Comparison of safety of total laparoscopic versus laparoscopic-assisted radical gastrectomy for distal gastric cancer in older patients / 中华胃肠外科杂志

Objective: To compare the effectiveness of total laparoscopic versus laparoscopic-assisted distal gastrectomy and investigate the safety and replicability of total laparoscopic distal gastrectomy in older patients. Methods: This was a retrospective cohort study. The inclusion criteria were as follows: (1) age ≥65 years; (2) malignant gastric tumor diagnosed pathologically preoperatively; (3) Eastern Cooperative Oncology Group performance status score 0-1; (4) Grade I-III American Society of Anesthesiologists physical status; (5) preoperative clinical tumor stage I-III; (6) total laparoscopic or laparoscopic-assisted distal gastrectomy performed; and (7) gastrointestinal tract reconstruction using uncut Roux-en-Y or Billroth-II+Braun procedure. Patients who had received neoadjuvant therapy, undergone conversion to open surgery, or had serious comorbidities or incomplete data were excluded. The clinical data of 129 patients who met the above criteria and had undergone laparoscopic surgery for gastric cancer from January 2012 to December 2021 in the Gastrointestinal Cancer Center in the Beijing Cancer Hospital were analyzed. According to the operation method, the patients were divided into total laparoscopic group and laparoscopic-assisted group. Variables studied comprised: (1) surgical procedure and postoperative recovery; (2) postoperative pathological findings; and (3) postoperative complications. Measurement data with skewed distribution are represented as mean(quartile 1, quartile 3). Comparisons between groups were evaluated using the Mann-Whitney U test. Results: After propensity score matching in a 1:1 ratio, there were 40 patients in the total laparoscopic distal gastrectomy group and 40 in the laparoscopic-assisted distal gastrectomy group. Baseline characteristics did not differ significantly between the two groups (all P>0.05).Compared with the laparoscopic-assisted group, the total laparoscopic group had shorter main incisions (4.1±1.0 cm vs. 8.5±2.8 cm, t=9.375, P<0.001), time to fluid intake [4.0 (3.0, 4.8) days vs. 5.0 (4.0, 6.0) days, Z=2.167, P=0.030], and duration of indwelling abdominal drainage catheter [6.0 (6.0, 7.0) days vs. 7.0 (6.0, 8.0) days, Z=2.323, P=0.020]. Numerical Rating Scale scores on postoperative days 1 and 2 were higher in the total laparoscopic than the laparoscopic-assisted group [2.5 (1.0, 3.0) vs. 1.5 (1.0, 2.0), Z=1.980, P=0.048; 2.0 (1.0, 3.0) vs. 1.0 (1.0, 2.0), Z=2.334, P=0.020, respectively]. However, there were no significant differences between the groups in operation time, intraoperative blood loss, white blood cell count, hemoglobin concentration, or albumin concentration on postoperative day 1, time to ambulation, mean time to bowel movement, postoperative admission to the intensive care unit, length of postoperative hospital stay, or Numerical Rating Scale scores on postoperative day 3 (all P>0.05). There were also no significant differences between the two groups in maximum tumor diameter, pathological tumor type, total number of lymph nodes dissected, or total number of positive lymph nodes (all P>0.05). The incidence of postoperative complications was 15.0% (6/40) in the total laparoscopic group and the laparoscopic-assisted group; these differences are not significant (χ2<0.001, P>0.999). Conclusions: Compared with laparoscopic-assisted radical gastrectomy for distal gastric cancer, total laparoscopic surgery has the advantages of shorter incision, shorter time to fluid intake, and shorter duration of indwelling abdominal drainage catheter in older patients (age ≥65 years). Total laparoscopic radical gastrectomy for distal gastric cancer does not increase the risk of postoperative complications and could therefore be performed more frequently.

Establishment and data quality control of a multicenter prospective database for prevalence of abdominal complications after gastroenterological surgery / 中华胃肠外科杂志

As the main cause of secondary operation and postoperative death, the incidence of intraperitoneal infectious complications varies significantly in different medical centers in China. Due to the lack of national data, it is not possible to assess and develop appropriate diagnosis and treatment strategies properly. To provide a high-quality data platform for complication registration and clinical research, a multicenter prospective database for the Prevalence of Abdominal Complications After GastroEnterological surgery was established. Based on the Hospital Information System (HIS)of 20 medical centers in China, the electronic case reporting form (e-CRF) listed on the website was used to collect medical information of patients undergoing gastric or colorectal cancer surgery. The data were verified by on-site auditing, and data cleaning was performed by R software. After the data cleaning, the data in the database was checked and evaluated by the principle investigators and data administrators. When all data queries and questions were corrected and answered, the database was locked to establish a multicenter prospective database for postoperative abdominal infectious complications (the PACAGE database). The PACAGE database has rich information resources and high data quality and is a good data platform for complication registration and clinical research.

Knocking-out of HIF1α gene by CRISPR/cas9 inhibits proliferation and invasiveness of prostate cancer DU145 cells / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To explore the role of HIF1α gene in prostate cancer cell line DU145 by knocking it out with a novel gene-editing tool CRISPR/cas9 system.</p><p><b>METHODS</b>A CRISPR/cas9 system with two sgRNAs targeting exon 1 of the HIF1α gene was constructed for the knock out experiment. CCK8 assay and transwell experiment were carried out to assess the effect of the knock out on the proliferation, migration and invasiveness of DU145 cells.</p><p><b>RESULTS</b>The efficiency of gene-targeting was measured through a T7E1 assaying and sequence analysis, which confirmed that the partial knock out was successful and has led to a significant decrease in the expression of HIF1α and inhibition of cell proliferation, migration and invasiveness.</p><p><b>CONCLUSION</b>A CRISPR/cas9 system for the knock out of HIF1α has been successfully constructed, which could inhibit the proliferation and migration of DU145 cells. The system can facilitate further studies of the HIF1α gene and its roles in tumorigenesis.</p>

Clinical characterisis and prognosis analysis of 107 adult onset Still's disease / 中华风湿病学杂志

Objective To analyze the clinical characteristics, laboratory results, treatment and prognosis of adult onset Still's disease (AOSD). Methods The clinical and laboratory data of 107 AOSD patients were retrospectively analyzed. SPSS 22.0 was used for statistical analysis. Categorical data were described as frequency and percentage, and numerical data were described using x±s deviation. Chi-square test was used to compare categorical data between groups and analysis of variance test was used to compare numerical data between groups. K-W test was used to compare skewed distributed data between groups and J-T test was compared in pairwise comparison. Logistic regression was applied to examine prognostic factors. Results The average age of 107 patients (12 male and 95 female) was(39±16) years and the average disease course was (1.4±2.7) years. The patients were classified into 3 types based on their disease course: monocyclic (38 cases, 35.5%), polycyclic (29 cases, 27.1%) and chronic arthritis (40 cases, 37.4%). The clinical characteristics were high fever (107 cases , 100%), rash (97 cases, 90.7%) and arthralgia/arthritis (86 cases, 80.4%). The most common involved joints were knee (24 cases, 23.3%), wrist (19 cases, 18.4%) and proximal interphalangeal joints (14, 13.7%). The laboratory results were elevated including white blood cells count (88/105, 83.8%) and elevated serum ferritin (107, 100%). Seventy-three out of 84 patients (86.9%) had negative rheumatic factor and 9 out of 91 (9.9%) had positive ANA, which were low titre in general. Eleven patients (10.3%) had joint erosions suggested by X-ray at diagnosis. Intergroup analysis revealed that patients with polycyclic type were less likely to have abnormal liver function tests at disease onset (χ2=9, P39.5 ℃ (P=0.030) were mostly fell into the monocyclic group. Compared with monocyclic type, patients with polycyclic or chronic arthritis type were less likely to have thrombocytosis (P=0.019, P=0.004). However, when compared with chronic arthritis type, patients with monocyclic or poly - cyclic type were less likely to have arthralgia/arthritis (P=0.030, P=0.000), especially the involvement of large joints (P<0.05). Conclusion AOSD mainly presents as high fever, rash, arthralgia and elevated inflammatory markers. Joint erosion may occur during the course of disease. The treatment of glucocorticoid and immunosup - pressive agent combinations is effective and most patients could achieve remission during 4 weeks of treatment. Patients with thrombocytosis at disease onset might be monocyclic type, while patients with arthritis, especially involvement of large joints at disease onset might be chronic arthritis type.

Nephron-sparing surgery for 69 patients with renal tumors / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the results of nephron-sparing surgery (NSS) for renal tumors.</p><p><b>METHODS</b>A retrospective analysis was performed for the clinical data of 66 patients who were affected by renal tumors and treated with NSS.</p><p><b>RESULTS</b>Among 66 cases, 63 were treated with partial nephrectomy and 6 with enucleation. The renal vessel was clamped in 45 cases intraoperative. The histological subtypes included clear cell carcinoma in 40 cases, papillary renal cell carcinoma (RCC) in 2 cases, chromophobe RCC in 2 cases, angiomyolipoma in 24 cases, and adenoma in one case. Surgical margins were negative in all cases. Seven patients had postoperative complications and no perioperative acute renal failure occurred. Among 44 cases with renal cell carcinoma, 42 were followed for mean 55.4 months. The overall and disease-free 5-year survival rates were 97.3% and 90.7%, respectively.</p><p><b>CONCLUSION</b>NSS is a effective and safe operation for selected patients with renal tumors, providing functional advantage gained by the maximal preservation of unaffected renal parenchyma without sacrificing cancer control.</p>