Updated contents interpretation of Japanese classification of colorectal,appendiceal,and anal Carcinoma / 中国实用外科杂志

The 9th Edition of Japanese Classification of Colorecta has been published, containing numerous differences compared to the 8 th, including the English title,general provisions, tumor staging(invasion depth, lymph node metastasis and distant metastasis), clinical and pathological staging, endoscopic and surgical treatment. The 9 th Edition gradually refines the Classification and Treatment Scheme,integrates with other Japanese Tumor Classification and refers to the International TNM Stage, providing an important reference basis for the diagnosis and treatment of Colorectal Cancer in Japan and even the world.

Anatomical ideas on infrapyloric lymphadenectomy in sagittal view of laparoscopic radical gastrectomy for gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To preliminarily discuss the anatomical ideas on infrapyloric lymphadenectomy in the sagittal view of laparoscopic radical gastrectomy for gastric cancer.</p><p><b>METHODS</b>A retrospective review was performed on the clinical data of 98 patients of lower-middle stomach cancer who underwent D2 radical gastrectomy in Department of Gastrointestinal Surgery of The First Hospital of Jilin University from June 2015 to December 2016. There were 56 males and 42 females with an average age of 59 years. TNM staging of gastric cancer revealed 22 cases of stage I, 37 cases of stage II, and 39 cases of stage III. All the patients underwent standardized No.6 lymph node dissection. Patients in stage II and above also received dissection of No.14v lymph nodes. During operation, sub-regional lymph node dissection was performed in the infrapyloric region according to sagittal anatomy. The dissection of each sub-region was to expose the corresponding anatomical landmarks as quality control standards. The region under the stomach pylorus was divided into the upper and lower parts by the pancreatic anterior plane and the gastroduodenal artery. The lower part was 6v region, and the upper part was 6a and 6i region. The lower part was further divided into front region and rear region by right vein of gastric omentum. The upper part was further divided into front, middle and posterior parts by right vein of gastric omentum and inferior pyloric artery. A total of 5 regions were established. Lymph node dissection in the lower pyloric region was performed at these five regions. Photographs were taken during operation and statistics was carried out in operation time and harvested lymph nodes from infrapyloric lymphadenectomy.</p><p><b>RESULTS</b>The time to complete No.6 lymph node dissection was (38±6) minutes for the 22 patients with stage I gastric cancer, and to finish No.6 and No.14v lymph node dissection was (49±8) minutes for the 76 patients with stage II and stage III gastric cancer. The mean number of harvested No.6 lymph nodes was 5.4±2.9, including 2.9±1.8 in No.6a,1.3±0.9 in No.6v, and 1.2±0.7 in No.6i. No.6 lymph node metastasis was found in 29 cases (29.6%), and No.14v lymph node metastasis in 19 patients (9.2%).</p><p><b>CONCLUSION</b>Sub-regional lymphadenectomy for infrapyloric region based on embryology and membrane anatomy may achieve complete dissection of No.6 lymph nodes.</p>

Development of precision medicine in the diagnosis and treatment of colorectal cancer / 中华消化外科杂志

Precision medicine is a medical model that proposes the individual therapy,with a joint medical method of genomics,proteomics,metabolomics and clinical big data tailored to the individual patient.The diagnosis and treatment of colorectal cancer have entered the model of precision medicine with the entering the era of precision medicine.In this article,authors summarized the recent progress of diagnosis and therapy under the guidance of precision medicine,with an aim to provide some new clues for surgeons and supports for precision prevention,diagnosis and therapy.

Study of introperitoneal hyperthermic perfusion chemotherapy combined with systemic neoadjuvent chemotherapy in treatment of gastric cancer patients with peritoneal carcinomatosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>The aim of this study is to discuss the curative effect of introperitoneal hyperthermic perfusion chemotherapy(IHPC) combined with systemic neoadjuvant chemotherapy on the gastric cancer patients with peritoneal carcinomatosis.</p><p><b>METHODS</b>Sixty-four patients with gastric cancer and peritoneal carcinomatosis who were hospitalized in the Department of Gastrointestinal Surgery of First Hospital of Jilin University from December 2006 to December 2013. After peritoneal carcinomatosis was confirmed during laparoscopic exploration, FOLFOX6 (oxaliplatin and calcium folinate and 5-Fu) was performed for systemic chemotherapy. One course was 14 days and a complete treatment includes four courses. At the same time, patients underwent peritoneal catheter insertion and received IHPC(5-Fu 1 500 mg/m(2) and Cisplatin 35 mg/m(2) were added into 0.9% NaCl solution 2 000 ml, the infusion velocity was 35-45 ml/min, infusion time was 45-60 minutes, the temperature was controlled to 41°C). A comprehensive evaluation was taken after the fourth course of treatment before operation. Further surgical therapy was performed according to the assessment result.</p><p><b>RESULTS</b>Sixty-four patients received IHPC combined with systemic chemotherapy. Thirty-two patients(50.0%) had partial response, 18(28.1%) stable disease, and 14(21.9%) progressive disease after chemotherapy. No severe complications or death occurred during the neoadjuvant chemotherapy. Thirty-two patients(50.0%) received radical resection, 10(15.6%) palliative operation, and another 22 patients(37.4%) didn't comply with inclusion criteria of operation. Patients receiving operation had a median survival time of 678 days, which was significantly longer than patients without operation, with a median survival time of 251(χ(2)=23.34, P=0.02).</p><p><b>CONCLUSIONS</b>IHPC combined with systemic chemotherapy is an effective therapeutic method for gastric cancer patients with peritoneal carcinomatosis in terms of reducing preoperative tumor load and achieving radical resection.</p>

Application of three-dimensional high-definition laparoscope in radical resection of lower rectal cancer / 中华消化外科杂志

The development of laparoscopic techniques has made surgical treatment enter into the era of minimally invasive surgery,and the application of three-dimensional (3D) high-definition laparoscopic system has brought the important innovation for laparoscopic techniques,meanwhile,it also provides stereoscopic visions and more accurate spatial orientation for surgeons.During the process of laparoscopic radical resection of lower rectal cancer,3D vision can help to identify blood vessels,nerve and tissues around the rectum,ensure accurate lymph node dissection,reduce difficulty of operation,and the learning curve of laparoscopic radical resection of lower rectal cancer for inferior surgeons might be shorten by using 3D imaging system.With the development of technology,the value on clinical application of 3D high-definition laparoscope will become more evident.

Effects of omega-3 polyunsaturated fatty acids on postoperative inflammatory reaction and clinical efficacy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of omega-3 polyunsaturated fatty acids (PUFA) on postoperative inflammatory response and clinical efficacy in gastric cancer patients with nutritional risk.</p><p><b>METHODS</b>All patients with gastric cancer in our department from June 2013 to January 2014 undergoing radical gastrectomy were prospectively enrolled in the study. Patients who matched the selection criteria were randomly divided into two groups: trial group (with omega-3 PUFA in parenteral nutrition) and control group (without omega-3 PUFA in parenteral nutrition). Levels of inflammatory factors (serum CRP, TNF-α, IL-1, IL-6, IL-10) and nutrition-related proteins (prealbumin, retinol conjugated protein and transferrin) were compared between the two groups before operation and 2, 4 and 6 days after operation. Incidence of postoperative systemic inflammatory response syndrome (SIRS) and other indicators associated with efficacy were compared between the two groups as well.</p><p><b>RESULTS</b>Forty-seven patients were finally included in this study with 21 patients in the trial group and other 26 in the control group. There were no significant differences of inflammatory factors and nutrition-related proteins between the two groups before operation (all P>0.05). In the 6th days after operation, the levels of proinflammatory cytokines, including CRP, IL-1 and IL-6 were significantly lower in the trial group as compared to the control group, while the level of IL-10 (inhibiting inflammatory cytokine) was higher in the trial group, as well as levels of nutrition proteins(all P<0.05). The trial group had significantly lower rate of SIRS than the control group [57.1%(12/21) vs. 84.6% (22/26), P=0.036]. Compared with the control group, patients in the trial group had shorter bowel sound recovery time [(12.3±1.1) d vs. (3.1±1.3) d, P=0.025], earlier passage of flatus [(3.1±1.0) d vs. (3.9±1.2) d, P=0.025] and shorter hospital stay [(9.4±2.1) d vs. (10.9±2.5) d, P=0.038], but there was no difference in postoperative complication rate between the two groups (P=0.678).</p><p><b>CONCLUSIONS</b>Omega-3 PUFA can reduce the release of inflammatory promoters, promote the release of inhibiting inflammatory cytokine IL-10, decrease the incidence of SIRS, improve patients' nutritional state, expedite the recovery of gastrointestinal function and shorten patients' recovery time.</p>

β-catenin and PCNA expression in gastric cancer tissues and their correlation with clinical prognosis / 中华普通外科杂志

Objective To investigate the expression of β-catenin and PCNA,and its relationship with clinical parameters and prognosis.Methods Tissue microarray technology and immunohistochemical method were used to detect the expression of β-catenin and PCNA in gastric carcinoma and normal tissue collected from January 2000 to December 2006.Data were analyzed by SPSS 19.0.Results The percentage of expression of β-catenin and PCNA in gastric carcinoma is 96.7％,99.2％,respectively,and higher than the normal gastric tissue (x2 =41.082,P =0;x2 =97.692,P =0).ROC curve was used to find that PCNA was better than β-catenin to discriminate gastric carcinoma from normal gastric tissue in sensitivity,specificity,coincidence rate(84.4％,87.5％,84.6％).The expression of β-catenin is related to lymph node metastasis in gastric cancer (x2 =6.107,P =0.04).The expression of PCNA is related to pathological type (x2 =9.71,P =0.02).The expression of β-catenin and PCNA in gastric carcinoma were positively correlated (r =0.24,P =0.005).Multivariate analysis showed that TNM staging and both positive β-catenin and PCNA were independent factors impacting on the overall survival rate of patient with gastric cancer.Conclusions The expression of β-catenin and PCNA in gastric carcinoma is signifrcandy high.PCNA is more important than β-catenin in discriminating gastric carcinoma from normal gastric tissue.Combined detection of the two kinds of protein have some clinical significance in predicting the prognosis of patients with early gastric cancer.

Reasonable option of digestive tract reconstruction after proctocolectomy / 中华消化外科杂志

Digestive tract reconstruction after proctocolectomy is a critical step of colorectal surgery, proper reconstruction can promote the recovery of digestive tract function and improve the quality of life.At present, there are some candidate reconstruction methods after proctocolectomy, but standardized and proper one is not still established.Since there are differences of the reconstruction methods after proctocolectomy at the different parts of colorectum, the best reconstruction methords should be selected according to the condition and intraoperative situation of patients.

Thinking of laparoscopic anatomy of laparoscopic distal D2 radical gastrectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss laparoscopic assisted radical D2 resection of distal gastric anatomy application ideas.</p><p><b>METHODS</b>Collected the clinical data from January 2009 to January 2012 who underwent laparoscopic distal gastric resection in patients with D2 349 cases. There were 180 male and 169 female patients, and the age were (57 ± 3) years old (range 29-86 years), the body mass index of patients were (26.0 ± 2.0) kg/m(2) (range 20.5-32.8 kg/m(2)). The relevant surgical anatomy ideas had summarized.</p><p><b>RESULTS</b>In addition to 5 cases of obese patients with conversion to open, the remaining patients underwent laparoscopic distal gastric D2 resection. The operation is divided into 7 operating anatomical view. The operation time were 120-210 minutes and the blood loss were 50-200 ml. Postoperative complications occurred in 11 cases, including 5 cases of duodenal stump leakage, 2 cases of gastroparesis, 3 cases of small bowel obstruction, and abdominal bleeding in 1 case. All patients were discharged.</p><p><b>CONCLUSIONS</b>Use zoning, exterior to interior of the anatomy, more conducive to master the operation of laparoscopic radical gastrectomy and standardized cleaning, to improve the operation efficiency and shorten the surgical learning curve and improve the quality of surgery has an important role.</p>

Multimordality of cluster treatment strategy for early postoperative inflammatory small bowel obstruction / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the application of multimordality of cluster treatment strategy in early postoperative inflammatory small bowel obstruction.</p><p><b>METHODS</b>Clinical data of 31 cases of early postoperative inflammatory small bowel obstruction in our department from July 2007 to July 2011 were analyzed retrospectively. Multimordality of cluster treatment strategy was used in 13 cases (treatment group), and other non-surgical treatment was applied in 18 cases (control group). Efficacy and prognosis were compared between the two groups.</p><p><b>RESULTS</b>Four-day improvement rate was 76.9% (10/13) and 44.4% (8/18), and 7-day cure rate was 92.3% (12/13) and 77.8% (14/18) in the treatment group and the control group, respectively. The differences were statistically significant (both P<0.05). The recovery time of bowel sounds and flatus, defecation time, bloating-free time, oral intake time, abdominal CT intestine improvement time, and hospital stay were all significantly shorter in the treatment group as compared to the control group (all P<0.05).</p><p><b>CONCLUSION</b>Multimordality of cluster treatment strategy can effectively shorten the healing time of early postoperative inflammatory small bowel obstruction, which possesses a good clinical application prospect.</p>

Visceral myopathy causing acute colonic pseudoobstruction / 中华消化外科杂志

Visceral myopathy is a rare disorder characterized by atrophy,losing and fibrosis of visceral smooth muscle.Digestive tract is often invaded by the lesions,and the symptoms are various according to different lesions and degrees.Small intestinal involvement is characterized by abdominal distension,diarrhea and vomiting.Colon involvement is characterized by chronic intestinal pseudoobstruction.Malnutrition and hypoproteinemia may be secondary to this disease.The diagnosis of visceral myopathy is difficult,paralytic ileus,chronic constipation and systemic sclerosis must be considered in the differential diagnosis.The progression of the disease is slow,and the longterm prognosis is poor.In this article,the diagnosis and treatment of visceral myopathy causing acute intestinal pseudoobstruction were introduced based on the clinical data of 1 patient.

Use of laparoscope complete mesocolic excision in the surgical treatment of right colon cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of laparoscope complete mesocolic excision (CME) for right colon cancer.</p><p><b>METHODS</b>The clinical data of 49 cases of right colon cancer without metastasis and intestinal obstruction who underwent elective laparoscope CME by the same group of surgeons between October 2009 and June 2011 at the First Hospital of Jilin University were analyzed retrospectively.</p><p><b>RESULTS</b>Among the 49 cases with CME, the median number of total lymph node retrieved was 22. The positive rate of lymph node in patients with stage III disease was 16.3%. The median operative time of all the cases was 145 min. The mean intraoperative blood loss was 75 ml. The median time to flatus passage and defecation was 3 days and 6 days respectively. The median hospital stay was 12 days. The overall postoperative complication rate was 12.2% (6/49).</p><p><b>CONCLUSION</b>Laparoscope complete mesocolic excision for right colon cancer is safe and feasible.</p>

Techniques and feasibility of laparoscopic total gastrectomy combined with distal pancreatectomy and splenectomy / 中华消化外科杂志

Laparoscopic curative gastrectomy has been widely adopted because it is minimal invasiveness.The efficacy of laparoscopic gastrectomy is comparable to that of open gastrectomy for patients with early or advanced gastric cancer,but few studies of laparoscopic total gastrectomy combined with distal pancreatectomy and splenectomy for patients with advanced gastric cancer have been reported.Seven patients with advanced gastric cancer received laparoscopic total gastrectomy combined with distal pancreatectomy and splenectomy at the First Hospital of Jilin University from September 2010 to September 2011.The mean operation time,blood loss,postoperative hospital stay and the nunber of lymph nodes resected were (218 ± 24) minutes,(366 ± 174) ml,( 14.6 ± 2.8 ) days and 32 ± 15,respectively.Two patients were complicated by pancreatic juice leakage and were cured with drainage. No anastomotic leakage,abdominal bleeding or mortality was observed. With the development of techniques and equipments,laparoscopic total gastrectony combined with distal pancreatectomy and splenectomy is safe and feasible in selected patients.

Combination of AD5-10 and epirubicin in treating rheumatoid arthritis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the mechanism of anti-death receptor 5-10 (AD5-10) combined with epirubicin in treating rheumatoid arthritis (RA).</p><p><b>METHODS</b>We detected the cell viability of the fibroblast-like synoviocytes (FLS) from RA patients with MTT. The expression level of apoptosis signaling pathways protein, p53, and p21 were evaluated with Western blot.</p><p><b>RESULTS</b>We found that epirubicin, at different doses, could enhance the effect of AD5-10 on FLS, promoting the apoptosis of FLS. The expression levels of caspase-3, -8, -9, c-FLIP, Bcl-2, p53, and p21 in the FLS changed after epirubicin treatment.</p><p><b>CONCLUSION</b>Epirubicin may coordinate with AD5-10 in inducing FLS apoptosis through affecting the levels of p53, p21, c-FLIP, and Bcl-2.</p>

Correlation between breast cancer and microsatellite instability / 中华内分泌外科杂志

Objective To investigate the correlation between clinical features of breast cancer and microsatellite instability(MSI).Methods 60 samples of breast cancer were eollected and 5 microsatellite polymorphism loci were selected.MSI analysis Was made after DNA isolation,PCR amplification,electrophoresis and EB staining.Results The rate of MSI was 33.3%in breast cancer and 0%in normal breast tissues.MSI in breast cancer was associated with carcinoma differentiation degree.Conclusion MSI is an early event during breast carcinogenesis and it plays an important role in estimation of malignant degree.

Retrospective study of the effect of alimentary tract reconstruction after gastrectomy on the treatment of type 2 diabetes mellitus / 中华内分泌外科杂志

Objective To research the effect of alimentary tract reconstruction after gastrectomy on the treatment of type 2 diabetes mellitus(non-insulin-dependent diabetes mellitus, NIDDM). Methods From January 2005 to January 2008, perioperative blood glucose level and insulin therapy in 24 gastric cancer or periampullary carcinoma patients with non-obesity type 2 diabetes were retrospectively analyzed. These patients underwent different alimentary tract reconstruction, including 8 patients for Billroth I, 10 for standard Whipples operation, 6 for esophageal Roux-en-Y jejunostomy after total gastrectomy. Glucose level and insulin dosage of thease patients were compared. Results In the patients underwent Billroth I operation, change of blood glucose level before and after operation was not significant(P＞0.05). The level of blood glucose in patients underwent Whipples operation and total gastrectomy were significant changed 1 and 2 months after the operation (P<0.001). In Billroth I group, 5 patients used insulin to control hyperglycemia preoperatively. After the operation, 2 patents maintained preoperative insulin dosage, 2 had to increase the use of insulin and 1 decreased the insulin dosage. In Whipples group, 6 patients used insulin preoperatively. Interestingly, 4 patents needed less insulin to control hyperglycemia and 2 were free of insulin dependance. In total gastrectomy group, there were 4 patients using insulin to control hyperglycemia. After the operation, 2 patents needed less insulin dosage and 2 stopped using insulin. Conclusions Both Whipples operation and total gastrectomy lead to decreased blood glucose level in NIDDM patients and less need of insulin.The effect of some types of alimentary tract reconstruction after gastrectomy on treatment of type 2 diabetes mellitus is assertive.

Influences of transforming growth factor-?1 on scavenger receptor class A and class B (CD36) in THP-1 derived macrophages / 吉林大学学报(医学版)

Objective To investigate the influence of transforming growth factor-?1(TGF-?1) on macrophage scavenger receptor (ScR) class A and B(ScR-B,CD36) in order to provide theoretical foundation for expounding the formation and therapy of atherosclerosis(AS).Methods THP-1 derived macrophages were divided into control group and experimental group,the cells in experimental group were treated with 3.0 mg?L-1Anti TGF-?1 Ab,the cells in control group were treated with 3.0 mg?L-1 IgG. The 125I-acetylated low density lipoprotein (125I-Ac-LDL for ScR-A) and 125I-oxidized low density lipoprotein (125I-Ox-LDL for CD36) uptaking (including 4℃ binding,37℃ association and degradation) were measured respectively.Influence of anti TGF-?1 antibody (Anti TGF-?1 Ab) on the ScR-A and CD36 mRNA expressions in THP-1 derived macrophages was measured meanwhile,respectively.Results Compared with control group ( binding: 8.23 ?g?g-1 ?1.24 ?g?g-1 protein,association:45.69 ?g?g-1 ?6.92 ?g?g-1 protein,and degradation: 112.18 ?g?g-1 ?20.15 ?g?g-1 protein),Anti TGF-?1 Ab increased 125I-Ac-LDL binding(48.67 ?g?g-1 ?6.52 ?g?g-1 protein),association (412.30 ?g?g-1?12.21 ?g?g-1 protein),and degradation (896.48 ?g?g-1 ?32.74 ?g?g-1 protein) significantly (P

Expression of hMLH_1 gene in gastric cancer and its significance / 吉林大学学报(医学版)

Objective To investigate the expression of hMLH_1 in gastric cancer and its significance,Methods The expressions of hMLH_1 protein and mRNA were detected by immunohistochemistry and reverse transcription polymerase chain reaction(RT-PCR) in 68 cases of gastric cancer tissues,33 cases of para-cancer tissues and(35 cases) of normal gastric tissues.Apoptosis was assayed by terminal deoxytransferase mediated dUTP nicked labeling.Results The positive expression rates of hMLH_1 mRNA were 63.3%(43/68),100%(33/33) and 100%(35/35),and those of protein were 61.8%(42/68),93.9%(31/33),100%(35/35),respectively,in gastric cancer tissues,para-cancer tissues and normal gastric tissues.There was a correlation between the expression of hMLH_1 and clinical grade of gastric cancer(r=0.531,P

Inhibition of angiogenesis inhibitor SU5416 on growth and metastasis of experimental rat pancreatic cancer / 中国普通外科杂志

Objective To study the effects of angiogenesis inhibitor SU5416 on the growth and metastasis of pancreatic cancer in SD rat model. Methods Dimethylbenzanthracine (9 mg) (DMBA),was implanted into the parenchyma of Sprague Dawley rat pancreas to induce pancreatic cancer. Rats with established pancreatic carcinoma were randomly divided into 4 groups (15 rats each) to receive every the other day for consecutive 13 weeks before sacrifice peritoneal cavity injection of: Normal saline (control),5-fluorouracil 30 mg?kg -1 (5-Fu group),SU5416 16 mg?kg -1 (SU5416 group),and both 5-Fu and SU5416(combined treatment group). Tumor weight,inhibition rates,intratumoral microvessel density (MVD),apoptotic index (AI) and metastasis were evaluated. Results Tumor weight was (1.15?0.21) g,(0.68?0.42) g,(0.31?0.11) g,(0.19?0.06) g respectively;the inhibition rate was 0,48%,80%,85% respectively;the intratumoral microvessel density (MVD) was (12.3?3.2),(11.4?3.8),(2.1?1.5),(1.8?1.1) respectively;The apoptotic index (AI) was (2.64?1.86)%,(5.71?3.14)%,(13.21?4.26)%,(21.12?7.15)% respectively. Peritoneal metastasis was significantly less severe in 5-Fu group,SU5416 group and combined group than that in control group(83% versus 46%,25% and 0) ( P

Antitumor effect of H22 cells transfected with B7-1 in mice / 中国免疫学杂志

Objective:To study the effect of B7-1 costimulatory molecule in inducing tumor immunity.Methods:The lymphocytes were examined in vitro,for both proliferation induces(PI) and specific cytotoxic activity,H22 mice were challenged subcutaneously either by the mock following which the latency,survival time and tumor mass growth were noted.Results:The H22-B7-1 cells more effectively induced the proliferation of effecter lymphocytes and the generation of specific lytic activity against H22 cells.The H22-B7-1 cells demonstrated slower rate(P