Abstract:ObjectiveTo explore the significance of using cytologic and RTPCR methods to examine peritonealwashings and peritoneal tissues of gastric cancer patients in prediction of peritoneal micrometastasis. MethodsThe peritoneal washings of 38 patients with gastric cancer and 5 patients with benign gastric lesionswere collected and, at the same time, a small amount of omentum and peritoneum were removed for control. CEAmRNA expression of free cells in peritoneal washings were detected by RTPCR method and alsocytology of the washings were performed.ResultsThe CEAmRNA expression rate of peritoneal washings and peritoneal tissues were 36.8%(14/38) and 39.5％(15/38)respectively. Both were more sensitivethan that of cytologic examination 26.3％(10/38).TNM staging,depth of invasion,lymph node metastasis, and serosal involvement were related to the expression rate of CEAmRNA.ConclusionsmRNA of CEA is more sensitive and specific than cytologic examination for detecting free cancer cells in peritoneal cavity. It is an effective method for detecting peritoneal micrometastases in gastric cancer patient.

Abstract:ObjectiveTo explore the diagnosis, treatment and prognosis of primary gastric malignant lymphoma(PGML). MethodsThe diagnosis and treatment data of 21 cases of PGML admitted in our hospitalduring 8 years was retrospectively analyzed. The diagnostic methods included barium meal examination, gastroscopy, B type ultrasonography, and CT scan. All patients underwent operative treatment and most of the patients received adjuvant chemotherapy. ResultsUpper abdominal pain, digestive tract bleeding, emaciation and abdominal mass were common clinical manifestations of PGML. The resectabilty rate of PGML was 90.5% while the 5year survival rate was 57.1%. ConclusionsThe key to a satisfactory prognosis was early diagnosis, radical curative operation and combined treatment.

Abstract:ObjectiveTo investigate the therapeutic effect of total mesorectal excision(TME) for low rectal cancer.MethodsOne hundred nineteen patients with rectal cancer, located on an average within 8 cm of the anal verge, were included in the study. Fiftyfour patients underwent traditional operation, and sixtyfive patients underwent total mesorectal excision. Operation time, loss of blood at operation and local recurrence rates were compared between the two groups. ResultsThe average operation time and blood loss were 118 minutes, and 100mL respectively in TME group, and they were 182 minutes, and 340 ml respectively in traditional operation group. There were significant differences between them(all P<0.05). The local recurrencerates were 9.23% and 35.18% respectively in the two groups（P<0.01）, there was not significantdifference on the hospital stay between the two groups(P>0.05). ConclusionsIn TME group, operation time was shorter, operative blood loss was less, and local recurrence rate was lower. TME should be applicated for patients with low rectal cancer.

Abstract:ObjectiveTo evalute the feasibility of Total mesorectal excision with preservation of superior hypogastricnerve and inferior hypogastric nerve.MethodsSeventy two cases of rectal cancer were divided into2 groups according to whether or not the superior and inferior hypogastric nerves were preserved. Local tumor recurrence, sexual function and bladder function between the 2 groups were compared.ResultsThe localrecurrence rate in nerve preservation group was 3.4% and in the control group was 4.7%, and with no significant difference(P>0.05). Sexual dysfunction was 13.8% and 46.5% respectively, and was significant(P<0.01). ConclusionsTotal mesorectal excision with preservation of superior hypogastric nerve and inferior hypogastric nerve for treatment of rectal cancer could reduce the sexual and bladder dysfunctionrate and result in better quality of life, and without an increase in local recurrence rate.

Abstract:ObjectiveTo explore the effect and clinical significance of expression of nuclear factorκB(NFκB), ICAM1 and COX2 on the occurrence and metastasis of gastric carcinoma. MethodsThe expressionof NFκB, ICAM1 and COX2 in 142 patients with gastric carcinoma was examined by immunohistochemicalSP technique. The adjacent gastric tissue(30 cases) served as a control group. ResultsThe expression of NFκB was 62.0% in gastric carcinoma tissue, much higher than that of the control group (P<0.01).The positive rate of NFκB was significantly related to local lymph node metastasis, histological differentiation grade and distant metastasis (P<0.05). The expressions of ICAM1(72.5%) and COX2(64.1%) in gastric carcinoma were higher than those in the control group (P<0.01) and were both closely related to local lymph node metastasis (P<0.01). NFκB expression positively correlatedwith ICAM1 (rs＝0.477，P<0.01) and COX2(rs＝0.380，P<0.01). ConclusionsThe control of transcription of ICAM1 and COX2, NFκB plays an important action in the occurrence and metastasis of gastric carcinoma. It could become a new target of treatment of gastric carcinoma.

Abstract:ObjectiveTo investigate the expression and clinical significance of tumor infiltrating dendritic cells(TIDCs) within gastric tumor tissues. MethodsImmunohistochemistry(IHC),insitu hybridization(ISH) and flow cytometry were applied to detect the expression of S100, CD83 mRNA and CD83 on DCs in 45 gastric adenocarcinoma tissues. The corelationship of the S100 and CD83 expression with clinical pathologicalfeatures was analyzed. ResultsIHC showed that S100 expression was unevenly distributed within42 cancer tissue and CD83 was only expressed in tumoradjacent tissue and normal tissue. ISH showed that CD83 mRNA was limitedly expressed within 7 samples. S100 expression had no significant correlationwith clinical pathological features, while CD83 reversely correlated with TNM stages. Detected by flow cytometry, CD83 was expressed in low level in all 45 gastric cancer tissues and negative correlations were found with lymph node metastasis and TNM stages of gastric cancer(r=-0.879,P<0.01; r=-0.782, P<0.05). ConclusionsTIDCs in gastric cancer tissue mainly appear in an immature state. The expression of S100 suggests the amount of TIDCS, while CD83 suggests their function. CD83 expression correlated with lymph node metastasis and TNM stages of gastric cancer, and could be used as a marker in further research.

Abstract:ObjectiveTo investigate the influence of selective HGF/cMet inhibitorNK4 against colon cancerand reveal the potential signaling pathway mechanism of NK4 effect on colon cancer cell. MethodsLoVo colon cancer cells were treated with NK4（a selective inhibitor of cMet phosphorylation）at different times. MTT assay and flow cytometry were used to measure cell proliferation and apoptosis. The expression of cMet, pcMet, MEK2, pERK and Cmyc were measured by Western blot. ResultsIn NK4treated group, cells proliferation were inhibited and apoptosis induced in a dose dependent manner, and resulted in significantdownregulation of pcMet and MEK2/ERK pathwayrelated protein. The effect of HGF/on LoVo was the opposite. The ratios of pcMet, MEK2, pERK and Cmyc expression between blank group and the NK4（1μg/mL）treated for 24h group were 2.58, 1.89, 1.67 and 2.21(P<0.01), and for HGF(50mg/mL) group were 0.46, 0.71, 068, 0.58(P<0.01), respectively. ConclusionsThe results showed that selective cMet inhibitor NK4 may inhibit proliferation and induce apoptosis of colon cancer cell lines LoVo through blockade of MEK2/ERK signaling pathway. It may be a new target of selective HGF/cMet inhibitor effect on colon cancer.

Abstract:ObjectiveTo find early diagnostic biomarkers for colorectal carcinoma by comparing differential expressingproteins from colorectal carcinoma and normal colorectal tissues. MethodsColorectal carcinoma tissues and paired normal tumoradjacent colorectal tissues were collected, and tissue total protein was extracted; differential proteome profiles were established and analysed by means of immobilized pH gradientbasedtwodimesional polyacrylamide gel electrophoresis(2DPAGE) and matrixassisted laser desorption/ionization time of flight mass spectrometry(MALDITOFMS). ResultsWellresolved, reproducible2DE profiles of human colorectal carcinoma tissues and paired normal tumor adjacent colorectal tissues were obtained. For tumor tissue, a total of 1098±28 spots were detected, and for normal tissue, 760±45 spots were detected. For normal tissue, The average deviation of spot position was（0.542±0.12）mm in IEF direction and（0.933±0.098）mm in SDSPGE direction for tumor tissue. The average deviation of spot position was（ 0.745±0.130）mm in IEF direction and（1.233±0.272）mm in SDSPGEdirection. 30 differential expressing proteins were analysed by mass spectrometry and bioinformation,
16 of them were well characterized including Apolipoprotein A1 (apoA1),calreticulin precursor,glutathione Stransferase, hepatic fatty acidbinding protein、heat shock protein 27 ect. ConclusionsDifferential expression proteins can be candidate biomarkers for early diagnosis of colorectal carcinoma; and proteomic technique is valuable for screening the diagnostic biomarkers.

Abstract:ObjectiveTo investigate the expressions of EMMPRIN, MMP1, MMP9 and TIMP1 in rectal cancer tissues and their clinicopathotogic significances. MethodsImmunohistochemical method of avidinbiotincomplex was used for four targets on the routinely paraffinembedded sections of 41 cases of surgical resected specimens of rectal carcinoma and 15 noncancerous rectal tissues in the 41 cases. Results The expression positive rate of EMMPRIN, MMP1, MMP9 and TIMP1 was 58.5%, 53.6%, 51.2% and 46.3%, respectively. The positive rate of EMMPRIN, MMP1, MMP9 and TIMP1 was 13.3%, 13.3%, 6.7% and 86.7%, respectively, and the positive rates of rectal cancer showed significant differentiation compared with those of noncancerous rectal tissues. The positive rates of EMMPRIN, MMP1 and MMP9 were significantlyhigher in cancer tissuse of poordifferentiation, infiltration of serous layer by cancer cells, maximaldiameter of mass >5cm and with metastasis of lymph nodes than that in the ones of wellor milddifferentiation, filtration of only muscular layer by cancer cells, maximal diameter of mass <5cm and withoutmetastasis of lymph nodes, but those of TIMP1 were the opposite. ConclusionsThe expression of EMMPRIN, MMP1, MMP9 and TIMP1 might be important biological markers for reflecting clinicopathologic features、biological behaviors and prognosis of rectal cancer.

Abstract:ObjectiveTo investigate the diagnosis and therapeutic methods of primary tumors of duodenum(PTD). MethodsClinical data of 86 patients with primary duodenal tumors who were hospitalized in the First Affiliated Hospital of China Medical University during 26 years were analyzed retrospectively. Of all the tumors,18 cases were benign tumors and 68 cases were malignant tumors. ResultsThe clinical manifestationswere symptoms of bile duct obstruction, GI and nonspecific symptoms, and signs included fever, anemia and weight loss. The correct preoperative diagnostic rate by auxiliary examinations were:duodenalendoscopy 92％, air barium double radiography 89％, MRCP 85％, BUS 33％, CT 51％, MRI 75％, and duodenal endoscopy combined with air barium double radiography were 95%. Tumors were mostly located in the descending portion of duodenum(71 cases). Eighteen cases of benign PTDs were resected completelywith a 5year survival of 92.3%. Among the 68 maligant PTD cases, 35 cases underwent pancreatoduodenectomy, and 8 cases received segmental duodenectomy, with a resection rate of 63.2% and the 5year survival rate of 31.0%. The remaining 25 cases, in which the tumors were unresectable, were treated by bypass operations, the 5year survival rate was 0%. ConclusionsPatients with PTD usually lack specific symptoms and signs, but combination of endoscopy, GI air barium double radiography and other examinationscan improve the preoperative positive diagnostic rate. Segmental duodenectomy and simple tumor resection are curable for primary benign tumors of duodenum; while for primary malignant tumors of duodenum, the therapy of choice should be pancreatoduodenectomy.

Abstract:ObjectiveTo explore the diagnosis and treatment of gastrointestinal stromal tumors(GISTs). MethodsClinical and pathological data of the 32 GISTs cases treated over the recent 5 years in our hospital were reviewed retrospectively. ResultsStomach was the most frequent site for GISTs. Abdominal pain was the most common symptom. Before operation, 81.3%(26/32) of the cases were misdiagnosed. All of the cases underwent surgical resection. 10 recurrent GIST patients received a second resection, and 8 patients underwantthree or more resections. Follow-up was made from six months to 5 years, and 8 patients died. ConclusionsThe diagnosis of GISTs is difficult and mainly depends on histopathology and immunohistochemistry. Surgical resection is the principal treatment of GISTs. Reoperation is effective for the treatment of recurrent cases.

Abstract:ObjectiveTo investigate the clinical value of laparoscopic resection of gastric stromal tumors. MethodsThirtytwo cases received this new type of operation.The tumors ranged in size from 1.5 to 5 .5cm with a mean diameter of 2.6 cm. The operative methods included the full laparoscopic resection of gastrictumor and the handassisted laparoscopic resection of gastric tumor. ResultsAll cases were successfullyresected and no complications were observed. The mean operative time was 75min.The mean intraoperativeblood loss was 50ml.Postoperative pain was slight. Postoperative flatus and feces were passed at a mean of 34 hours, and average postoperational hospital stay was 7.5days. Postoperative pathologic examinationconfirmed that 25 cases were benign GIST and 7 cases were of lowgrade malignancy. No recurrenceswere observed at follow up of 8 to 30 months.ConclusionsLaparoscopic resection of gastric stromaltumor is a technically simple，safe and effective procedure that could be widely used.

Abstract:ObjectiveTo explore the principles and methods of surgcal treatment for acute neoplastic colorectal obstruction.MethodsThe clinical data of 103 patients diagnosed as acute neoplastic colorectal obstruction were analyzed retrospectively.ResultsIn this group, 80 cases underwent emergency surgical treatment, amongwhich, 25 cases of carcinoma of right colon underwent primary resection and anastomosis; in 45 cases of carcinoma of left colon, primary resection and anastomosis was performed in 37 cases; and emergent operationswere performed in 10 cases of rectal cancer. 23 cases received nonemergency surgery. Anastomoticfistula occurred in 3 patients, pulmonary infection in 2 patients, pelvic cavity infection in 1 patient, 1 patient died and the rest recovered well and were discharged.ConclusionsThe initial treatment for acute neoplastic colorectal obstruction should be nonsurgcal treatment for 1~3d to make nonemergency surgical treatment more possible. If indications are properly selected, primary tumor resection and anastomosis is safe. For patients with severe contamination of abdominal cavity and bowel perforation, primary tumor resectionshould be performed if possible.

Abstract:ObjectiveTo discuss the diagnosis and treatment of spontaneous perforation of the large intestine.MethodsThe clinical data of 9 cases with spontaneous perforation of the large intestine admitted into our hospital since 1994 were analyzed retrospectively.ResultsAll the 9 cases were over 60 years of age, had no specific clinical manifestations, and were misdiagnosed preoperatively. Among them, 4 cases had a longstandinghistory of hypertension and arteriosclerosis, and 6 cases had habitual constipation.There was 1 case with perforation of transverse colon,1 case of descending colon, 3 cases of sigmoid colon, and 4 cases of upper rectum. Four cases underwent exteriorization after a simple closure of the perforation, while in the other 5 cases closure of the perforation was followed by a loop colostomy.The postoperative complications included cardiac arrhythmia(1 case), lung infection(2 cases), and infection of incisional wound(1 case).All cases recovered smoothly and were discharged.ConclusionsSpontaneous perforation of the large intestine usually presents in old patients, and frequeatly occurs in the rectum and sigmoid colon. It is usually misdiagnosed preoperatively, and surgical intervention should be performed as soon as possible. The operation should be simple. It is crucial to intensify management after operation.

Abstract:ObjectiveTo explore the monitoring methods for pancreatic graft function after upper abdominal cluster transplantation. MethodsAnalysis of the clinical data of 5 cases of successful upper abdominal clustertransplantation in our center. ResultsThe patients recovered well after the operation. Endocrine and exocrine functions of all the pancreas graft returned to normal without any rejection. ConclusionsDynamic monitoring of blood glucose, Cpeptide, blood insulin, blood amylase, urine amylase, amylase in abdominal drainage and duodenal tube decompression drainage, in addition to Doppler color ultrasound examination, can effectively detect the endocrine and exocrine function of the pancreas graft.