Volume 18,Issue 5,2009 Table of Contents

1 Ductal carcinoma in situ of breast: a report of 123 cases

JIANG Yue , MA Wenfeng , LI Xiang

2009, 18(5):1-434. DOI: 10.7659/j.issn.1005-6947.2009.05.001

[Abstract](1081) [HTML](0) [PDF 925.00 Byte](367)

Abstract:
Objective:In order to deeper understand DCIS, improve the rate of diagnosis and therapeutic efficacy.
Methods :The clinical data of 123 DCIS treated at the First Affiliated Hospital of China Medical University were retrospectively analyzed in regards to age at onset of disease, clinical features, breast ultrasound examination, mammography examination, pathology, immunohistochemistry examination,and surgical methods.
Results:(1) The average age at onset was (47.7±9.3) years. (2)The major features on physical examination were breast lump in 79cases, nipple discharge in 19cases, and breast pain with glandular thickening in 30 cases. (3)Among 45 cases that underwent both ultrasound and mammography examination, in 17cases (60%) and 30 cases (66.7%) respectively,might be positive for malignancy, but the difference between the 2 melhods was not significant. With the use of both methods togather, diagmosis of possible malignant lesion was made in 37 cases (82.2%). (4) Sixty-five cases underwent breast ultrasound examination, substantive mass was found in 43 cases (66%), blood flow signals in 41 cases (63%),ductal dilatation in 52 cases (80%) and intraductal spotty strong light beam in 33 cases (50.7%).(5) Fifty-two cases underwent breast mammography examination, which showed sand-like calcification, mass with calcification clusters,localized gland density and breast tumor. (6)The immunohistochemistry examination included estrogen receptor (ER), progesterone receptor(PR), p53 and c-erbB-2,but the rate of positive expressios of those indices showed no significance difference between DCIS and DIS with microvasion (DCIS-MI).(7)Six cases underwent radical mastectomy (of which there were 3 cases of DCIS-MI). Modified radical mastectomy was done in 86 cases, including 59 cases of DCIS, 27 cases of DCIS-MI. Lymph node metastasis was found in 2 cases of DCIS,and 5 cases of DCIS-MI.
Conclusions:Combined breast ultrasound and mammography can increase the rate of DCIS diagnosis.

2 Unilateral multicentric breast cancer:a report of 14 cases

WANG Lingcheng , WANG Lingsheng , WANG Yuming , ZHU Meili

2009, 18(5):2-437. DOI: 10.7659/j.issn.1005-6947.2009.05.002

[Abstract](1182) [HTML](0) [PDF 837.00 Byte](271)

Abstract:
Objective:To study the clinical features and treatment of unilateral multicentric breast cancer.
Methods :The clinical data of 14 cases of unilateral multicentric breast cancer,which were found from July, 2004 to December, 2007 were analyzed retrospectively.
Results:Six cases (42.9%) had infiltrating lobular carcinoma,and the other 8 cases (57.1%) were invasive ductal carcinoma. The number of cancer focus was 2 to 9,and with a diameter of 0.5-4.3 cm.The focus in 12 cases were located in upper lateral quadrant; 1 case was located in the upper medial and lateral quadrant; 1 case was located in the upper lateral quadrants, the junction area of upper medial and upper lateral quadrants,and between upper lateral quadrant and lower lateral quadrants. One patient was treated by breast conservation operation, with no recurrence at 3-5 years follow-up; while the other 13 cases received modified radical operation,and with no recurrence at 2-37 months of follow-up.
Conclusions:Unilateral multicentric breast cancer are often distributed in the same quadrant or adjacent quadrants of breast,and the majority cases are with invasive ductal carcinoma. For treatment of these lesions were a modified radical operation combine with comprehensive treatment.

3 Expressions and significance of survivin and Ki-67 in breast cancer tissues after neoadjuvant chemotherapy

CHEN Qi , YAO Yumin , ZHANG Ying , XU Junlong

2009, 18(5):3-441. DOI: 10.7659/j.issn.1005-6947.2009.05.003

[Abstract](941) [HTML](0) [PDF 1.23 K](246)

Abstract:
Objective:To explore the expressions of survivin and Ki-67 in breast cancer tissues after neo-adjuvant chemotherapy and their clinical significance.
Methods :The expressions of survivin and Ki-67 in 60 cases of breast cancer with neo-adjuvant chemotherapy (NACT) with CTF regimen and 60 cases without NACT were detected by SABC immunohistochemical technique.
Results:The positive rates of survivin（36.7%）and Ki-67（38.3%） in neo-adjuvant chemotherapy group were significantly lower than those in control group（71.7%，61.7%）(P<0.05).There was a significantly positive relationship between the expression of survivin and Ki-67 in neo-adjuvant chemotherapy group(r= 0.47，P<0.05).The overall response rate of the neo-adjuvant chemotherapy was 73.3%.In neo-adjuvant chemotherapy group, the positive rate of survivin in partial remission (PR) cases（18.2%）was markedly lower than that in no respose (NC) cases（81.3%）(P<0.01).In neo-adjuvant chemotherapy group, the positive rate of Ki-67 in PR cases（47.7%）was lower than that in NC cases（56.3%）(P>0.05).
Conclusions:The therapeutic effect of neo-adjuvant chemotherapy with CTF regimen can increase the remission rate of breast cancer. Neo-adjuvant chemotherapy could inhibit the expression of survivin protein, and thus further inhibit proliferation of tumor cell.

4 Study of the therapeutic time window and dose response effects of epirubicin on the expression of c-FLIP in breast cancer

QIU Fang , PENG Songlin , DAI Xianwei

2009, 18(5):4-446. DOI: 10.7659/j.issn.1005-6947.2009.05.004

[Abstract](1063) [HTML](0) [PDF 1.33 K](253)

Abstract:
Objective:To investigate the therapeutic time window and the dose response effects of epirubicin on the expression of c-FLIP in breast cancer.
Methods :MCF-7and MDA-MB-231 breast cancer cells were divided into two groups: epirubicin groups were treated with 4.0,2.0,1.0,0.5 and 0.25mg/L of epirubicin, and control groups were treated with 0.9% sodium chloride solution at the same dose. After treatment for 24, 48 and 72 h, the incubated cells were collected for the measurement of c-FLIP by RT-PCR, and for examination of percent of apoptosis cells with flow cytometry.
Results:A dose-time-dependent pattern was observed. The expression of c-FLIP in MCF-7and MDA-MB-231 breast cancer cell lines declined gradually as the epirubicin concentration increased and treatment time was prolonged. Percentage of apoptosis breast cancer cells increased gradually as the epirubicin concentration was increased and treatment time was prolonged, and percentage of apoptosis cells was the highest when breast cancer cells were treated with 2 mg/L epirubicin for 72 h.
Conclusions:Epirubicin can promote apoptosis of breast cancer cells by inhibiting the expression of c-FLIP, and its inhibitory effect is most pronounced when breast cancer cells are treated with 2 mg/L epirubicin for 72 h.

5 The influences of Pirh2mRNA,Her-2,VEGF,MVD and TNF-α on the prognosis of stage I & II breast cancer

ZHANG Chaojie , TANG Lili , OUYANG Huiying , REN Lifeng , WU Yuhui , LUO Gengqiu

2009, 18(5):5-453. DOI: 10.7659/j.issn.1005-6947.2009.05.005

[Abstract](1215) [HTML](0) [PDF 1.47 K](218)

Abstract:
Objective:To investigate the malignant biologic behavioral significance of Pirh2mRNA, Her-2,VEGF,MVD and TNF-alpha in stage I and II breast cancer.
Methods :Randomly selected 87 stage I or stage II (according to AJCC, 2003) pathological samples of breast cancer, which were operated and were followed-up by the Department of Mammary Gland of Xiangya Hospital from Jan. 1996 to Oct. 2005. Hybridization in situ was used to detect the expression of Pirh2mRNA, and immunohistochemical SABC method to detect Her-2,VEGF,MVD and TNF-alpha expression in those tissue samples. Combining the clinical pathological parameters, the multifactorial Cox proportional hazards model was founded to analyze the influence of Pirh2mRNA on prognosis of breast cancer.
Results:All patients were female, aged 26 to 71 years, with the median age of 44 years. Distant metastasis within 5 years after operation occurred in 40 cases(Group A),and disease free survival for 5 years was found in 47 eases (Group B).The expression of Pirh2mRNA in group A (57.5%) was higher significantly than that of group B（21.3%）（P=0.0009）.There was no correlation between Pirh2mRNA and Her-2 (r=0.020,P＝0.856). The Kaplan-Meier survival analysis revealed the prognosis of the patients with positive expression of Pirh2mRNA,Her-2,VEGF,MVD and TNF-alpha was worse than the patients with negative results(all P<0.05). Multifactorial Cox proportional hazards model indicated that Pirh2mRNA,Her-2,VEGF,MVD and TNF-alpha were independent prognotic factors of stage I and II breast cancer.
Conclusions:The positive expression of Pirh2mRNA,Her-2,VEGF and TNF-α imply unfavourable prognosis of stage I and II breast cancer.

6 Research on correlation factors of breast cancer stem cell and breast cancer metastasis

YANG Guohua , CHEN Xiaogeng

2009, 18(5):6-456. DOI: 10.7659/j.issn.1005-6947.2009.05.006

[Abstract](705) [HTML](0) [PDF 911.00 Byte](392)

Abstract:
Objective:To examine the expression of VEGF, MMP-1, and CXCR4 in breast cancer stem cells and its significance.
Methods :Flow cytometry was employed to separate breast cancer stem cells from MCF-7 cell. Then the expression of VEGF, MMP-1, and CXCR4 was detected by PCR in different subsets of cells.
Results:Compared with the non-stem cells of breast cancer, the expression of VEGF, MMP-1, and CXCR4 in breast cancer stem cells was significantly higher, but the expression of MMP-1 was not different.
Conclusions:The breast cancer stem cells could achieve increased metastasis ability by enhanced expression of VEGF and CXCR4, which are the key factors in metastasis of breast cancer.

7 Research on the expression and the relationship of MTA1 and ER in breast cancer

HE Chunlan , MIAO Yi , CHENG Ping

2009, 18(5):7-462. DOI: 10.7659/j.issn.1005-6947.2009.05.007

[Abstract](1166) [HTML](0) [PDF 1.00 K](411)

Abstract:
Objective:To observe the expression of MTA1 and ER in breast cancer, the correlation of the two factors and with the invasive capability of breast cancer.
Methods :The expression of MTA1 and ER in normal breast, precancerous lesions and breast cancer tissues was detected by using nucleic acid hybridization in situ(ISH) and immunocytochemistry(IHC) methods, and their correlation was analyzed by Spearman method.
Results:The expression of MTA1 and ER was higher in ISH than in IHC. The mRNA expression of MTA1 in normal breast tissue, precancerous lesions and breast cancer tissne was 12.2%，33.3%, and 81.1% respectively, and the expression by IHC was 11.1%, 31.1% and 72.2% respectively. The mRNA expression of ER in normal breast tissue, precancerous lesions and breast cancer tissue was 83.3%，61.1% and 37.8%,respectively, and the expression by IHC was70.9%，56.7% and 35.6% respectively.The positive expression of MTA1 was higher in ER-negative patients than that in ER-positive ones(86.2﹪vs.46.9﹪).
Conclusions:Combined ISH and IHC detection can improve the detection rate of MTA1 and ER. With advancement of the disease and lowering of tumor differentiation,the expression of MTA1 gradually increases,while expression of ER decreases and even disappears.The expression of MTA1 is negative in relation to that of ER (the coefficient is -0.466).MTA1and ER could be important molecular markers for the prognosis and therapy of breast cancer.

8 Effect of mitofusin-2 gene on RECK expression and the activity of MMP-9 and MMP-2 in breast carcinoma cells

ZHANG Yong , QU Xincai , WANG Yao , HU Wenjun , HU Qinggang , ZHENG Qichang

2009, 18(5):8-467. DOI: 10.7659/j.issn.1005-6947.2009.05.008

[Abstract](984) [HTML](0) [PDF 1.15 K](348)

Abstract:
Objective:To investigate the regulative effect of the mfn2 gene on RECK expression and the activity of MMP-9 and MMP-2 in breast carcinoma cell (MCF-7 cell line).
Methods :The pEGFP-mfn2 was transfected to MCF-7 cells with lipofectamine2000, the mRNA expression of mfn2 and RECK was assessed with RT-PCR, Western analysis was used to detect the protein expression of the mfn2 and RECK gene;and MMP-9 and MMP-2 activity was analyzed using gelatin zymograph.
Results:After transfection of pEGFP-mfn2, the stable expression of Mitofusin-2 gene was detected in MCF-7 cells, the expression of RECK mRNA level and protein were increased significantly, while the MMP-9 and and MMP-2 activity level was markedly lower in the transfected Mitofusin-2 gene group than in the control(P<0.05).
Conclusions:The mfn2 gene induces the expression of the RECK gene and inhibits the activity of MMP-9 and MMP-2 in MCF-7 cells, which might be a new mechanism of its anti-tumor effect.

9 Study on the transfer of the rhNIS gene into human bile duct carcinoma cells to induce125I uptake

ZHANG Xianlin , DING Zhiqiang , CHEN Yongjun , YU Yahong , YANG Jixin , CHEN Zhong

2009, 18(5):9-472. DOI: 10.7659/j.issn.1005-6947.2009.05.009

[Abstract](1070) [HTML](0) [PDF 876.00 Byte](402)

Abstract:
Objective:To study the expression level and effect of hNIS gene to induced125I uptake after transfecting hNIS gene into cholangiocarcinoma cell line QBC939.
Methods :The hNIS cDNA sequences by amplification were ligated with plasmid pMD18-T, selected, subcloned and ligated with eucaryotic expressing plasmid PDC316, using lipofectamine to transfect eucaryotic expressing plasmid vector hNIS-DNA-PDC316（experimental group）and plasmid PDC316（control group）into cholangiocarcinoma cell line QBC939, establishing new cell lines(QBC939-A,QBC939-B) and QBC939-C (control).The expression level of hNIS gene was detected by semi-quantitative RT-PCR in 2-, 3-, and 6-day, and the effect of induced125I uptaking was studied on the 1-,2-, 3-, and 6 day in cell lines of vitro culture.
Results:QBC939-A stably expressed hNIS-DNA-PDC316.The expression level on QBC939-A compared with QBC939-B and QBC939-C had significant difference （P<0.05）, the peak of induced125I uptaking was detected on the 3rd day in QBC939-A, and cell line QBC939-A accumulated 14 and 16 times more radio-iodide in vitro than QBC939-C and QBC939-B respectively.
Conclusions:Tramsfer of hNIS gene into cholangiocarcinoma cells can induce125I uptake in the short-term, This study can be as a foundation for study of targeting action to bile duct carcinoma using radionuclide125I.

10 Construction and identification of eukaryotic expression vector bearing mouse ghrelin receptor

WANG Weigang， WANG Zhigang， QIU Wencai， FEI Zhaoliang， FEI Jian， ZHENG Qi

2009, 18(5):10-476. DOI: 10.7659/j.issn.1005-6947.2009.05.010

[Abstract](803) [HTML](0) [PDF 1008.00 Byte](349)

Abstract:
Objective:To construct mouse ghrelin receptor (GHS-R) eukaryotic expression vector, and observe its expression in transient transfeted COS-7 cell line.
Methods :The coding DNA sequence of ghrelin receptor gene(CDS) was amplified by SOE-PCR technology from mouse genomic DNA and cloned into PCDNA3 vector. The positive clone was confirmed by enzyme digestion and sequencing. The expression vector was transiently transfected into COS-7 cell line. The expression of GHS-R protein was identified by Western blot.
Results:The CDS of mouse GHS-R was successfully cloned. The construction of pcDNA3-GHS-R was correct and its expression of GHS-R protein was confirmed by Western blot.
Conclusions:The eukaryotic expression vector pcDNA3-GHS-R was successfully constructed and mouse GHS-R protein was successfully expressed. This study can be a basis for further study on GHS-R gene function in vitro.

11 Clinical application of intraoperative parathyroid hormone assay during parathyroidectomy for secondary hyperparathyroidism

LIU Xinjie , YAN Wenhui , MAI Peicheng , ZHOU Dongxian , LUO Ming , ZHOU Wenbin

2009, 18(5):11-480. DOI: 10.7659/j.issn.1005-6947.2009.05.011

[Abstract](1101) [HTML](0) [PDF 845.00 Byte](298)

Abstract:
Objective:To investigate the application and criteria of intraoperative parathyroid hormone assay during surgery of secondary hyperparathyroidism.
Methods :Subtotal parathyroidectomy was performed in 17 cases of secondary hyperparathyroidism. Parathyroid hormone assay was performed after induction of anaesthesia but before incision(PTH0) and 10min(PTH10) after subtotal parathyroidectomy. Two successive criteria of PTH decrease were used: (1) PTH10 of ≤150pg/mL; (2) PTH10 /PTH0≤30%.
Results:Fifteen cases met the criteria. There were PTH<15 pg/m in 4 cases, PTH of 15-65 pg/mL in 6 cases, and PTH of 65-185.2 pg/mL in 5 cases day 7 postoperatively. Bone pain resolved in all cases after operation.
Conclusions:Intraoperative parathyroid hormone assay can help for hyperparathyroid gland resection in secondary hyperparathyroidism, and can improve the successful rate of operation

12 The clinical value of lymph node micrometastases in central lymph node group in follicular carcinoma of thyroid

LIU Qinjiang , TIAN Youxin , MA Shihong

2009, 18(5):12-483. DOI: 10.7659/j.issn.1005-6947.2009.05.012

[Abstract](854) [HTML](0) [PDF 838.00 Byte](420)

Abstract:
Objective:To evaluate the clinical value of lymph node micrometastases in central group (Ⅵ) lymph node in follicular carcinoma of thyroid.
Methods :Three hundred and twenty-six negative neck lymph nodes in 68 cases on routine pathological examination(pN0) were examined by keratin-19 monoclonal antibody and S-P immunohistochemistry to detect expression of keratin-19 to confirm lymph node micrometastasis in each neck lymph node, and compare the pathological type and follow-up data of all cases.
Results:There were 46 neck lymph nodes showed positive lymph node micrometastasis among 326 negative neck lymph nodes that included 4 lymph nodes in group Ⅱ（4/42）, 5 lymph nodes in group Ⅲ(5/34), 5 lymph nodes in group Ⅳ(5/49), 1 lymph node in groupⅤ(1/17) and 31 lymph nodes in group Ⅵ(31/184). 6 in 14 cases with positive lymph node micrometastases showed distant metastasis or local recurrence, but only 3 in 54 cases with negative lymph node that micrometastases distant metastasis or local recurrence (P＜0.01).
Conclusions:The research shows that group Ⅵ neck lymph node micrometastasis is easy to occur and is closely related to local recurrence and metastasis in follicular carcinoma of thyroid.

13 The clinical implication of exposure of recurrent laryngeal nerve during operation for benign thyroid neoplasm

ZHANG Sheqin , YI Wenjun , LI Zhiqun , LING Feng

2009, 18(5):13-486. DOI: 10.7659/j.issn.1005-6947.2009.05.013

[Abstract](677) [HTML](0) [PDF 833.00 Byte](331)

Abstract:
Objective:To explore the clinical effect of exposure of recurrent laryngeal nerve(RLN) during operation in patients with benign thyroid neoplasm.
Methods :Seven hundred and sixty-eight patients with benign thyroid neoplasm admitted between July 2005 and June 2008 were randomly divided into three groups according to the operation procedure:(1) For patients with lobectomy or subtotal lobectomy, the dorsum of gland could not be retained or with reoperation,RLN was selectively exposured; (2) 278 cases with non-exposure of RLN; (3) 384 patients had routine exposure of RLN.
Results:Of all the cases，the injury rate of RLN was 1.04% (8/768)，no permanent injury or bilateral RLN injury ouarred.The injury rate of RLN in non-exposure groups was 0.72% (2/278), in selective explore groups and routine groups was 0.94%(1/106) and 1.30%(5/384),respectively,but the difference was not significant between the three groups(P>0.05). Operative procedure time was significantly shorter in non-exposure groups than that in selective group and routine group［(78.96±17.60)min vs. (89.05±18.50)min and (93.44±18.90)min,P＜0.05］.The bood loss during operation was significantly less in non-exposure group than that in selective group and routine group［(42.73±23.08)mL vs. (56.47±24.43)mL and (62.03±27.46)mL,P＜0.05］.
Conclusions:Exposure and non-exposure of the RLN should be determined by the patient′s condition of benign thyroid neoplasm during operation.

14 Prevention strategies for small-for-size syndrome in adult-to-adult living-related liver transplantation:a report of 6 cases

ZHOU Ledu , WANG Zhiming , TANG Huihuang , HUANG Yun , LI Jingdong , ZAHNG Gewen , LI Xinying , LU Xinsheng

2009, 18(5):14-491. DOI: 10.7659/j.issn.1005-6947.2009.05.014

[Abstract](747) [HTML](0) [PDF 850.00 Byte](370)

Abstract:
Objective:To explore the methods to prevent small-for-size syndrome(SFSS) in adult-to-adult living-related liver transplantation(A-A LDLT).
Methods :The clinical data of 6 cases of A-A LDLT performed in our hospital between February 2007 to October 2008 were retrospectively analyzed,including blood cell count, spleen thickness, diameter of portal vein in recipients before operation,graft recipient body weight ratio(GRWR),graft volume and standard liver volume ratio of receptor(GV/SLV),and hepatic vein reconstruction.
Results:Of the six grafts,the GV/SLV was more than 40%,the GRWR was always above 0.8% except one case was 0.74%. All the recipient grafts had good hepatic vein reconstruction,with no congestion in the grafts;of the six recipients no severe portal hypertension was observed, and no SFSS occurred in the six cases.
Conclusions: The occurrence of SFSS can be prevented by selecting the appropriate graft size, adequate venous blood drainage through hepatic veins, and control of the portal pressure.

15 Diagnosis and management of chylous ascites: a report of 11 cases

CHEN Jian , LI Ke , CHEN Keqin

2009, 18(5):15-494. DOI: 10.7659/j.issn.1005-6947.2009.05.015

[Abstract](649) [HTML](0) [PDF 830.00 Byte](380)

Abstract:
To stady the diagnosis and management of traumatic chylous ascites.
Methods :Retrospective analysis was conducted on the clinical dada of 11 cases of traumatic chylous ascites resulting from various causes.
Results:There were 5 cases of open abdominal injury, 2 cases of closed abdominal injury and 4 cases of operative injury. Nine cases were treated with operation. According to the location and extent of injury, patients were respectively managed by operation of direct repair or ligation. Two cases had non-surgical treatment. All of the11 patients were cured and had satisfactory result at 0.5~3 years of follow-up.
Conclusions:For traumatic chylous ascites,if the injurg occurrence on cisterna chili, the best treatmeat is primary repair;if injury occarrence on the small intestinal trunks or lumbar trunk, which can be treated with ligation; while blunt injury and cases found after operation are mainly treated conservatively.

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Volume 18,Issue 5,2009 Table of Contents

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