Mechanism of reversing cisplatin resistance by Xiaoyan Decoction in lung cancer / 中草药

Objective: To investigate the possible mechanism of reversal of cisplatin resistance in lung cancer by Xiaoyan Decoction. Methods: The migration ability of cancer cells was observed by the scratch test, and the MTT was used to test the mobility of cancer cells. The siRNA transfection was applied to demonstrate the possible molecular mechanisms. The mRNA and protein expression levels were detected by real-time quantitative reverse transcription PCR and Western Blot. Results: MTT showed that A549/DDP could significantly inhibit cell proliferation at later points of time. Similarly, cisplatin combined with Xiaoyan Decoction could significantly inhibit cell proliferation at 48, 72 and 96 h. Scratch test showed that the migration distance was shorter in A549/DDP/siRNA-Beclin1 cell line than NC. MTT showed the proliferation of A549/DDP/siRNA-Beclin1 cell line was decreased when compaired with NC. Western blot also showed that the protein expression of P-gp and LRP was decreased. MTT also detected that cisplatin and Xiaoyan Decoction significantly inhibited cell proliferation of A549/DDP/siRNA-Beclin1 cell at later points of time. Cisplatin combined with Xiaoyan Decoction significantly inhibited cell proliferation in the whole course. The results showed that protein expression level of YAP1, P-gp and LRP in A549/DDP/siRNA-Beclin1 cell line was significantly lower than those in NC. Conclusion: Xiaoyan Decoction may improve the sensitivity to cisplatin may via Beclin 1-YAP1 pathway.

Influence of head position on radiation dose distribution in whole brain volume-modulated arc therapy / 中华放射肿瘤学杂志

Objective To explore the intensity of coplanar arc-adjusted radiotherapy with volume-modulated arc therapy (VMAT) and whether the position of the head tilt influences the distribution of radiotherapy dose.Methods From 2015 to 2017,500 patients underwent radiotherapy of the head and kept their head tilted.The simulated non-inclined CT images were obtained by rotating the original CT images.The protocol of the coplanar VMAT whole brain irradiation was 30 Gy and the maximum dose of planning target volume in the hippocampus was limited to 16 Gy.The doses of the optic nerve,optic chiasm and eyeball were lower than 37.5 Gy.The dosimetric parameters of two different protocols were statistically compared by paired t-test.Results The average head tilt angle was (11.12°±0.68°).The homogeneity and the conformal index in the tilted and non-tilted positions were decreased by (8.3±9.6) ％(P=0.033) and (5.2±4.1)％(P=0.009).The dose of hippocampus in the tilted position of the head was decreased by (13.6±6.2) ％ on average compared with that in the non-inclined position (P=0.004).The dose of the lenses was decreased by (15.5±11.1)％(P=0.008) on average.The doses of optic nerve and eyeball were declined by (6.8±5.6) ％(P=0.013) and (8.6±6.5) ％(P=0.016).Conclusions By tilting the head at an appropriate angle during VMAT whole-brain radiotherapy,the radiation dose distribution of the target volume can be significantly improved and the radiation dose in the hippocampus and visual system can be reduced simultaneously to maintain the therapeutic effect and minimize the effect upon the cognitive and memory function of patients.

Influence of head position on radiation dose distribution in whole brain volume-modulated arc therapy / 中华放射肿瘤学杂志

Objective@#To explore the intensity of coplanar arc-adjusted radiotherapy with volume-modulated arc therapy (VMAT) and whether the position of the head tilt influences the distribution of radiotherapy dose.@*Methods@#From 2015 to 2017, 500 patients underwent radiotherapy of the head and kept their head tilted. The simulated non-inclined CT images were obtained by rotating the original CT images. The protocol of the coplanar VMAT whole brain irradiation was 30 Gy and the maximum dose of planning target volume in the hippocampus was limited to 16 Gy. The doses of the optic nerve, optic chiasm and eyeball were lower than 37.5 Gy. The dosimetric parameters of two different protocols were statistically compared by paired t-test.@*Results@#The average head tilt angle was (11.12°±0.68°). The homogeneity and the conformal index in the tilted and non-tilted positions were decreased by (8.3±9.6)%(P=0.033) and (5.2±4.1)%(P=0.009). The dose of hippocampus in the tilted position of the head was decreased by (13.6±6.2)% on average compared with that in the non-inclined position (P=0.004). The dose of the lenses was decreased by (15.5±11.1)%(P=0.008) on average. The doses of optic nerve and eyeball were declined by (6.8±5.6)%(P=0.013) and (8.6±6.5)%(P=0.016).@*Conclusions@#By tilting the head at an appropriate angle during VMAT whole-brain radiotherapy, the radiation dose distribution of the target volume can be significantly improved and the radiation dose in the hippocampus and visual system can be reduced simultaneously to maintain the therapeutic effect and minimize the effect upon the cognitive and memory function of patients.

Segmented cloning and expression of the pigment epithelium derived factor and its effect on the proliferation of human SCL-1 cells / 医学研究生学报

Objective Studies are rarely reported on the effect of short peptides of the pigment epithelium derived factor (PEDF) on the proliferation of human cutaneous squamous (SCL-1) cells. The purpose of this study is to investigate segmented cloning and expression of the PEDF protein and observe its effect on the proliferation of human SCL-1 cells. Methods The target genes of PEDF1, PEDF2 and PEDF3 were amplified by PCR and the recovered fragments subjected to double digestion of NheⅠ and Hind Ⅲ and inserted into the pET28a(+) plasmid. The product was transformed into human E coli BL21 and induced to express, followed by isolation and purification of the fusion protein. CCK-8 assay was used to detect the proliferation of the SCL-1 cells with PEDF1, PEDF2 and PEDF3 at 100, 400, 800 and 1000 nmol/L at 24, 48 and 72 hours. Results The prokaryotic expression vectors of PEDF1, PEDF2 and PEDF3 were successfully constructed, and their fusion proteins prepared, with the molecular weight of 18 000, 17 000 and 13 000, respectively. The proliferation of the SCL-1 cells was significantly decreased in the 800 and 1000 nmol/L PEDF3 groups compared with that in the 0 nmol/L PEDF3 group at 24 hours (0.16 ± 0.03 and 0.78 ± 0.07 vs 1.00 ± 0.00, P < 0.05), inhibited in a concentration-dependent manner in the 400, 800 and 1000 nmol/L PEDF3 groups at 48 hours (P < 0.05), markedly lower in the 800 and 1000 nmol/L PEDF3 groups at 72 hours (0.53 ± 0.05 and 0.51 ± 0.05) than in the in the 400 and 0 nmol/L PEDF3 groups (0.60 ± 0.05 and 1.00 ± 0.00) (P < 0.05). Conclusion The PEDF fusion proteins were successfully segmentally cloned and expressed and PEDF3 inhibited the proliferation of SCL-1 cells, which has paved the ground for further screening of active functional short peptides of PEDF.

Expression of Extracellular Matrix Protein Reelin in Patients with Multiple Myeloma and Its Relationship with Prognosis / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To investigate the expression of extracellular matrix protein Reelin (RELN) and its relationship with the prognosis of patients with multiple myeloma.</p><p><b>METHODS</b>The mononuclear cells were collected from bone marrows of multiple myeloma patients by Ficoll gradient density centrifugation, the CD138 cells were then purified by flow cytometry, the mRNA level of RELN was detected by real time PCR. The myeloma patients were divided into 2 groups according to the relative expression levels of RELN. Then the relationship of RELN expression level with clinical data was analyzed statistically.</p><p><b>RESULTS</b>The high expression of RELN significantly correlated with the percentage of CD138 cells, progress-free and total survival, but did not correlate significantly with DS (P>0.05) and ISS stages (P>0.05). The RELN high expression group showed higher levels of serum M protein, uric acid and serum calcium, lower hemoglobin, and more abnormal FISH results (including RB1 deletion, 1q21 amplification, IgH recombination, P53 deletion, D13S319 deletion) than those in RELN low expression group.</p><p><b>CONCLUSION</b>Reelin correlates with the progression of multiple myeloma.</p>

Research frontiers of Chinese medicine pharmaceutics: foundations and key issues of components preparation technology / 药学学报

Based on the integrity and systematicness of Chinese medicine, the components preparation simplifies the complex problems of multi-components of Chinese medicine, provides an effective and feasible model for the development of Chinese medicine preparation. It has become a hot topic in the research of prep-aration, and is also considered as one of the effective ways to realize the modernization of Chinese medicine. Based on the previous research on multi-components and the work of our research group, the research frontiers of multi-components are elucidated, including the properties and characterization techniques of components, the construction of components release unit, and the multiple drug delivery system. The purpose of this paper is to explore the technical basis and key problem of components preparation, and then bring some inspiration and thought to the relevant researchers.

Meta analysis of unilateral condylar replacement and high tibial osteotomy in the treatment of medial compartment osteoarthritis of the knee / 中国骨伤

OBJECTIVE@#Meta-analysis was used to compare the clinical efficacy of high tibial osteotomy(HTO) and unicondylar arthroplasty (UKA) in the treatment of medial compartment osteoarthritis (MIOA) and provide a better surgical choice for patients with MIOA.@*METHODS@#The Cochrane Library (Issue 6, 2017), PubMed, Ovid, ELSIVE, CNKI and Wanfang databases were searched by a computer. Literatures on HTO and UKA for MIOA from January 1, 1970 to June 30, 2017, including complications, knee joint score, knee mobility, revision rate and excellent and good rate, were searched and screened out according to the inclusion criteria, and strict quality evaluation was carried out. RevMan 5.0 software provided by Cochrane collaboration network was used to conduct the meta-analysis of the included research results and to test the heterogeneity of the data.@*RESULTS@#Total 13 articles met the inclusion criteria, and the total sample size was 1 043. Among them, 462 were HTO treatment group and 581 were UKA treatment group. By comparison between HTO treatment group and UKA treatment group, there were significant differences in the contralateral deterioration rate[WMD=3.21, 95%CI(1.13, 9.10)], pre-operative knee range of motion[WMD=6.55, 95%CI(1.44, 11.66)], Lysholm knee score[WMD=-3.15, 95%CI(-4.77, -1.53)], complications[WMD=2.78, 95%CI(1.52, 5.11], revision rate[WMD=1.81, 95%CI(1.17, 2.80)], the rate of excellent and good[WMD=0.49, 95%CI(0.30, 0.80)], and femorotibial angle changes[WMD=-2.37, 95%CI, (-3.63, -1.11)](0.05).@*CONCLUSIONS@#Based on the limited data, high tibial osteotomy is a better choice for the treatment of medial compartment osteoarthritis in the comparison of short and medium-term clinical outcomes, and long-term clinical outcomes may need further study.

Comparison of fixation of sustentaculum tali of calcaneus aided by director for sustentaculum tali screwing and ordinary screwing guide / 中国骨伤

<p><b>OBJECTIVE</b>To explore clinical outcomes of director for sustentaculum tali screwing for fixing sustentaculum tali of calcaneus.</p><p><b>METHODS</b>From May 2012 to October 2013, totally 50 patients (60 feet) with calcaneal fractures were analyzed, and divided into director for sustentaculum calcaneous tali screwing treatment group (group A) and ordinary screwing group(group B). In group A, there were 25 patients, including 22 males and 3 females, aged from 17 to 75 years old with an average of (45.08±11.98) years; according to Sanders classification, 9 feet were type II, 16 feet were type III, and 7 feet were type IV. In group B, there were 25 patients, including 20 males and 5 females, aged from 19 to 78 years old with an average of (46.36±15.74) years; according to Sanders classification, 8 feet were type II, 13 feet were type III, and 7 feet were type IV. Radiological change, operative time, postoperative complications were observed and compared, Maryland scoring at 1 year after operation was applied to evaluate clinical outcomes.</p><p><b>RESULTS</b>Fifty patients were followed up, group A was followed up from 12 to 24 months with an average of (17.72±4.08) months;while group B was followed up from 12 to 24 months with an average of (18.68±3.40) months;there was no significant difference between two groups in following-up time(>0.05). There were significant difference in operative time, complications and fluoroscopy times between two groups(<0.05). There were significant difference in Böhler angle and Gissanes angle between two groups before and after operation(<0.05). Maryland score at 1 year after operation in group A was (84.94±12.75) and (76.96±15.32) in group B, had significant meaning between two groups (<0.05).</p><p><b>CONCLUSIONS</b>Fixation of sustentaculum tali of calcaneus aided by director for sustentaculum tali screwing, has advantages of less operative time, fluoroscopy times, incidence of complications and good recovery of function, which could provide a new aiding method for treating intra-articular calcaneal fractures.</p>

Meta-analysis on limb salvage and amputation for patients with local Enneking II osteosarcoma / 中国骨伤

<p><b>OBJECTIVE</b>To explore 5-year survival rate, local recurrence and metastasis rate of limb salvage and amputation for patients with local Enneking II osteosarcoma by Meta-analysis.</p><p><b>METHODS</b>From January 1, 1970 to December 1, 2015, Subject term and keywords about limb salvage and amputation for local Enneking II osteosarcoma with pathological fracture were searched from Cochrane, PubMed, Ovid, Spinger Link, Embase, CNKI and WanFang database foundation. Literature confirm with inclusion criteria were choose and quality evaluation were performed. RevMan 5.0 software from Cochrane collaboration was used to perform Meta-analysis. Local recurrence, 5-year survival rate and odds ratio of transfer risk were compared between limb salvage and amputation group.</p><p><b>RESULTS</b>Ten literatures confirm with inclusion criteria were included, and total sample size was 453. There were 315 patients in limb salvage group and 138 patients in amputation group. Five-year survival rate in amputation group was lower than that of limb salvage group [OR=2.88, 95%CI(1.40, 5.93)], however metastasis rate in limb salvage was less than that of amputation group [OR=0.43, 95%CI(0.20, 0.94)];there were no significant differences in local recurrence between two groups [OR=1.47, 95%CI (0.73, 2.97)]. Functional rehabilitation in limb salvage group was better than that of amputation group by MSTS systematic review.</p><p><b>CONCLUSIONS</b>Limb salvage as an alternative in treating local Enneking II osteosarcoma with pathological fracture does not greatly increase risk of local recurrence or 5-year overall survival rate compared with amputation group, and has a lower risk of metastatic occurrence.</p>

Intralesional curettage and wide excision for treatment of giant cell tumors (GCTs) of the distal radius: A Meta-analysis / 中国骨伤

<p><b>OBJECTIVE</b>To search all studies that had been published in the world with regarding to the effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complications and comparative functional outcomes in patients with giant cell tumours (GCT) of the distal radius and analyze them which were in high quality by means of Meta analysis, in order to give some evidences for the choice of method dealing with giant cell tumors GCT in surgery.</p><p><b>METHODS</b>Cochrane central register of controlled trials(Issue 8 2014), PubMed(1970-01-01/2013-01-01), Ovid (1970-01-01/2013- 01-01), Elsevier (1970-01-01/2013-01-01), CNKI (1970-01-01/2013-01-01) were searched. Including intralesional curettage and wide excision were performed to treat giant cell tumors (GCTs) of the distal radius in the literatures, selecting on meet eligibility in the standard literatures underwent strict quality assessment. The Meta-analysis was performed with software RevMan5.0 from the Cochrane collaboration. Additionally, the analysis checked the heterogeneity of data. The effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complication in patients with giant cell tumours of the distal radius were evaluated and Odds Ratio was calculated.</p><p><b>RESULTS</b>Seven relevant articles were identified involving total 163 cases. Among them, 92 cases were intralesional curettage (PMMA, n = 54; bone graft, n = 33; no PMMA or bone grafts, n = 5) and 71 cases were wide excision. The patients in the intralesional curettage group had a higher recurrence rate [OR = 3.87, 95% CI (1.42, 10.53)],especially for Campanacci grade 3 GCTs [OR = 10.12, 95% CI (1.57, 65.27)], yet fewer major complications [OR = 0.13, 95% CI (0.04, 0.40)] than the wide excision group. The use of PMMA versus bone graft did not affect the recur- rence rate [OR = 0.96, 95% CI (0.26, 3.56)]. By selecting the system evaluation of MSTS, the VAS and dynamometer, the result showed that the intralesional curettage group was equivalent or preferable to wide excision in terms of function rehabilitation.</p><p><b>CONCLUSION</b>Based on data obtained from the limited number of studies available, intralesional curettage appears to be moreappropriate for the treatment of local lesions (Grade 1 and 2) than Grade 3 GCTs of the distal radius. Moreover, PMMA was not additionally effective as an adjuvant, the intralesional curettage group was found to be equivalent or preferable to wide excision in terms of function rehabilitation.</p>

Treatment of the postoperative infection of limbs fracture after internal fixation with vacuum sealing drainage (VSD) combined with continual irrigation / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effects of VSD combined with continual irrigation in treating the infection of limbs fracture after internal fixation.</p><p><b>METHODS</b>From March 2010 to June 2015, 10 patients with infection of limbs fracture after internal fixation were treated with VSD combined with continual irrigation. There were 7 males and 3 females, aged from 11 to 58 years with an average of 34.4 years. Course of disease was from 1 to 8 months with an average of 4.8 months. Postoperative infection occurred in fractures of ulna and radius of 4 cases, tibiofibular fractures of 3 cases, calcaneal fractures of 2 cases, femoral fractures of 1 case. Eight infections were open fracture and 2 infections were close fracture. In additon to above treatment, antibiotics, dressing changing or skingrafting were used in the patients. Informations of wound surface healing, change dressings, original infection focus were observed.</p><p><b>RESULTS</b>All infections got control, the wound healing after change dressings or skingrafting, and no complications such as osteomyelitis were found. The mean treatment time was 38.4 days(ranged, 29 to 45 days) and replacement times was 2.2 times(ranged, 1 to 4 times). All patients were followed up, no recurrent infections were found at 1 year after fracture healing.</p><p><b>CONCLUSIONS</b>VSD combined with continual irrigation can effectively decrease the incidence of complications and promote the wound growth, healing and considerably shorten the healing time. It is an effective method for the treatment of infection of limbs fracture after internal fixation.</p>

Short term clinical outcome of total hip arthroplasty for the treatment of Crowe IV congenital dysplasia of the hip in adults / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate the short term clinical effects and surgery methods of the total hip arthroplasty (THA)for the treatment of Crowe type IV congenital dysplasia of hip (CDH) in adults.</p><p><b>METHODS</b>From March 2013 to March 2015, 20 patients (20 hips) with Crowe type IV CDH in adults were underwent THA, including 4 males and 16 females, with an average age of 52 years old ranged from 32 to 68 years old. All the cementless acetabular cups were placed at the original anatomic location. S-ROM prosthesis was adopted together with subtrochanteric transverse osteotomy in femoral side. All the patients were evaluated by using the Modified Harris Hip Score. Radiographic evaluations were made preoperatively and during follow up.</p><p><b>RESULTS</b>The incisions were healed by first intention. There was no hip dislocation events and venous thrombosis occurred. All patients were followed up for 8 to 60 months with an average of 38.1 months. Postoperative X ray films showed all acetabular prosthesis were in true acetabulum. No nonunion and loosening were found in all patients. Harris score at final follow up improved from preoperative 50.90±9.35 to postoperative 90.25±3.16. The difference was statistically significant (<0.05). There were 1 patient with femoral split fracture, 1 patient with nerve injury, 1 patient with heterotopic ossification of Brooker I. The hip function of all patients was good, the pain was disappeared.</p><p><b>CONCLUSIONS</b>THA with S-ROM prosthesis and subtrochanteric osteotomy is an effective method for the treatment of Crowe type IV CDH in adults. The recent clinical curative effect is satisfied.</p>

Relationship between glyoxalase Ⅰ gene polymorphisms and atherosclerotic cerebral infarction / 中华神经科杂志

Objective To investigate the association of glyoxalase Ⅰ (GLO1) gene polymorphisms with susceptibility to atherosclerotic cerebral infarction (ACI).Methods Single nucleotide polymorphisms (SNPs) rs1130534 and rs1049346 in the GLO1 gene were genotyped in 300 ACI patients and 300 healthy controls using the SNaPshot technique.Additionally,quantitative real-time PCR was employed to determine the GLO1 expression levels in 50 ACI patients and 50 healthy controls,respectively.Results In terms of the rs1049346 polymorphism,the respective frequencies of CC,CT and TT genotypes were 9.3％,42.7％ and 48.0％ in the ACI patients,and 14.0％,47.7％ and 38.3％ in the control group.The respective frequencies of C and T alleles were 30.7％ and 69.3％ in the ACI patients,and 37.8％ and 62.2％ in the control group.There were statistically significant differences in the genotype and allele frequencies of rs1049346 between the ACI patients and controls (genotype:x2 =6.877,P =0.032;allele:x2 =6.842,P=0.009).For rs1130534,the respective frequencies of AA,AT and TT genotypes were 52.0％,42.0％ and 6.0％ in the ACI patients,and 60.0％,33.7％ and 6.3％ in the control group.The respective frequencies of A and T alleles were 73.0％ and 27.0％ in the ACI patients,and 76.8％ and 23.2％ in the control group.However,no statistically significant differences were found in the distribution of genotypes or alleles of the rs1130534 SNP between the ACI patients and controls (all P ＞ 0.05).The results of haplotype analysis revealed that the frequencies of the A-T and T-T (rs1130534-rs1049346) haplotypes in the ACI patients were all significantly higher compared to the controls (42.3％ vs 39.0％,x2 =4.733,P =0.030;27.0％ vs 23.2％,x2 =5.699,P =0.017).Additionally,the GLO1 expression levels in the ACI patients were significantly lower than that in the healthy controls (Mann-Whitney U =911.5,P =0.020).Conclusion The results indicate that the rs1049346 polymorphism of GLO1 gene is associated with the susceptibility to ACI.

An analysis on the direct economic loss and its influencing factors of pneumoconiosis in Zhejiang province / 预防医学

Objective To explore the characteristics and their influencing factors of economic burden for pneumoconiosis disease,and to provide a baseline to develop the prevention measures and to reduce the economic burden of pneumoconiosis. Methods The retrospective epidemiological method was used to investigate the general information of pneumoconiosis cases,frequency of outpatient and hospitalization per year,medical expenditure. Direct economic loss and its influencing factors of pneumoconiosis patients were analyzed. Results A total of 421 pneumoconiosis cases were investigated. All subjects were male,including 306 inpatients. The average medical expenditures of outpatient and inpatient were 594. 53 ± 336. 23 and 32 266. 06 ± 28 130. 67 Yuan,respectively. The annual average expenditures of outpatient and inpatient were 2 907. 25 and 48 721. 75 Yuan,respectively. In terms of health care costs,the highest proportion of western medicine was 44. 08% ,followed by traditional Chinese medicine(12. 62% ). With an increase in pneumoconiosis stage,the annual frequency of outpatient and hospitalization,as well as total expenditure increased accordingly. The average annual cost of pneumoconiosis inpatient with complications and non - complication inpatient were 55 822. 20 and 23 532. 21 Yuan,respectively. The annual average cost of outpatient with complications and without complications were 4 236. 41 and 882. 31 Yuan, respectively. The expenditures for pneumoconiosis disease with complications among outpatient and inpatient were significantly higher than those of pneumoconiosis patients without complications(P < 0. 05). Conclusion Direct economic loss of pneumoconiosis disease is relatively high. The disease stage and complications of pneumoconiosis are the main factors influencing the direct economic loss of pneumoconiosis.

The value of negative lymph node count in prediction of prognosis of advanced gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of negative lymph node count (NLNC) in prediction of prognosis of advanced gastric cancer after radical resection.</p><p><b>METHODS</b>The 544 cases of radical gastrectomy patients with complete clinical and follow-up data between January 2011 and July 2007 were collected. Survival was determined by the Kaplan-Merier method and univariate analysis was done by Log-rank test, Multivariate analysis was performed using the Cox proportional hazard regression model.</p><p><b>RESULTS</b>Univariate analysis showed age (χ(2) = 4.449), T stage (χ(2) = 30.482), N stage (χ(2) = 205.452), location of tumor (χ(2) = 16.649), tumor size (χ(2) = 35.117), macroscopic type (χ(2) = 4.750), histological grade (χ(2) = 6.130), NLNC stage (χ(2) = 150.369) and type of gastrectomy (χ(2) = 25.605) were related to survival. Among them, T stage, N stage, tumor size and NLNC stage were independent risk factors for survival (P < 0.05). The prognostic factors of patients were performed subgroup analysis, NLNC > 15 group can prolong the survival than NLNC ≤ 15 group in the T2 stage (HR = 0.315), T4 stage (HR = 0.401), the same classification of location of tumor (HR = 0.286-0.493), tumor size (HR = 0.336, 0.465), macroscopic type (HR = 0.306, 0.418), histological grade (HR = 0.411, 0.365) and type of gastrectomy (HR = 0.444, 0.358 and 0.356, all P < 0.05). More NLNC can prolong Disease-Free Survival for patient of early recurrence (χ(2) = 8.648, P = 0.003).</p><p><b>CONCLUSIONS</b>Sufficient negative lymph node count can prolong the survival and decrease the risk of early recurrence.</p>

Significance of No.14v lymph node dissection for advanced gastric cancer undergoing D2 lymphadenectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To elucidate the necessity of No.14v lymph node dissection in D2 lymphadenectomy for advanced gastric cancer.</p><p><b>METHODS</b>Clinicopathological data of 131 cases of advanced gastric cancer receiving D2 or D2+ plus No.14v lymph node dissection were reviewed retrospectively. Clinicopathological factors associated with No.14v lymph node metastasis were analyzed and prognostic value of No.14v lymph node metastasis was evaluated.</p><p><b>RESULTS</b>Of the 131 patients, 24 (18.3%) had positive No.14v lymph node. The incidence of 14v metastasis was associated with tumor location, tumor size, depth of invasion, N staging, TNM staging, No.1, No.6, and No.8a lymph nodes metastasis. Tumor location and N staging were independent risk factors for No.14v metastasis (all P<0.05). The 5-year survival rate was 8.3% and 37.8% in patients with and without No.14v metastasis respectively. The difference was statistically significant (P<0.01). Multivariate analysis revealed that metastasis of No.14v was an independent prognostic factor for advanced gastric cancer after D2 lymphadenectomy (P=0.029, RR=1.807, 95%CI:1.064-3.070).</p><p><b>CONCLUSIONS</b>For advanced middle and lower gastric cancers, especially those with larger size, serosa invasion and possibility of No.6 lymph node metastasis, it is necessary and feasible to remove the No.14v lymph node.</p>

Mode of lymph node metastasis in early gastric cancer and risk factors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the status of lymph node metastasis (LNM) and to discuss reasonable lymphadenectomy in early gastric cancer (EGC).</p><p><b>METHODS</b>Between January 1991 and December 2010, 242 EGC patients underwent surgery in the Tianjin Cancer Hospital. Their clinical characteristics, pathologic features, and lymph node metastasis were analyzed retrospectively.</p><p><b>RESULTS</b>LNM was observed in 22 of 242 patients (9.1%), and 10 (5.5%) in 182 mucosal lesions and 12 (20.0%) in 60 submueosal lesions. There were 14 patients had LNM in the first tier alone, 4 patients had skipped metastasis, and 4 patients had LNM in the first, second, and third ties. The LNM was identified in 18 patients at the first tier with groups 7 and 3 being the most common (8 patients in each group), 7 patients at the second tier (4 patients in group 8a and 3 in group 9), and 2 patients at the third tier (one 16b, and one 4sa). Multivariable analysis showed that the depth of invasion (P=0.003, OR=4.386, 95%CI:1.656-11.617), and lymphatic vessel involvement(P=0.002, OR=13.621, 95%CI:2.711-68.447) were independent risk factors for LNM.</p><p><b>CONCLUSIONS</b>LNM in EGC is mainly correlated with depth of invasion, and lymphatic vessel involvement. Precise evaluation of LNM pre- and intra-operatively is very important for the reasonable surgery.</p>

Prognostic value of metastatic lymph node ratio for gastric cancer patients with less than 15 lymph nodes dissection / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the prognostic value of metastatic lymph node ratio (MLR) for gastric cancer patients with less than 15 lymph nodes dissected.</p><p><b>METHODS</b>Clinical data of 610 gastric cancer patients undergoing operation in Tianjin Cancer Hospictal from January 2003 to July 2007 were analyzed retrospectively. Patients were divided into two groups: <15 lymph nodes dissected group (n=320) and ≥ 15 lymph nodes dissected group (n=290). MLR was classified based on the following intervals: rN1 ≤ 10%, rN2 10%-30%, rN3 30%-60% and rN4 >60%. Survival was determined by Kaplan-Meier method and difference was assessed by Log-rank test. Multivariate analysis was performed using Cox proportional hazard regression model. Survival rates were compared between two groups in pN and rN stages respectively.</p><p><b>RESULTS</b>In <15 nodes group, all the survival differences among various rN stages were not significant (all P>0.05), while in same rN stage, all the survival differences among various pN stages were not significant (all P>0.05). Significant differences of 5-year cumulative survival rates were found between the two groups in pN2 and pN3a stage patients (both P<0.05) while no significant differences were found among different rN stages (all P>0.05). Multivariate analysis demonstrated rN stage was an independent prognostic factor for gastric cancer patients with <15 lymph nodes dissected (P=0.012, RR=1.617, 95%CI:1.111-2.354).</p><p><b>CONCLUSION</b>The rN staging system based on MLR can predict the prognosis of gastric cancer patients with less than 15 lymph nodes dissected.</p>

Analysis of clinicopathologic characteristics and prognosis on mixed histology type of gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinicopathologic characteristics and prognosis of mixed histological type (MHT) gastric cancer.</p><p><b>METHODS</b>Clinical and follow-up data of 1108 gastric cancer patients undergoing radical operation in Tianjin Cancer Hospital between 2003 and 2006 were analyzed retrospectively. Clinicopathologic characteristics of MHT gastric cancer were summarized and the prognosis was analyzed by Kaplan-Meier analysis and COX regression.</p><p><b>RESULTS</b>Among the 1108 patients, 144 (13.0%) had mixed histology type of gastric cancer. Compared to the unitary histological type (UHT), MHT gastric cancer had bigger tumor size, higher proportion of T4 tumor, and was easier for lymph node and distant metastasis (all P<0.05). The 3- and 5-year survival rates of patients with MHT were 26.5% and 10.8% respectively, which were lower than those with UHT (58.8% and 35.0%, P<0.01). Univariate and multivariate analyses showed TNM classification was an independent prognostic factor (P<0.01).</p><p><b>CONCLUSIONS</b>MHT gastric cancer shows worse prognosis than UHT gastric cancer. There is no difference in prognosis among various combination of MHT gastric cancer. TNM classification is an independent prognostic factor of MHT gastric cancer.</p>

The prognostic influence of D2 lymphadenectomy with para-aortic lymph nodal dissection for gastric cancer in N3 stage / 中华外科杂志

<p><b>OBJECTIVE</b>To elucidate the necessity of para-aortic lymph nodal dissection in D2 lymphadenectomy for gastric cancer in N3 stage.</p><p><b>METHODS</b>A total of 278 gastric cancer patients staged N3 who underwent gastrectomy between January 2003 and December 2007 were enrolled. There were 180 male and 98 female patients, and the patients' age were 26-93 years (median was 61 years). All patients had undergone surgical treatment. There were R0 resection in 246 cases and R1 resection in 32 cases. Lymph node dissection included D1 lymphadenectomy with 125 cases, D2 lymphadenectomy with 109 cases and D2+para-aortic lymph nodal dissection(PAND) with 44 cases. The surgical approach were total gastrectomy (98 cases) and subtotal gastrectomy (180 cases). Potential prognostic factors were analyzed.</p><p><b>RESULTS</b>The lymph node metastasis of each station was high in gastric cancer patients staged N3 and 34.1% patients had the para-aortic lymph nodal metastasis. Borrmann type (HR = 1.350, 95%CI: 1.018-1.790, P = 0.037), curability (HR = 1.580, 95%CI: 1.076-2.322, P = 0.020), depth of invasion (HR = 1.697, 95%CI: 1.005-2.864, P = 0.048), metastatic lymph node ratio (HR = 1.631, 95%CI: 1.261-2.111, P = 0.000), extranodal metastasis (HR = 1.336, 95%CI: 1.027-1.738, P = 0.031), postoperative adjuvant chemotherapy (HR = 1.312, 95%CI: 1.015-1.696, P = 0.038), extent of lymphadenectomy (HR = 1.488 and 2.114, P = 0.054 and 0.000) and number of retrieved lymph node (HR = 1.503 and 2.112, P = 0.025 and 0.000) were found to be factors correlated to overall survival. In multivariate analysis, only Borrmann type (HR = 1.399, 95%CI: 1.050-1.863, P = 0.022), metastatic lymph node ratio (HR = 1.353, 95%CI: 1.016-1.802, P = 0.039) and extent of lymphadenectomy (HR = 1.725, 95%CI: 1.111-2.678, P = 0.015) were independent prognostic factors for gastric cancer patients in N3 stage.</p><p><b>CONCLUSIONS</b>Patients in N3 stage should at least have 30 lymph node examined. D2 lymph node dissection plus PAND may improve the overall survival for gastric cancer patients in N3 stage.</p>