux-en-Y esophagojejunostomy, P-type jejunal pouch Roux-en-Y esophagojejunostomy and distal jejunal aboral pouch Roux-en-Y esophagojejunostomy, were performed. Results：There were no significant differences among the three procedures in heartburn and the amount of food intake, frequencies of meal, weight loss, dumping syndrome, and hemoglobin and albumin levels. The operation time in P-type group was longer than the other two group(P<0.05).The size of pouch and pouch emptying function in aboral pouch group were significantly superior to the other groups. Conclusions：Distal jejunal aboral pouch Roux-en-Y esophagojejunostomy can be recommended as a new procedure for digestive reconstruction after total gastrectomy.

Abstract:Abstract:Objective：To explore the clinical and pathological characteristics of cancer deriving from chronic non-Crohn′s disease anal fistula. Methods：A retrospective study was made to analyze clinical and pathological data of 6 cases of chronic anal fistula from which cancer developed and were treated in our hospital from 1996 to 2005. Results：There were 5 males and 1 female averaging 55 years of age. The patients had chronic history of anal fistula for 15～30 years. The anal fistula carcinogenetic factor was chronic inflammation. The definitive diagnosis of the carcinogenesis depended on biopsy of the fistula wall and perianal mass. Metastasis to inguinal lymph nodes was found in 3 patients. All cases underwent abdomino-perineal radical resection(Miles operation )with adjuvant chemotherapy; three patients also had excision of inguinal lymph nodes. Three patients survived more than 5 years, two patients have survived for 3 years and 1 year respectively; 1 patient died of lung metastasis 1 year after operation later. Conclusions：Cancer deriving from chronic anal fistula develops slowly, is of relatively low malignancy but can be ignored easily in the early stage. Combined treatment in which the abdomino-perinal radical resection is the major method should be taken.

Abstract:Abstract:Objective：To investigate the risk factors and management of pancreatic fistula(PF) after pancreaticoduodenectomy（PD）. Methods：Two hundred and eighteen patients who underwent PD consecutively at our hospital from February 1994 to December 2005 were reviewed retrospectively. The management and outcomes of patients with PF were also evaluated. Sixteen factors which potentially affect the incidence of PF were analyzed with univariate and multivariate logistic regression model. Results：Of the 218 patients, the overall morbidity and hospital mortality were 29.8%（65/218）and 4.1%（9/218）respectively, and PE occurred in 30 patients(13.8%). PE was account for 46.1% in the overall morbidity. Of the 30 patients with PE, 25 had successful management conservatively with effective drainage including under B-ultrasonography guided or CT-guided percutaneous drainage. In the other 5 patients who had intra-abdominal abscess, two patients refused reoperation died of multiple organ failure, and one died of combination of intra-abdominal massive hemorrhage; the other two underwent reoperation for wide drainage, one survived, another died. The mortality of PF was 13.3%(4/30), which was account for 44.4% of overall mortality. Patients with PF had significantly higher morbidity（P＜0.01）and in-hospital mortality（P＜0.05）than those without PF. In univariate analysis, texture of the remnant pancreas, pancreatic duct size, drainage of pancreatic duct, duration of operation，perioperative nutrition support and use of prophylactic somatostatin analogues were related to occurrence of PF. Multivariate logistic regression analysis revealed that normal texture of the remnant pancreas and pancreatic duct size(≤3mm) were independent risk factors(OR=9.394 and 4.232). Conclusions：Pancreatic duct size and texture of the remnant pancreas are the independent risk factors of occurrence of PF after PD. If the optimal pancreatojejunal anastomotic technique is selected according to pancreatic duct size, texture of the remnant pancreas and experience of the surgeon, the incidence of PF can be reduced effectively. Early diagnosis and management of PE and other severe complications associated with PF are important to improve its outcome.

Abstract:Abstract:Objective：To study the diagnosis and treatment of the cystic neoplasms of pancreas(CNP). Methods：The clinical data of 30 cases of CNP, with comfirmed by pathology, admitted in our hospital in recent 6 years were retrospective analyzed. Results：CNP was more seen in mid-young women. The course of CNP was longer. Upper abdominal mass and abdminal distention and pain were the main clinical presentations. Ultrasounography, CT and ERCP could be help to the diagnosis of CNP. The CNP resection rate was 80%(in bengin CNP was 100%, in malignant CNP was 70.0%). Of the 7 patients with CNP located at head and neck of pancreas, pancreaticoduodenectomy was performed in 3 patients, near total resection of pancreas pancreas with preserving the duodenum in and small part of the head of pancreas 1, segmental resection of the pancreas in 2, and extraction of the tumor in 1. Among the 17 patients with CNP located at body and tail, resection of the body and tail with or wothout splenectomy in 15 patients, tumor extraction in 1, pancreas segmental resection with Roux-en-y pancreticojejunostomy in 1. The other 6 patients with diffused CNP were unresectable. The main operative complication was pancreatic fistula(20.0%); all the fistula was cured No death occurred in this series. Conclusions：CNP have no clinical characteristics. The discovery of this disease is mainly according to the upper mass and imaging examination(ultrasound , CT etc). The resection rate of CNP is high, the prognosis is good. So that, aggressive surgery treatment must be adopted. Resection of the whole tumor with part paratumor pancreas tissue is advocated.

Abstract:Abstract:Objective：To explore the appropriate strategy for the management of pancreatic pseudocyst. Methods：A total of eighty-nine patients with pancreatic pseudocyst from Jan 2000 to Jan 2005 managed in Xiangya hospital were involved in this study for retrospective analysis. Conservative management, percutaneous tube drainage and operation therapies were choicend according to the time of pseudocyst formation, the thickness of pseudocyst wall and the location of the pseudocyst. Tweenty patients were cured conservatively; 7 patients underwent percutaneous tube drainage. External drainage was performed in 8 patients, internal drainage in 45, and cyst excision in 9. Results：There was no operative mortality. All patients were followed up for 3 months to 5 years. The incidence of complications in this patients was 15.9%( 11/69), with a recurrence rate of 5.6 %( 5/89). Conclusions：The treatment of pancreatic pseudocysts varied under different conditions. Pancreatic pseudocysts without complications should be treated conservatively. External drainage should be chosen in emergency operation. When the cyst is matured, internal drainage gives good results.

Abstract:Abstract:Objective：To explore whether low molecular weight heparin (LMWH) could prevent acute pancreatitis after ERCP and its clinical significance. Methods：Sixty patients were randomly divided into 2 groups(30 in each group): ERCP group (E group), LMWH prevention group (H group). Changes of abdominal pain, biochemical parameters of amylase(AMS), endotoxin(ET),interleukin-6(IL6),nitricogen oxide(NO) and pancreatic morphology under ultrasonography between the two groups were investigated. Changes of coagulation function in H group before and after ERCP were also studied. Results：Abdominal pain of 5 patients in E group(16.7%) was aggravated, but none of H group. There were no significant differences in the values of biochemical parameters and pancreatic morphology between the two groups before ERCP. The values of AMS,ET in E group were significantly higher at 4h and 24h after ERCP than those of H group（P<0.05）; meanwhile the values of NO in H group were significantly higher at 4h and 24h than those of E group（P<0.05）. The values of IL6 in E group were significantly higher after ERCP than those of H group at all time points (P<0.05). One patient in E group had acute inflammatory change of pancreas under ultrasonography. No obvious change of coagulation function was observed after ERCP in H group（P>0.05）. Conclusions：LMWH therapy may prevent or reduce the occurrence of acute pancreatitis in those who undergo ERCP by improving microcirculation and reducing the release of inflammatory mediators, and is a simple, economic and safe method .

Abstract:Abstract:Objective：To investigate the value of ultrasonography in distinguishing pancreatic cancer from focal pancreatitis. Methods：The ultrasonographic characteristics of cases of 30 pancreatic cancer and 18 cases of focal pancreatitis verified by surgery and/or pathology were studied retrospectively to determine the value of ultrasonography in their differential diagnosis. Results：There was significant difference between pancreatic cancer and focal pancreatitis in regard to the age of patients, the finding of pancreatic ductal structure and hyperechoic plaque within the pancreatic mass and rear echo. The focal pancreatitis patients were younger. The presence of pancreatic ductal structure and hyperechoic plaque in the pancreatic mass and enhanced rear echo suggested focal pancreatitis. Conclusions：Ultrasonography has certain value in distinguishing pancreatic cancer from focal pancreatitis.

Abstract:Abstract:Objective：To summarize our experience in the prevention and treatment of iatrogenic vascular trauma. Methods：The clinical data of 24 different types of iatrogenic vascular trauma committed from 2003 to 2006 were retrospectively analyzed. Results：The 24 cases included 7 cases of superior mesenteric arteriovenous trauma, 3 cases of portal venous trauma,4 cases of carotid arterial trauma,6 cases of iliac and femoral arterial trauma, and each one of trauma of popliteal artery ,axillary artery, renal artery, left gastric artery, respectively. Treated method: Six cases underwent vascular repair, 5 cases had vascular anastomosis, 2 cases had vascular replacement, 3 cases had vascular ligation,2 cases had covered stent implantation under intervention, and other methods included thrombectomy, thrombolysis and packing. Among the 24 cases,22 were cured completely, one patient died from massive hemorrhage 24 hours after operation, and the other died 5 days after operation. Conclusions：Iatrogenic vascular trauma can be prevented and its incidence reduced by increased vigilance, clear identification of the anatomy, and accurate and careful operation. Once iatrogenic vascular trauma has occurred, its cause must be determined and then different treatment methods can be chosen, based on the cicumstaces. When effective treatment technique is not at hand, one should promptly seek outside support or transfer the patient to an advanced hostipal.