AIM To summarize the experience of surgical treatment of hilar cholangiocarcinoma and the results of aseries of experiments.METHODS AND RESULTS Personal perspectives of surgical treatment of hilar cholangiocarcinoma werebased on the experience of a series of patients with hilar bile duct cancer treated in the General Hospital ofPLA, Beijing from 1986 to 1999. A total of 157 cases were treated surgically, with 106 (67.5%) resections ofthe tumor , 37.6% of the resections was proved to be radical. The 1-, 2-, 3-, and 5-year survival rate of theradical resection group was 96.7%, 40.0%, 23.3% and 13.3%, respectively. No patient of the palliativeresection group lived beyond 3 years postoperatively. The recent trends of surgical management of hilar bileduct cancer were discussed. Experiments were carried out for cooperative clinicopathological study toevaluate the perineural space involvement, the neural cell adhesion molecule expression, p16 geneexpression, and the 3-dimensional reconstruction of the bile duct cancer specimens. The pathogeneticrelationship of HBV and HCV with extrahepatic cholangiocarcinoma was evaluated by histochemical and IS-PCR methods. And an inquiry into the possibility of gene therapy was made.CONCLUSION Hilar bile duct cancer rarely runs a “benign” course. It is a regional disease rather than alocal affection and may be related to HBV and HCV infection in China. It possesses the metastasing abilityalong the perineural space by a “jumping” fashion, therefore, in most cases, conventional surgical excision isbound to be unradical in the region of the porta hepatis for anatomical reasons.

作者： 刊期： 2000年第03期

AIM To study the development of D (somatostatin-secreting) and P (bombesin-secreting) cells ofproventriculus from Shao ducks at different ages.METHODS Ninety Shao ducks were divided into nine groups, 10 ducks per group. The ducks were slayedgroupby group at the nine time points of week 0 (after hatching), 1, 2, 4, 6, 10, 14, 18 and 22.Proventriculus samples from each duck were collected, fixed by Bouin solution and embedded with paraffin.gections were made and stained with an avidin-biotin-peroxidase complex kit (Dako Co., Ltd. ) to visualizeD and P cells of each proventriculus. Thirty glandular lobes per duck were observed for enumeration of Dand P cells.RESULTS ① Both D and P cells were mostly oval or polygonal shape with dumpy cytoplasmic processesand located in the inner and central area of the glandular lobe. ② The D and P cells peaked at wk 18 and 6respectively. ③ There was no apparent correlation between D cells and the body weight until wk 4. Negativecorrelation was observed from wk 6 and reached a marked level at 18wk (r = -0.829, P<0.05).Individuals with maximum body weight had less D cells than those with minimum body weight from wk 10-wk 18.CONCLUSION The morphology and distribution of D and P cells in the proventriculus of Shao ducks weresimilar to Peking ducks, gooses and chickens. Both D and P cells had continuing development during thepostnatal period, though the rates of their development were different. If appeared that beyond a definitenumber of D cells, they were negatively correlated with the body weight.

作者： 刊期： 2000年第03期

AIM To study the comprehensive prevention and treatment of gastric cancer among high-risk population inthe high risk areas.METHODS A gastrocarcinoma mass screening was performed in 16 villages of Zhuanghe region. About50 000 population were involved and 3033 cases aged above 35 suffering from gastric diseases, and/or hadfamily history of gastric cancer were screened. Clinical epidemiological investigation, double-contrast X-ray,serum pepsinogen monitor, gastroscopic biopsies and histopathologic examinations were adopted in thescreening.RESULTS The ratio of the examined patients with gastric disorder reached up to 82% and 32 patients withgastric cancer were detected (1.06%) and 18 cases were early gastric cancer (56.25%). Patients with gastriccancer were treated successively. Aside from gastric cancer, several gastric lesions were also detected, whichlaid a good foundation for further interventional treatment. It was also found in the examination that93.97% of the local residents were addicted to salted pork and more than 60% of the residents had Hpinfection.CONCLUSION Gastric diseases, Hp infection of gastric mucosa and eating salted pork are very common inZhuanghe region. These are very dangerous factors causing gastric cancer. It is feasible to quit eating saltedpork and eradicate Hp infection and cure precancerous diseases.

作者： 刊期： 2000年第03期

AIM To study the safety and the traumatic degree of D4 approach by retrospective analysis of the para-operative data from the para-aortic lymph nodes excision in comparison with those from standard radicalresection in advanced gastric cancer (AGC).METHODS Several para-operative data including the resectability, the mortality, the complicatedmorbidity, the amount of transfused blood, and the hospitalized days relating to the operation were analyzedstatistically between D4(n = 30) and D2 lymph nodes excision (n = 34) groups. The data expressed as means±SD was analyzed statistically by Student t test. Percentage of the data was analyzed by x2 test statistically.It was taken as significant difference if P value was less than 0.05.RESULTS The percentage of palliated resection in D4 group was significantly lower than that in D2 group(16.67% vs 47.06%, P<0.05). This D4 radical resection would indeed prolong the drainage time (7.35±0.98 days vs 14.78±2.16 days, P < 0.01). The amount of transfused blood during operation (774.32±112.09mL) and the operative consuming time in D4 group (7.14±0.39h) increased significantly toocompared with those in D2 group (538.67±59.87mL, P < 0.05; 4.12±0.18h, P < 0.05), suggesting that thedraumatic degree of D4 operation was severer than that of D2 operation. But the mortality, the morbidity ofcomplication and the hospitalized time after D4 operation did not increase significantly, indicating that D4lymph nodes excision as a choice of the surgical treatment of AGC was safe and feasible.CONCLUSION D4 lymph nodes excision for AGC is safe, reasonable and feasible.

作者： 刊期： 2000年第03期

AIM To observe the effects of Innovar and Atropine on Visceral pull response.METHODS Patients were randomly divided into two groups. The experimental group was treated by DanNang Xue blockade with Innovar 4 mL and Atropine 0.5 mg (n = 40) and the control group was treated byabdominal vagus blockade with 10 mL of 10 g/L Lidocaine (n = 40). Dan Nang Xue was chosen for insertionof No 5 needle (5 cm in length) after local sterilization. The acupoint of Dan Nang Xue is located at theoutside of knee-jont and it is one-finger wider below Yanglingquan can be found. A sensitive point. Theneedle was inserted between tibia and fibulae, lifted, thrusted and twirled until the patient felt ache. Innovarand Atropine were injected on Dan Nang Xue and the acupoint was gently messaged.RESULTS Patients in the experimental group remained quiet during operation. Neither nausea or vomitingnor uncomfortable reaction was complained, 85% of the patients belonged to grade m. Acupunctureenhanced the peristalsis of gallbladder and biliary secretions. Atropine relieved muscular spasm andprevented vomiting. A low heart rate was noted in the control during abdominal survey and gallbladder pull(P<0.05).CONCLUSION Dan Nang Xue blockade with innovar and atropine can prevent visceral pull response.

作者： 刊期： 2000年第03期

AIM To incorporate p12 in a plasmid under the control of the CMV promotor and test for the ability of theconstruct to produce specific immune responses in DNA-immunized mice.METHODS A His-tag fusion of the protein p12, was expressed in the prokaryotic expression vector (pQE)and the recombinant protein purified using nickel-chelate chromatography. His-tagged p12 was sub-clonedinto the pBK-CMV vector for expression in eukaryotic systems. Groups of six female balb/c mice werevaccinated with either 50μg im of the DNA pBK-CMV-p12 or pBK-CMV vector alone at week 0, andboosted at 2 and 4 weeks. ELISPOT assays (detection of p12 T-cell dependant IF-γ release) on mouse spleniccells were used to measure cell mediated immune responses and anti-mouse IgG ELISAs to detect antibodyresponse.RESULTS Significant CMI and humoral immune responses to recombinant p12 were detected in micevaccinated with pBK-CMV-p12 vector compared to mice vaccinated with pBK-CMV vector alone. The miceremained well throughout the development of immunity to p12.CONCLUSION A DNA vaccine coding for a specific MAP protein will stimulate humoral and cell mediatedimmune responses in mice.

作者： 刊期： 2000年第03期

AIM To investigate the protective effects and mechanism of Diltiazem (Dil) on liver, pancreas and smallintestine in hemorrhagic-shock canine.METHODS The canines were bled to a mean arterial pressure (MAP) of 5.33kPa-6.67kPa for 30min toestablish the shock model. During the shock state, the dogs received either water-soluble calcium blocker Dilor saline solution. The MAP was kept at this level for 90min, then the total blood which was bled previouslywas reperfused. The total observation time of the experiment was 240min.RESULTS Dil could significantly increase MAP from 150min to 240min (P<0.01) and the activity ofsuperoxide dismutase (SOD) of pancreas tissue (P<0.01), and it could also decrease the content ofmalondialdehyde (MDA) in liver, pancreas and small intestine tissues (P< 0.01) and the activity of SOD ofthe liver and small intestinal tissues (P<0.01) in the canines. Electron microscopic data indicated that theultrastructures of liver, pancreas and small intestine tissues were normal in Dil group.CONCLUSION Dil can protect the structure and function of the liver, pancreas and small intestinal inhemorrhagic-shock canine.

作者： 刊期： 2000年第03期

AIM To study the relationship among typing of Traditional Chinese Medicine (TCM) and Helicobacterpylori infection, expression of oncogene and tumor suppresser genes in gastric cancer and precancerouslessions.METHODS According to TCM typing, 120 patients with chronic superficial gastritis, intestinal metaplasia,atypical hyperplasia and gastric cancer were divided into 4 groups: 21 patients with coexistence of cold andheat syndrome (group R), 22 patients with in coordination between the liver and the spleen (group U), 29patients with deficiency of the spleen-yin (group I) and 48 patients with insufficiency of the spleen-yang(group H). Protein expression of c-myc, p21 and p53 were detected immunohistochemically, and Hp wereconfirmed by modified Giemsa method.RESULTS The Hp infection of the group H was significantly higher (72.9%) than that of group R(38.1%, P<0.01) and group U (40.9%, P<0.01). Expression of c-myc, p21 and p53 were significantlyrelated to Hp infection and severity of gastric mucosa lesions (group H>group I>group U>group R).CONCLUSION Hp infection, expression of oncogene and tumor suppresser genes were related to TCMtyping. These parameters were helpful in identification of symptoms and signs and TCM differentiationdiagnosis.

作者： 刊期： 2000年第03期

AIM To study the effect of a wide range of concentration of arsenic trioxide on human hepatoma cell lineBEL-7402 and its mechanism.METHODS The BEL-7402 cells were treated with arsenic trioxide (a final concentration of 0.5, 1 and2 μmol/L, respectively) in various durations or for 4 successive days. The cell growth and proliferation wereobserved by cell counting and cell-growth curve. Morphologic changes were studied under electronmicroscopy. Flow cytometry was used to assay cell-DNA distribution and the protein expression of Bcl-2 andBax was detected by immunocytochemical method.RESULTS The cell growth was significantly inhibited by the different concentrations of arsenic trioxide asrevealed by cell counting and cell-growth curve. Arsenic trioxide treatment at 0.5, 1 and 2 μmol/L, resultedin a sub-G1 cell peak. The decreased G0/G1 phase cell and the increased percentage of S phase cell were observed by flow cytometer, suggesting that the inhibiting effect of arsernic trioxide on BEL-7402 cell lay inG0/G1 phase cell. Apoptotis-related morphology, such as intact cell membrane, nucleic condensation,apoptotic body formation, can be seen under the electron microscopy. High protein expression level of Bcl-2and Bax was detected in 1 and 2 μmol/L arsenic trioxide-treated cells, but that of Bax was more significant.Arsenic trioxide treatment at 0.5 μmol/L resulted in higher expression level of Bcl-2 and lower expressionlevel of Bax compared with control (P1<0.01, P2<0.01).CONCLUSION Arsenic trioxide not only inhibited the proliferation but also induced apoptosis of humanhepatoma cell line BEL-7402. The induced-apoptosis effect of 1 and 2 μmol/L arsenic trioxide was relative tothe expression level of Bcl-2 and Bax.

作者： 刊期： 2000年第03期

AIM To clarify the surgical strategy for patients with stage Ⅳa primary hepatic carcinoma (PHC).METHODS Twenty-seven patients with stage Ⅳ a PHC were retrospectively studied in 1989 - 1998,including resected group (19 cases) whose all tumor nodes were resected and cytoreductive group (8 cases)whose most tumor nodules were resected and remnant nodules treated by ethanol injection. B-ultrosoundshould be used intraoperation in order to prevent from missing any tumor nodule. All the tumor nodules inthe liver should be removed, and residual nodules should be treated by ethanol injection during operation ifall the tumor nodules can not be removed. Multidisciphinary therapies were undertaken perioperatively.RESULTS The 1-, 2- and 3-year survival rates were 71.4%, 55.6% and 7.7% respectively. The 1-, 2- and3-year survival rates of the resected and cytoreductive groups were 73.3%, 53.3%, 10.0% and 66.7%,50.0%, 0% (P>0.05) respectively. The rate of complications was 22.0%, without operative and in-hospital mortality.CONCLUSION The surgical treatment included resected or cytoreductive operation plus supplementarytherapy considered to be both useful and the first choise for stage Ⅳa PHC.

作者： 刊期： 2000年第03期

AIM To study the changes of IL-6,IL-2, sIL-2R and TNF ir patients with hepatocellular carcinoma(HCC)and their clinical significance.METHODS IL-6, IL-2, sIL-2R and TNF were detected by avidin-biotin-system ELISA, double-sandwichELISA respectively in 60 patients with HCC and 36 patients with liver cirrhosis (LC) and 66 healthy persons.RESULTS The levels of IL-6, sIL-2R and TNF increased, but IL-2 level was lower in patients with HCCthan that in normal controls (NC) (t test, t=8.21, 4.71, 3.87, 2.13, P<0.01 or 0.05). IL-6 level in HCCwas 10 fold higher than NC, and also much higher than LC. IL-6 level was higher in later stage than that inearlier stage. There was a positive correlation between IL-6 and sIL-2R, TNF, while no positive correlationwas found between IL-2 and IL-6, sIL-2R in HCC.CONCLUSION The remarkably higher level of IL-6 is helpful for the early diagnosis of HCC.

作者： 刊期： 2000年第03期

mycobacterium avium; paratuberculosis; glycosyltransferases; bacillus subtilis;chromatography, affinity; antibodies, anti-idiotypic

作者： 刊期： 2000年第03期

AIM To investigate the diagnostic value of CagA IgG in serum.METHODS Seventy three patients with peptic ulcer infected with HP were eradicated by antibioticstherapy. At pretreatment, wk9 and wk20 after treatment, the detection of Hp in gastric muscosa bybacteriologic method were performed, and CagA and whole-cell antigen of HP igG in serum by ELISAmethod were also performed at the same time.RESULTS The IgG titres of Hp CagA and whole-cell antigen changes in accordance with the efficacy ofHp eradicated. The former with an earlier appearance and a greater number of cases decreased to normallevel in comparison with the latter.CONCLUSION CagA IgG is a better index for observing the effectiveness of the eradication of Hp.

作者： 刊期： 2000年第03期

AIM To determine the effect of glutathione (GSH) on stress gastric mucosal lesion.METHODS The stress gastric mucosal lesion as produced by restraint water-immersion in rats and gastricmucosal lesion, gastric mucosal GSH content, gastric acid secretion and gastric barrier mucus secretion wereexamined. We also observed the effect of GSH on gastric mucosal lesion and the effect of N-ethylmaleimine(NEM) and indomethacin on GSH protection. Comparisons between two groups were made using the Students t test.RESULTS GSH (100 and 200 mg/kg) intraperitoneally protected against stress gastric mucosal lesion(P<0.001 and P<0.001). Restraint water-immersion stress significantly reduced gastric mucosal GSHcontent (P < 0.001), but pretreatment with GSH (100 mg/kg) had no effect on gastric mucosal GSH content(P>0.05). The preinjection of NEM (10 mg/kg, sc.), a sulfhydryl-blocking reagent, or indomethacin(5 mg/kg, im.), a cyclooxygenase inhibitor, had no effect on protection of GSH (P>0.05). GSH(100mg/kg) significantly increased secretion of gastric barrier mucus (P<0.05), but had no effect onsecretion of gastric acid in restraint water-immersed rats (P >0.05).CONCLUSION GSH can inhibit the formation of gastric mucosal lesions induced by restraint water-immersion. The protective effect of GSH was due, in part, to promoting the secretion of gastric barriermucus, but not to suppress the gastric acid secretion. The protection effect of GSH has no relation withgastric mucosal GSH and PGs.

作者： 刊期： 2000年第03期

AIM To observe the therapeutic effect of colloidal bismuth tartrate in an animal colitis model.METHODS Immune-complex colitis was induced in groups of rabbits by formalin, and two hours later0.85 mL heat-aggregated rabbit IgG was given intravenously through the ear cannula. Animals wereintracolonically treated with colloidal bismuth tartrate (BITNAL), and its effect was compared withsulfasalazine (SASP), indomethacin (IND) and bifidobiogen (BIFG). Animals were killed, the mucosalappearance was scored (0-4), and tissue saved for histological studies, the number of neutrophils present ininflamed colonic tissue was quantitated by the myeloperoxidase (MPO) activity assay, the production oflipoxygenase and cyclo-oxygenase products was monitored and eicosanoid production were assayed byincubation colonic specimens and the media for prostaglandin E2(PGE2), leukotriene (LTB4), thromboxaneB2(TXPe) were examined by radiommunoassay.RESULTS Immune-complex colitis was induced by formalin and IgG, colonic damage persisted for at least1 wk by macrography. Histologically, the inflammatory response included mucosal and submucosalinfiltration by polymorphonuclear leukocytes, macrophages, lymphocytes and fibroblasts, the macroscopic,persent 2 wk after IgG, was correlated with greatly increased PGE2, LTB4 and TXB2 compared with levels incontrols. Treatment with BITNAL (500 mg/kg) resulted in a lowered inflammation index, lowered MPOactivity and inhibited the increased formation of PGF-2, LTB4 and TXB2 by the inflamed colon, and IND(500 mg/kg) markedly inhibited prostanoid formation in both inflamed and control colon but did not reducetissue damage, SASP (500 mg/kg) also inhibited the formation of PGE2, LTB4 and TXB2 but the effectswere less marked. BIFG (400 mg/kg) did not significantly reduce the colonic injury and the media sythesizedby the rabbit colon.CONCLUSION BITAL provides better therapeutic effects in experimental colitis than anti-inflammatorydrug IND or SASP.

作者： 刊期： 2000年第03期

AIM To observe the clinical effect of self-made Jinhuang Pingan Decoction (JHPAD) in treating intestinaladhesion.METHODS Among 580 cases of intestinal adhesion, 492 cases were treated with oral JHPAD alone; 88cases with incomplete intestinal obstruction were treated by gastrointestinal decompression, then givingconcentrated JHPAD through the GI tube as well as fluid replacement and anti-inflammation therapy.RESULTS Among 580 cases, 302 cases were cured, 232 cases, improved and 46 cases had no change, thetotal effective rate was 92.1%. In 492 patients treated with JHPAD alone, 264 cases had obvious effect, 202cases were improved and 26 cases had no effect, the total effective rate was 94.7%, and the corresponingresults in 88 cases treated with JHPAD and gastrointestinal decompression were 39 cases, 29 cases, 20 casesand 77.3% respectively. In addition, there was close relationship between the therapeutic efficacy anddisease course, and had significant statistical difference in therapeutic efficacy with the disease course of lessthan 30 d or over 12 m (x2=87.32, P<0.0001).CONCLUSION JHPAD has the effect of clearing heat, detoxication, anti-inflammation, relieving edema,analgesia, hemostasis and anti-adhesion in the treatment of intestinal adhesion. It has a satisfactory efficacyand no toxic reaction, so it is worthy to popularize in clinical practice.

作者： 刊期： 2000年第03期

AIM To study the effects of ATRA on experimental liver metastasis of gastric cancer cells.METHODS MGc80-3 and SGC-7901 cells were injectied into spleen subcapsule of nude mice, who weresubsequently administrated with ATRA every other day. Food-intake and body weight of mice were measuredweekly. After six weeks, the nude mice were executed, tumors in spleen and liver were examinedpathologically, microtumor vessel density (MVD) was accounted by immunohistochemical method and serumCEA was measured by radioimmunoassay.RESULTS Nude mice administrated with ATRA, the growth of spleen tumor and its metastatic ability toliver were inhibited, the metastatic rate was decreased by 33.3% (MGc80-3) and 50.0% (SGC-7901). SpleenMVD and liver MVD were reduced by 28.6% and 22.9% (MGc80-3), 23.7% and 37.6% (SGC-7901),respectively. The serum CEA was lowered by 43.4% (MGc80-3).CONCLUSION ATRA can effectively inhibit the experimental liver metastasis of gastric cancer cells,which is relavant with the decrease of MVD and CEA.

作者： 刊期： 2000年第03期

AIM To observe the effect of herbs-partition moxibustion on IL-1β and TNF-c in UC rats.METHODS The animal models were created by immunological method. They were divided into 5 groups atrandom, after treated by different methods, IL-1β and TNF-α in colon tissue of UC rats were detected withimmunologic technique.RESULTS In control group, there was a little or no IL-1β positive cell in colon mucosa. Compared withthat in rats of control group, the number of IL-1 positive cell in model group was much larger, and IL-1βcells with brown granules were mainly expressed in cytoplasm of macrophage in lamina propria of colon.Compared with model group, IL-1β positive cells in mild moxibustion group markedly decreased (P < 0.05),and those in electro-acupuncture group and herbs-partition moxibustion group decreased even more markedly(P < 0.01). The difference between the last two groups is evident (P < 0.05). TNF-α positive cells are not or seldomly found in UC rats, but in model group, these cells increasedevidently, which were mainly the macrophages in lamina propria of colon. Compared with those in modelgroup, the positive cells decreased markedly in electro-acupuncture group (P<0.05), and decreased moremarkedly in mild moxibustion group and in herbs-partition moxibustion group (P<0.01). There werestatistically significant differences between herbs-partition moxibustion group and electro-acupuncture group(P<0.05).CONCLUSION The mechanism of acupuncture and moxibustion may be that inhibited macrophageactivation, reduced expression of IL-1β and TNF-a and thereby blocking their further activation and thencontrolled, the initiated inflammation and its immunity cascade reaction and resulted in restoring the normalimmunity function and benefited in healing of ulcer.

作者： 刊期： 2000年第03期

AIM To investigate the therapeutic effect of TNF gene transfected LAK cells on ascitic liver carcinoma-bearing mice.METHODS TNF gene was transfected into murine LAK cells by retrovirus. Low dose TNF gene-transfectcdLAK cells and IL-2 were i.p. injected into murine model. Cytotoxicity of gene transfected LAK cells wasstudied in vitro growth and the survival time of murine model was observed.RESULTS TNF gene-transfected LAK cells secreted higher level of TNF than that of normal LAK cells orcontrol gene-transfected LAK ceils. The in vitro growth ability and cytotoxicity of TNF gene-transfectedLAK cells were markedly inhibited by anti-TNF monoclonal antibodies. Significant therapeutic effect onascitic liver carcinoma-bearing mice was achieved.CONCLUSION TNF gene-transfected LAK cells have therapeutic effect on ascitic liver carcinoma-bearingmice.

作者： 刊期： 2000年第03期

AIM To evaluate the clinical value of creatine kinase macroisoenzyme type 2 (CK-M2) and oligosaccharideprotein (OP) in serum from patients with gastric carcinoma (GC).METHODS Serum level of CK-M2 was detected by agar gel electrophoresis. OP concentration was measuredby an enzyme immunoassay.RESULTS Serum levels of CK-M2 and OP in 57 cases of GC were significantly higher than those in 51 caseswith gastric precancerous lesion and 28 controls. The diagnostic sensitivity and specificity for GC with CK-M2 was 56.10% and 98.63% respectively. CK-M2 and OP were not associated with histologic type and degreeof differentiation.CONCLUSION These results suggest that CK-M2 may serve as a marker to diagnose GC, and the specificityis higher, whereas OP is not more significant for GC diagnosis, but it could be a useful indicator forevaluation the status of body immune.

作者： 刊期： 2000年第03期