Characteristics of CD8+ T cell infiltration in colorectal cancer and their correlation with prognosis / 中华胃肠外科杂志

Objective: As cytotoxic T cells, CD8+ T lymphocytes can kill tumor cells by releasing perforin and other effector molecules, but the correlation between their infiltration level and the prognosis of colorectal cancer varies in previous studies. This study aims to explore the distribution of CD8+T cells in tumor center and invasive margin of colorectal cancer, and to analyze their correlation with the prognosis of patients. Methods: A retrospective cohort study was used to analyze the clinicopathological features of 221 patients with colorectal cancer from the colorectal cancer pathological database of the Sixth Affiliated Hospital of Sun Yat-sen University between 2009 and 2012. Case inclusion criteria: (1) colorectal cancers confirmed by postoperative pathology; (2) patients with follow-up data. Exclusion criteria: (1) multiple primary cancers; (2) inflammatory bowel disease, Lynch syndrome or familial adenomatous polyposis; (3) no available paraffin slides; (4) patients receiving preoperative radiotherapy or chemotherapy. A total of 221 patients met the criteria. Immunohistochemical staining was used to count the CD8+ T cells in tumor center and invasive margin in the paraffin slides. Meanwhile the relative expression of CD8B gene in 22 fresh freeze samples of colorectal cancer was detected. Then the correlation of the expression with CD8+T cell density was examined. The patients were divided into high and low infiltration groups according to the level of CD8+T cells. Log-rank test was applied to compare the overall survival of the two groups of patients, and Cox regression analysis was used to adjust the prognostic significance of CD8+T cell infiltration. Results: There were 118 males and 103 females. In 221 slides, CD8+T cells infiltrating in invasive margin were more than those in tumor center [median (range): 37(0-141) / field vs. 14(0-106) / field, Z=-11.985, P<0.001], and the number of CD8+T cell in the tumor center was positively correlated with those in invasive margin (r=0.610, P<0.001). The number of CD8+ T cell in tumor center was positively correlated with the relative expression of CD8B gene (r=0.524, P=0.012). Survival analysis showed that the overall survival of the high infiltration group was better than that of the low infiltration group both in tumor center and invasive margin (median survival: 84.1 months vs. 73.5 months, P<0.001; 84.2 months vs. 75.9 months, P=0.002). Cox regression analysis revealed that high CD8+T cell infiltration in tumor center was an independent protective factor of overall survival (HR=0.369, 95% CI: 0.168-0.812, P=0.013). Conclusions: The infiltration level of CD8+T cells in tumor center is lower than that in invasive margin, and they are positively correlated. The level of CD8+ T cell infiltration in tumor center is related to overall survival and can be used as a potential pronostic marker.

Clinical significance of preoperative colonoscopy for benign anal diseases / 中华消化外科杂志

Objective To investigate the clinical significance of preoperative colonoscopy for patients with benign anal diseases,and to compare the success rates of examination done by sedated colonoscopy and conventional colonoscopy.Methods The clinical data of 333 patients with benign anal disease who received preoperative colonoscopy at the Six Affiliated Hospital of Sun Yat-Sen University from April 2010 to March 2011 were retrospectively analyzed.All the patients were divided into the lesion group (120 patients) and normal group (213 patients)according to the results of colonoscopy.The measurement data and count data were analyzed using the t test and chi-square test,respectively.Results The age of patients in the lesion group was (48 ± 14) years,which was significantly older than (42 ± 14) years (t =3.75,P ＜ 0.05).The constituent ratio of patients older than 40 years in the lesion group was 72.50％ (87/120),which was significantly higher than 39.44％ (84/213) in the normal group (x2=33.59,P ＜0.05).The proportions of male and female patients were 71.67％ (86/120) and 28.33％ (34/120) in the lesion group,and 62.44％ (133/213) and 37.56％ (80/213) in the normal group,with no significant difference between the 2 groups (x2 =2.90,P ＞ 0.05).The benign anal diseases in the lesion group included polyp (80 cases),enteritis (30 cases),malignant tumor (7 cases),infflammatory bowel disease (7 cases),diverticulum (5 cases) and ulcer (1 case).The application rates of sedated colonoscopy in the lesion group and the normal goup were 51.67％ (62/120) and 54.93％ (117/213),respectively,with no significant difference between the 2 groups (x2=0.33,P ＞0.05).The success rate of terminal ileum intubation was 99.44％ (178/179) in patients who received sedated colonoscopy,which was significantly higher than 95.45％ (147/154) of patients who received conventional colonoscopy (x2 =5.61,P ＜ 0.05).Conclusion Patients with benign anal disease might complicated with colorectal lesions,and sedated colonoscopy is recommended for preoperative diagnosis,especially for patients who are older than 40 years.

Focus on the diagnosis and treatment of benign anorectal diseases / 中华胃肠外科杂志

In recent years, researches regarding benign anorectal diseases have experienced unprecedented boom in China, but also exposed a series of problems, such as lack of attention of medical professionals and patients on benign anorectal diseases, lack of basic and clinical researches, and lack of standard diagnosis and treatment etc. This article discusses the problems of current diagnosis and treatment of benign anorectal diseases in China. Clinician should pay close attention to the diagnosis and treatment of benign anorectal disease.

New concepts and techniques of colorectal surgery / 中华胃肠外科杂志

This paper describes some new concepts and new technologies about the current colorectal surgery, such as minimally invasive, bloodless surgery, no touch technique, and some new techniques of gastrointestinal anastomosis. Meantime, bloodless technique and closed resection in our clinic practice are introduced. These new concepts and new techniques widely used improve significantly the efficacy of colorectal surgery.

Function of colonic mucosal barrier of patients with colonic slow transit constipation / 中华消化杂志

Objective To explore the function of colonic mucosal barrier of patients with colonic slow transit constipation (STC).Methods From June 2008 to June 2012,a total of 136 patients with STC were enrolled.Among them,course of disease of 55 cases was between one and six years,of 43 cases was between six and 10 years,and of 38 cases was over 10 years.The colonic transit time of 66 cases was between three and five days,of 42 cases was between five and seven days,and of 28 cases was over seven days.Altogether,35 cases received subtotal resection of the colon.At same time,individuals who received partial resection of the colon because of single polypus were set as control group.Fasting blood and urine samples of all subjects were collected.The colonic specimens of STC patients who received surgery and control group were harvested.The urinary lactulose and mannitol ratio (L/M) was detected by high performance liquid chromatography (HPLC).The level of blood Dlactic acid (D-LAC) was tested by enzymatic spectrophotometric.The level of blood diamine oxidase (DAO) was determined by speetrophotometry.The level of endotoxin (ET) was detected by azo chromogenic substrate limulus test.The colonic epithelial cells membrane resistance (TER) and paracellular mannitol permeability (PMP) were measured with Ussing perfusion chamber.t-test was performed for comparison between groups.Results Urinary L/M of STC group and control group was 0.16±0.03 and 0.10±0.02,respectively.The level of blood D-LAC was (1.81±0.19) and (1.04±0.13) mmol/L.The level of blood DAO was (17.07±1.81) and (9.78±1.14) U/L.The level of blood ET was (64.20±6.85) and (51.30±5.90) EU/L.The TER of colonic epithelia cell was (61.23±7.76) and (75.87±9.65) Ω/cm2.The PMP of colonic epithelia cell was (3.17±0.35) ％ and (2.14 ±0.22)％.All the differences were statistically significant (t =3.185,3.378,3.863,3.201,3.125 and 3.543,all P＜0.05).Among patients with disease course between one and six years,six to 10 years and over 10 years,colonic transit time of STC between three and five days,five to seven days and over seven days,urinary L/M,blood D-LAC level and blood DAO level increased along with the disease course and colonic transit time and the differences were statistical significantly compared with control group (urinary L/M:t=1.993,2.311,2.356,2.204,2.347 and 3.673; blood D-LAC level:t=2.023,2.886,4.124,1.999,2.998 and 3.465; blood DAO level:t=1.994,2.995,4.423,2.203,3.673 and 5.211; all P＜0.05).Compared with control group,there were significant differences in blood ET level of course of STC between six and 10 years,over 10 years,colonic transit time of STC between five and seven days and over seven days (t=2.121,4.245,3.241 and 4.657,all P＜0.05).Conclusion The permeability of colonic mucosal barrier increased and which was more significant in longer colonic transit time and long course of disease.

Effect and mechanism of bishudiwan(BSDW) against allergy / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the effect and mechanism of BSDW on the model of allergic rhinitis and the model of guinea pigs by histamine shocking in guinea pigs.</p><p><b>METHOD</b>Using the model of allergic rhinitis in guinea pigs caused by 10% TDI, we observed the effect of BSDW on physiological and pathological symptoms of allergic rhinitis in guinea pigs, the effect of the levels of serum IgE and serum and nasal histamine. Using the model of guinea pigs by histamine shocking, we observed the effect of BSDW on physiological symptoms in guinea pigs.</p><p><b>RESULT</b>BSDW significantly relieved the pathological symptoms of allergic rhinitis in guinea pigs, alleviated the hyperplasia of columnar epithelium, decreased the number of monocyte and eosinocyte compared with the model group. It also reduced the levels of serum IgE, and decreased the release of serum and nasal histamine. BSDW significantly prolonged the occurent time of gasping, eclampsia and death caused by shock, reduced the times of gasping in the model of guinea pigs by histamine shocking.</p><p><b>CONCLUSION</b>BSDW has significant effect against allergy. The mechanism relates to its effects of decreasing the levels of serum IgE and inhibiting the release of serum and nasal histamine.</p>