Influences of inferior mesenteric artery types and Riolan artery arcade absence on the incidence of anastomotic leakage after laparoscopic resection of rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the influences of inferior mesenteric artery (IMA) types and Riolan artery arcade absence on the incidence of anastomotic leakage(AL) after laparoscopic resection of rectal cancer.</p><p><b>METHODS</b>Clinical data of 116 local advanced rectal cancer patients who underwent laparoscopic resection in The Sixth Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2014 were analyzed retrospectively. IMA and Riolan artery arcade were examined by preoperative computed tomography angiography (CTA) reconstruction. The influences of IMA type, Riolan artery arcade absence and ligation site (high or low) on AL were analyzed by Logistic regression.</p><p><b>RESULTS</b>The proportion of IMA types(I(-IIII() was 57.8%(67/116), 10.3%(12/116), 31.0%(36/116) and 0.9%(1/116), respectively. Riolan artery arcade absence was found in 60.3%(70/116). Eight (6.9%) patients suffered from AL. IMA type III( had significantly higher AL incidence as compared to other IMA types [19.4%(7/36) vs. 1.2%(1/80), P=0.001]. Meanwhile, patients with Riolan artery arcade absence also had significantly higher AL incidence[11.4%(8/70) vs. 0.0%(0/46), P=0.030]. However, the difference in AL incidence between high and Low IMA ligation was not statistically significant [8.0%(7/87) vs. 3.4%(1/29), P=0.531]. Seven of these 8 AL patients were found in IMA type III( with Riolan artery arcade absence and high ligation. Multivariate analysis showed that IMA type III( (P=0.001) and Riolan artery arcade absence (P=0.002) were independent risk factors of AL.</p><p><b>CONCLUSIONS</b>IMA type III( with Riolan artery arcade absence increases AL incidence significantly in laparoscopic resection of rectal cancer. IMA type and Riolan aretry arcade absence or not contribute to the selection of IMA ligation site in the operation. For the colorectal cancer patients with IMA type III( and Riolan artery arcade absence, selective low IMA ligation with root lymph node dissection should be recommended.</p>

Efficacy comparison of laparoscopic versus open distal gastrectomy with D2 lymph dissection for advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the long-term clinical outcomes between laparoscopic and open distal gastrectomy with D2 lymph dissection for advanced gastric cancer.</p><p><b>METHODS</b>Clinical data of 377 cases of laparoscopic distal gastrectomy and 301 cases of open distal gastrectomy with D2 lymph dissection at the Southwest Hospital, the Third Military Medical University from January 2004 to June 2010 were retrospectively analyzed. Patients were followed up until September 2015. Surgical outcomes, postoperative complications and long-term survival were compared between the two groups.</p><p><b>RESULTS</b>Compared with conventional open group, laparoscopic group was associated with lower intraoperative blood loss [(125±89) ml vs. (290±161) ml, t=-15.942, P=0.000], shorter time to oral intake [(2.9±0.7) days vs. (4.1±1.6) days, t=-12.120, P=0.000], quicker bowel function retum[(2.7±1.4) days vs. (3.6±1.6) days, t=-7.804, P=0.000], shorter postoperative hospital stay [(7.7±3.6) days vs. (10.1±4.1) days, t=-8.107, P=0.000]. In addition, there were no significant differences in the operative time[(207±57) minutes vs. (202±43) minutes, P>0.05], number of retrieved lymph nodes(33±13 vs. 31±15, P>0.05), resection margin length(P>0.05) between two groups. The postoperative complication morbidity in laparoscopic group was significantly lower than that in open group[7.2%(22/377) vs. 12.6%(38/301), χ(2)=5.762, P=0.016]. Within perioperative period, 7 patients underwent operation again due to complication and 1 case died of peritoneal bleeding in laparoscopic group; 6 patients underwent re-operation and 2 cases died of peritoneal infection with hepatic failure and lung infection with respiratory failure. During the median follow-up of 86 months (range from 3-140 months), relapse occurred in 171(45.4%) patients and 183(48.5%, among them, 156 cases died of primary disease) patients died in laparoscopic group; relapse occurred in 140(46.5%) patients and 151(50.2%, among them, 127 cases died of primary disease) patients died in open group. The difference in overall 5-year survival rate between two groups was not statistically significant (51.5% vs. 49.8%, χ(2)=0.142, P=0.706). No significant difference was seen in 5-year disease-free survival rate (49.1% vs. 47.8%, χ(2)=0.062, P=0.803). Stratified analysis based on TNM stage also showed no significant difference in 5-year overall or disease-free survival rate(both P>0.05).</p><p><b>CONCLUSION</b>Laparoscopic distal gastrectomy with D2 lymph dissection for advanced gastric cancer has better short-term efficacy and similar long-tern efficacy as compared to open surgery.</p>

Dengue virus specific T cells are involved in the pathogenesis of dengue virus infection / 第三军医大学学报

Objective To study the roles of dengue (DEN) virus specific T cells in the pathogenesis of DEN virus infection. Methods 2D42 cells, DEN virus specific CD8 + cell clones, were employed to investigate their in vivo function in DEN virus infection using an animal model. HepG2 was implanted into mice with severe combined immunodeficiency disease (HepG2-SCID) for the establishment of HepG2-SCID model. The animals were divided into 3 groups: Group A: HepG2-SCID mice were inoculated with 2D42 cells and then infected with DEN virus type 2 (DEN2) intraperitoneally; Group B: HepG2-SCID mice were inoculated with normal mouse thymuscytes (NMT) and then intraperitoneally infected with DEN2; Group C: HepG2-SCID mice were intraperitoneally infected with DEN2 alone. The mortality, viremia, and frequency of histopathological changes in the major organs of mice in the three groups were observed after infection. Results After inoculation of 2D42 cells, 80% infected mice showed severe clinical signs and died at the average 12.8 d after infection. The others only had transient manifestations, and then recovered from the disease and survived for more than 3 months. In contrast, after inoculation of NMT and /or DEN2 alone, 100% mortality rate was noted in these two groups. High viremia and frequency of histopathological changes in the major organs were observed in the mice in groups A and B. Conclusion Our data support both protective and pathogenic roles for DEN-specific CD8 + T cells in DEN virus infection.