目的 研究乳腺浸润性导管癌(IDC)及其前期病变乳腺导管原位癌(DCIS)、微小浸润癌(MA)的超声弹性成像(UE)与中医证型特点及相关性,并探讨其病理基础.方法 60例乳腺癌患者,按CK5/6、P63不同表达分为A组(DCIS及MA,n=10)、B组(IDC与DCIS混合的导管癌,n=29)和C组(完全为IDC或仅有肿物周边小灶DCIS残留的IDC,n=21),所有患者术前均行UE评分及中医辩证分型.结果 A组UE评分低于B、C组(LSD,P为0.019、0.008);各组间中医证型分型构成差异有统计学意义(P=0.049).不同中医证型患者UE评分差异有统计学意义(P=0.000),由肝郁痰凝型到冲任失调型到正虚毒炽型,UE评分呈上升趋势(rs =0.538,P=0.000).结论 乳腺癌不同病理阶段UE评分及中医证型不同,二者间存在相关性,推测与疾病的分子病理学基础有关.

BACKGROUND Gastric cancer ranks high among the most common causes of cancer-related death worldwide. This study was designed to explore key genes involved in the progression of normal gastric epithelial cells to moderate gastric epithelial dysplasia (mGED) and to gastric cancer. METHODS Twelve pairs of mGED tissues, gastric cancer tissues, and normal gastric tissues were collected by gastroscopy. Total RNA was then extracted and purified. After the addition of fluorescent tags, hybridization was carried out on a Gene chip microarray slide. Significance analysis of microarrays was performed to determine significant differences in gene expression between the different tissue types. RESULTS Microarray data analysis revealed totally 34 genes that were expressed differently: 18 highly expressed (fold change > 2; P < 0.01) and 16 down-regulated (fold change > 2; P < 0.01). Of the 34 genes, 24 belonged to several different functional categories such as structural molecule activity, extracellular regions, structural formation, cell death, biological adhesion, developmental processes, locomotion, and biological regulation that were associated with cancer. The remaining 10 genes were not involved in cancer research. Of these genes, the expression levels of Matrix metalloproteinase-12 (MMP12), Caspase-associated recruitment domain 14 (CARD14), and Chitinase 3-like 1 (CHI3L1) were confirmed by semi-quantitative RT-PCR. A two-way clustering algorithm divided the 36 samples into three categories and the overall correct classification efficiency was 80.6% (29/36). Almost all of these genes (31/34) showed constant changes in the process of normal gastric epithelial cells to mGED to gastric cancer. CONCLUSIONS The results of this study provided global gene expression profiles during the development and progression from normal gastric epithelial cells to mGED to gastric cancer. These data may provide new insights into the molecular pathology of gastric cancer which may be useful for the detection, diagnosis, and treatment.

Objective:To explore the relation between the position of internal opening and the recurrence of anal fistula after the elastic cutting-seton technique.Methods:97 patients who underwent the elastic cutting-seton for anal fistula were divided into the Higher Internal Opening (HIO) group and the Lower Internal Opening (LIO) group by the internal opening located more or less 1 cm over the dentate line. Post-operative complication and recurrence of two groups were compared retrospectively.Results:The total recurrent rate was 9.28%(9/97),and the recurrent rate in HIO group (n=34) was higher than in LIO group (n=63) significantly (20.59% vs 3.17%),P0.01.Conclusion:To deal the internal opening correctly may be the key step to prevent the postoperative recurrence of anal fistula.

Objective To blockade co-stimulatory receptors in diabetic mice for inducing the immune tolerance for prolonging the survival of porcine islet xenografts. Methods The porcine islets were transplanted beneath the left kidney capsule of male diabetic C57BL/6 mice induced by intravenous injection of STZ, and the diabetic mice were treated with CTLA-4Ig, anti-CD40L and anti-LFA1 antibodies to blockade the co-stimulating pathway. The survival and functions of porcine islet xenografts were observed. Results Euglycemia could be achieved in diabetic mice after xenografted porcine islet was transplantation. Compared with the controls, the survival of islet xenografts was prolonged in treated group. Conclusion Combined CTLA-4Ig, antiCD40L and anti-LFA1 therapy can prolong survival time of porcine islet xengraft in mice.

Objective: To evaluate the clinical value of NMP22,UBC,BTA,CA-199 and β2-MG in urine in the prognosis judgement and early recrudescent.Method: The concentration of NMP22,UBC and BTA were determined by ELISA,the concentration of CA-199 and β2-MG were determined by chemiluminescence method.Result: The concentration of NMP22,UBC and CA-199 in urine after surgery were significantly lower than that before surgery in patients with bladder cancer of late stage(P0.05),but were significantly higher than the normal control group.β2-MG didn't differ between before and after surgery,but were significantly higher than the normal control group.Conclusion: The level of NMP22,UBC,BTA and CA-199 in urine after surgery were significantly lower than before surgery,and thus could be used to evaluate the prognosis.

Objective:To evaluate the clinical value of NMP22,UBC and BTA in the early diagnosis of bladder cancer.Methods:Enzyme-linked immunosorbent assay was used to detect the concentration of NMP22,UBC and BTA in the urine in suspected patients,and the concentration were compared with that in the normal people.Results:The concentration of NMP22,UBC and BTA in urine in people with bladder cancer were significantly higher than that in normal people.When the clinical value for NMP22 was 10.0 U/ ml,the sensitivity was 76.5%,the specificity was 72%,the positive prediction was 78.8%,the negative prediction was 69.2%;When the clinical value for UBC was 12μg/L,the sensitivity was 67.5%;the specificity was 76%,the positive prediction was 79.3%,the negative prediction was 63.3%;When the clinical value for BTA was 11.2U/ L,the sensitivity was 73.5%,the specificity was 64%,the positive pre diction was 73.5%,the negative prediction was 64%.The sensitivity and specificity of NMP22 and BTA were significantly higher than that of BTA;the specificity of UBC and BTA were significantly higher than BTA.while the negative prediction of NMP22 was significantly higher than that of UBC and BTA.The sensitivity,specialty,positive prediction and negative prediction in the combined detection of NMP22,UBC and BTA were significantly higher that in any single detection,they were 97.1%,80%,86.8%,95.2%,respectively.The concentration of NMP22 and UBC improved with the rise of grade and stage of bladder transitional cell carcinoma,while the concentration of BTA didn't differ according grade and stage.Conclusions:NMP22,UBC and BTA could be used to diagnose bladder cancer,and the combined detection is better than any single detection.

目的 探讨大肠癌患者手术前后血清肿瘤相关抗原199(cancer antigen 199,CA199)和癌胚抗原(CEA)变化及其临床价值.方法 应用化学发光免疫分析法测定大肠癌患者术前和术后0～3个月血清CA199和CEA值,并对测定结果进行统计分析.结果 (1)血清CA199和CEA在大肠癌根治术或姑息术术后表达水平均明显下降(P＜0.05),实行根治术的表达率显著下降(P＜0.05),而实行姑息术的表达率下降不明显(P＞0.05).(2)血清CA199和CEA在大肠癌管状腺癌和黏液腺癌术后的表达水平均明显下降(P＜0.05),而乳突状腺癌下降不明显(P＞0.05);管状腺癌术后的表达率明显下降(P＜0.05),乳突状腺癌术后的表达率下降不明显(P＞0.05),黏液腺癌术后仅CEA表达率有明显下降(P＜0.05).(3)血清CA199和CEA在A期、B期大肠癌术后的表达水平和表达率均明显下降(P＜0.05),CA199在C期、D期术后表达水平和表达率的变化不同步,而CEA的变化则趋于一致;不同Dukes分期大肠癌CA199和CEA表达水平有显著差异(P＜0.05),二者表达水平随分期进展而上升,但表达率递增并不明显(P＞0.05).(4)大肠癌术前CA199与CEA二者联合检测的敏感度显著高于CA199单项(P＜0.05),与CEA单项比较,虽敏感度有所上升,但幅度不明显(P＞0.05);大肠癌术后CA199和CEA联检的敏感度与单项检测差异无统计学意义(P＞0.05).结论 大肠癌患者手术前后血清CA199和CEA的变化有一定的规律和特点,运用好这些规律和特点有助于判断临床分期、病理类型和选择恰当的手术方式;有助于评估手术效果和预测首程化疗疗效,为判断预后、及早发现术后复发患者提供参考依据.

Objective To explore the best way to treat perforating duodenal ulcer based on experiences with surgical treatment of patients with perforating duodenal ulcer during the two periods of 10 years (1985-1995 and 1995-2005 respectively). Methods There were two groups ,from January 1985 to January 1995 ,221 patients (B group) and, from February 1995 to January 2005, 149 patients (A group).Hospital records of these patients, with duodenal ulcer perforation, were retrospectively analyzed. Results B group was chiefly treated with subtotal gastrectomy, after resection of the stomach 14 out of 161 patients (8.7) had postoperative complications in short term, and 4 out of 161 patients (2.4) died . A group had conventional medical treatment followed by simple repair of perforation mostly, after operation, in 98 patients of A group, only 1 patient had reperforation, 1 patient had delayed healing, no patients died; During follow-up visit to the patients, 28.7 of the patients had recrudescence, 11.5 of the patients had reoperation. Conclusion With progresses of research on ulcer's etiopathogenisis along with clinical application of new drugs, it has been demonstrated that simple repair of perforation with conventional internal medical treatment is an ideal therapeutic method for duodenal ulcer perforation and the effect is satisfactory.

Objective To investigate the expression of PTEN protein in human gastric cancer and its relative lymph nodes,so to explore its role in the development and metastasis of gastric cancer.Methods The expression of PTEN protein in 62 cases of gastric primary carcinoma,the matched adjacent normal gastric tissue and peripheral lymph nodes were detected by immunohistochemical S-P technique,which was analyzed with patients' pathological data.Results The expression rate of PTEN in gastric cancerous focus(41.9%,26/62) was lower than that in the matched adjacent normal gastric tissue (100.0%,62/62),but was higher than that in the lymph node with metastasis of gastric carcer(31.4%,27/86),with statistic significance(χ2=8.41 and χ2=6.75,respectly, P0.01).The Expression rate of PTEN in peripheral lymph nodes with metastasis(31.4%,27/86) was lower than that without metastasis(92.1%,35/38)(χ2=8.34,P0.01),but there was no difference between in N1(32.1%,18/53) and in N2(30.3%(10/33) with lymph nodes metastasis (χ2=2.31,P0.05).There was negative correlation between the expression of PTEN and lymph node metastasis.Conclusions The tumor suppressor gene PTEN plays some roles in the lymph nodes metastasis of human gastric cancer.

目的:探讨老年人重症胰腺炎(SAP)的临床特点及治疗原则.方法:回顾性分析12年期间我院外科住院治疗的老年人SAP病例,并取同期非老年人SAP病例为对照.结果:全组38例,治愈24例,死亡14例,死亡率36.8%;其中手术治疗14例,死亡8例(57.1%),保守治疗24例,死亡6例(25%).结论:老年人SAP因其内科并存病多,严重并发症发生率高,尽量避免早期手术,并且应严格掌握手术适应证,加强围手术期处理,包括重症监护、早期应用抗生素、积极处理肠麻痹及营养支持等.

目的探讨左侧结肠癌及高位直肠癌并急性肠梗阻一期切除吻合的可行性.方法对1990年6月以来14年期间急诊左侧结肠及直肠切除一期吻合92例进行分析总结.结果一期切除吻合占同期左侧结肠癌及高位直肠癌急诊病例的82.9%(92/111),其中施行根治性切除56例,姑息性切除36例.全部病例治愈.术后并发吻合瘘1例,腹腔感染3例,切口感染9例,腹部并发症发生率14.1%(13/92).结论对左侧结肠癌及高位直肠癌并急性肠梗阻,应积极创造条件施行一期切除吻合术,并加强围手术期营养支持、抗感染等处理.

目的 探讨老年胃癌患者术后肠内、肠外营养联合应用的合理性和安全性.方法 36例老年进展期胃癌患者术后分为全肠外营养( TPN)组、肠内营养( TEN)组和 PN加 EN组,每组 12例.检测手术前后人体测量学指标及血浆白蛋白( Alb)、血红蛋白( Hb)和氮平衡变化并进行比较,同时观察胃肠道功能恢复情况及各种不良反应.结果术后 3个营养支持组的人体测量学指标和 Alb比较,差异均无显著性意义( P \u003e0.05),但术后第 2、 4、 8天 PN加 EN组氮平衡改善较 TEN组明显,P\u003c 0.01.TEN组术后早期( 6～ 8 h)经鼻肠导管营养液滴注后,5例出现腹胀,其中 3例伴腹泻,而 PN加 EN组采用术后 36～ 48 h或听诊可闻及肠鸣音(每分钟 3次以上)后方开始输注 EN液,则可以较好地耐受.结论老年胃癌患者术后 EN时间应适当延长至 36～ 48 h或听诊可闻及肠鸣音(每分钟 3次以上)开始为宜,在 EN支持前可辅以经周围静脉的 PN。

Purpose To research the change of serum level of CA199 and CEA pre and post-operation in the patients with colon cancer, and there clinical meaning. Methods The serim level of CA199 and CEA in 50 cases of clinical diag .osed patients of colon cancer and 50 cases of normal volunteer were detected by full-auto-immunochemical analyzer. Results The serum level of CA199 and CEA of the patients pre-operation were higher than of normal volunteer (P0. 01), and they decreased abruptly after operation. There were a significance difference between pre-radical-operation and post-radical-operation (P0. 05), and there were no significance difference in the cases of palliative operation (P0. 05). Conclusion The serum level of CA199 and CEA in colon caner patients increase pre-operation, and decreased abruptly after radical operation.