Safety and efficacy of hand-assisted laparoscopic versus open distal gastrectomy for gastric cancer: A systematic review and meta-analysis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To systematically assess the safety and efficacy of hand-assisted laparoscopic distal gastrectomy (HALG) versus open distal gastrectomy (ODG) for gastric cancer.</p><p><b>METHODS</b>Chinese or English literature regarding comparison of HALG and ODG were collected by searching in databases (such as PubMed, Cochrane Library, CNKI, Wanfang database) between January 1996 and September 2016. The data of operative time, incision length, blood loss, number of harvested lymph nodes, time to flatus, hospital stay, postoperative complication morbidity and long-term outcomes were compared between the two procedures. Then funnel plot was used to evaluate publication bias and sensitivity analysis was used to evaluate the stability of the results. All these data analyses were performed using the Meta for or Meta package of R version 3.3.1.</p><p><b>RESULTS</b>A total of 7 studies with 835 patients (323 cases in HALG group and 512 cases in ODG group) were included. Compared with ODG, HALG had a longer operative time (WMD=28.93 minutes, 95%CI=9.59 to 48.28, Z=2.93, P=0.000), a shorter incision length (WMD=-10.31 cm, 95%CI=-14.01 to -6.62, Z=-5.47, P=0.000), less blood loss (WMD=-140.08 ml, 95%CI=-215.07 to -65.09, Z=-3.66, P=0.000), faster gastrointestinal recovery (WMD=-1.23 days, 95%CI=-1.89 to -0.56, Z=-3.62, P=0.000), shorter postoperative hospital stay (WMD=-3.24 days, 95%CI=-5.47 to -1.02, Z=-2.85, P=0.000). In subgroup analysis, 3 studies published before 2013 vs. 4 studies published afterwards, the number of harvested lymph nodes (WMD=-0.78, 95%CI=-2.05 to 0.50, Z=-1.19, P=0.235) and postoperative complication morbidity (RR=1.02, 95%CI=0.43 to 2.44, Z=0.05, P=0.961) did not differ significantly between two groups. Compared with ODG, the RR(95%CI) of ileus of HALG was 0.43 (0.07 to 2.82), but the difference was not statistically significant (P=0.383). One study reported the 5-year overall survival rates of HALG and ODG were 81.0% vs 67.5%, and the tumor recurrence rates were 7.1% vs 22%, respectively, but the differences were not statistically significant(all P>0.05). Sensitivity analysis showed that the above results were stable. The funnel plots of the lymph nodes and postoperative complication morbidity did not present significant publication bias.</p><p><b>CONCLUSIONS</b>HALG has the advantages of minimal invasiveness such as shorter incision length and quicker recovery. Furthermore, the short-term efficacy of HALG is similar to conventional open surgery. However, the long-term efficacy is lack of support from multicenter long-term follow-up results.</p>

Value of 131I SPECT/CT on the re-staging and recurrence risk stratification and its impact on subsequent treatment strategy in post-surgical patients with differentiated thyroid carcinoma / 中华核医学与分子影像杂志

Objective To evaluate the role of 131I SPECT/CT in post-surgical re-staging and recurrence risk stratification in patients with DTC and its impact on subsequent treatment strategy.Methods 131I-WBS and 131I SPECT/CT were performed at the same time 5 to 7 d after 131I treatment in 118 patients (33 males,85 females,average age 45 years) with DTC.Difference in the localization and qualitative diagnosis of 131I uptake lesions between 131I-WBS and 131I SPECT/CT were compared.Value of 131I SPECT/CT in the diagnosis of TNM staging,risk stratification and impact on the treatment strategy was evaluated.Paired χ2 test was used for data analysis.Results A total of 509 foci with 131I uptake were detected.131I-WBS found 449 foci with 131I uptake,354 of which (78.84％) were correctly diagnosed.131I SPECT/CT found 509 foci with 131I uptake,and 504(99.02％) were correctly diagnosed.The difference was statistically significant (χ2=21.51,P<0.01).131I-WBS changed the clinical staging in 13 cases with diagnostic accuracy of 5/13.131I SPECT/CT changed the clinical staging in 19 cases and with diagnostic accuracy of 19/19 (χ2=74.41,P<0.01).131I-WBS changed the risk stratification of 13 patients after operation and the accuracy was 5/13,the corresponding data were 22 and 100％(22/22) for 131I SPECT/CT (χ2=74.41,P<0.01).The treatment strategy was changed in 50 patients with 131I SPECT/CT.Conclusions Compared with 131I-WBS,131I SPECT/CT could provide more accurate positioning and qualitative information for 131I treatment and is more accurate in re-staging and risk stratification.

Value of Urinary KIM-1 and NGAL in Predicting the Early Diabetic Nephropathy / 现代检验医学杂志

Objective To investigate the value of KIM-1 and NGAL in predicting the early diabetes nephropathy(DN).Meth-ods 132 cases of type 1 and type 2 diabetic patients were recruited in this study,patients were divided into four groups based on the urine albumin/creatinine and serum creatinine levels,as follows:normal albuminuria group (45 cases),mi-croalbuminuria group (36 cases),clinical albuminuria group (30 cases),renal failure group (21 cases),65 healthy subjects were recruited as control group.Urinary KIM-1 and NGAL levels were measured by enzyme linked immunosorbent assay (ELISA).Results With the progress of DN,urinary KIM-1 and NGAL levels gradually increased (P<0.05),the urinary KIM-1/Ucr level was positively correlated with ACR (r=0.822,P<0.01),and the urinary NGAL/Ucr was positively cor-related with ACR (r=0.842,P<0.01).Conclusion The urinary KIM-1 and NGAL level can predict the occurrence of ear-ly DN,and also monitor the progression of DN.

Predictors of local recurrence and survival in primary retroperitoneal leiomyosarcoma / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the predictors of local recurrence and survival in primary retroperitoneal leiomyosarcoma (PRLS).</p><p><b>METHODS</b>A retrospective analysis was conducted on 46 cases of PRLS between August 2006 and April 2012. There were 9 male and 37 female patients, and they were 30-79 year old (median 49 year old). Kaplan-Meier estimations and Cox regression analyses were performed.</p><p><b>RESULTS</b>The tumor size were 5-36 cm, and 29 cases (63.1%) of this group was more than 10 cm. Local 3- and 5-year control rates after complete resection were 47% and 30%. FNCLCC (Fédération Nationale des Centres de Lutte Contre le Cancer) grading (RR = 3.10, 95%CI: 1.59-6.04), gender (RR = 5.30, 95%CI: 1.64-17.13) and blood loss (RR = 3.12, 95%CI: 1.28-7.60) were independent prognostic factor of local recurrence in multivariable analysis (P < 0.05). The 5-year disease-free survival rates after complete resection of PRLS was 26%; and the 5-year disease-specific survival (DSS) rates after complete resection was 48%. The median DSS was 60 months in negative margin of resection and 50 months in positive margin. However, by multivariate analysis, only FNCLCC grading was significant independent predictors of DSS (RR = 2.01, 95%CI: 1.16-3.49, P = 0.013).</p><p><b>CONCLUSIONS</b>Gender, FNCLCC grading and blood loss were independent prognostic factor of local recurrence. The disease-specific survival in PRLS varied significantly according to FNCLCC grading.</p>

Evaluating the effects of an angiogenesis inhibitor of endostar with a novel RGD dimer probe labeled by 99Tcm / 中华核医学与分子影像杂志

Objective To study the feasibility of a novel probe 99Tcm-HYNIC-2(poly-(ethylene glycol),PEG) 4-Dimer (Dimer:E-[c (RGDfK) 2]) as a potential imaging agent for integrin αv β3 positive tumors,and also to observe the influence of an angiogenesis inhibitor,endostar,on the biodistribution and tumor uptake of the tracer in tumor bearing nude mice.Methods The expression of integrin αv β3 in human glioma cells U87MG was determined with immunofluorescence staining before and after treatment with endostar.99Tcm-HYNIC-2PEG4-Dimer was prepared and administered in U87MG tumor bearing mice in 6 h after either administration of endostar (200 μl) or saline (control group) and then biodistribution study was performed.Other 16 mice were divided into endostar treated group (20 mg/kg) and control group (saline) and then gamma imaging was performed in the two groups.Statistical significance of differences between the two groups was assessed using two-sample t test.Results Radiochemical purity of 99Tcm-HYNIC-2PEG4-Dimer was exceeded 95％.The expression of integrin αvβ3 in U87MG cell was high and gradually decreased after treatment with endostar.There was a negative dose-effect relationship between the dose of endostar and the expression of integrin αvβ3 with the peak effect at the dose of 400 μg/ml.The distribution study in vivo showed that the tracer uptake of U87MG tumors was high,but it decreased after injection of endostar.At 90 min,the ％ID/g of endostar and control groups were 1.50±0.08 and 6.27±0.33,respectively (t =40.23,P＜0.05).The average T/NT ratios of 99Tcm-HYNIC-2PEG4-Dimer uptake in the endostar and control groups were 1.02±0.11 and 2.58±0.36,respectively (t =10.25,P＜0.05).The integrin αv β3 positive expression ratios of tumor in endostar and control groups were (33.1 ±2.7) ％ and (81.5±3.2) ％,respectively (t =32.60,P＜0.05).Conclusions The novel probe 99Tcm-HYNIC-2PEG4-Dimer may be a promising radiotracer for integrin αvβ3-positive tumor imaging.It may be used for monitoring the therapeutic effect of endostar and may be potentially used for screening the candidates of anti-angiogenesis therapy.

~(99m)Tc-octreotide scintigraphy and planar X-ray mammography diagnosis of breast cancer / 中国医学影像技术

Objective To compare the value of (~99m) Tc-octreotide scintigraphy and planar X-ray mammography in the diagnosis of breast cancer. Methods A total of 32 patients with suspected breast cancer were enrolled into this study. All patients underwent (~99m) Tc-octreotide scintigraphy and planar X-ray mammography. The diagnostic efficiency of (~99m) Tc-octreotide scintigraphy and planar X-ray mammography were compared based on the post-surgery pathology. Results The sensitivity of (~99m) Tc-octreotide scintigraphy and planar X-ray mammography in the diagnosis of breast cancer was 91.67% and 66.67%, the specificity was 100% and 37.50%, the accuracy was 93.75% and 59.38%, respectively. Combining (~99m) Tc-octreotide scintigraphy with planar X-ray mammography, the sensitivity, specificity, accuracy, positive predicting values and negative predicting values for breast cancer was 95.83%, 100%, 96.88%, 82.14% and 47.06%, respectively. Conclusion The diagnostic efficiency of (~99m) Tc-octreotide scintigraphy for breast cancer is superior to planar X-ray mammography. (~99m) Tc-octreotide scintigraphy combined with planar X-ray mammography, the diagnostic efficiency for breast cancer will be further improved.

Directed differentiation of embryonic stem cells towards thyroid cells in vitro / 中国组织工程研究

BACKGROUND: Embryonic stem cells fESCs) develop from early blastular inner cell mass.Under proper condition,ESCs can maintain undifferentiated state in vitro,normal diploid nuclear type,and proliferative potential.In addition,ESCs possess multi-directional differentiation capacity and can differentiate into all sorts of cells of three germ layers. OBJECTIVE: To investigate the feasibility of directed differentiation of ESCs towards thyroid cells in vitro as well as related molecular expression. DESIGN,TIME AND SETTING: A cell-based observational experiment was performed at the Bank of Cord Blood,Second Hospital Affiliated to Sun Yat-sen University between January 2004 and December 2006.MATERIALS: Balb/c pregnant mice at pregnancy 12.5-14.5 days were used for preparation of embryonic fibroblast feeder layer.E14 mouse embryonic stem cell (ESC) strains were gifted by professor Xu from Harvard University.METHODS: Murine El4 ESCs were cultured in methylcellulose semisolid medium to form embryoid bodies (Ebs).These Ebs were transferred for further inductive culture with the stepwise addition of growth factors- thyrotropin (TSH),insulin and kalium iodidum (KI).The cultured thyroid cells of adult Kunming mice were taken as positive control.MAIN OUTCOME MEASURES: ①Cellular morphological change in the process of differentiation.② Detection of expression levels of TSHR,PAX8,TTF-2,and TIF-1 by immunofluorescence assay.③ Detection of expression levels of TSHR,PAX8,NIS,TPO,and Tg by reverse transcription-polymerase chain reaction (RT-PCR).RESULTS: The differentiated cells had clear boundary,exhibiting round,oval,shuttle-shaped,or polygon adhesive growth.On day 6 of inductive ifferentiation,the differentiated cells showed the expression of PAX8,NIS,TPO,Tg,and TSHR,the specific gene of thyroid ceils.On day 8 of inductive differentiation,the expression of TSHR,TIF-1,PAX8,and TIF-2 was detectable in the differentiated cells with morphous similar to thyroid cells.CONCLUSION: ESCs can differentiate towards thyroid cells under given inductive conditions.