A multi-center retrospective study of perioperative chemotherapy for gastric cancer based on real-world data / 中华胃肠外科杂志

Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.

Phase II Study of Preoperative IntraArterial Epirubicin, Etoposide, and Oxaliplatin Combined with Oral S-1 Chemotherapy for the Treatment of Borrmann Type 4 Gastric Cancer

Purpose@#A phase II study was conducted to evaluate the safety and efficacy of preoperative, intra-arterial perfusion of epirubicin, etoposide, and oxaliplatin combined with oral chemotherapy S-1 (SEEOX) for the treatment of type 4 gastric cancer. @*Materials and Methods@#A single-center, single-arm phase II trial was conducted on 36 patients with histologically proven type 4 gastric cancer without distant peritoneal or organ metastasis. Patients received 3, 21-day courses of SEEOX preoperative chemotherapy. The primary endpoint was overall survival (OS) and the secondary outcomes assessed were chemotherapeutic response, radical resection rate, pathological regression, toxicities, postoperative morbidity, and mortality. @*Results@#All patients were at an advanced stage of cancer (stage III or IV) and completed the entire course of treatment. Based on changes in tumor volume and peritoneal metastasis, the objective response rate was 55.6% (20/36; 95% confidence interval [CI], 38.5%–72.6%) and the disease control rate was 69.4% (25/36; 95% CI, 53.6%–85.3%). The radical resection rate was 75% (27/36; 95% CI, 60.1%–89.9%) and the proportion of R0 resections was 66.7% (21/36; 95% CI, 50.5%–82.8%). The pathological response rate was 33.3%, of which 13.9% showed complete pathological regression. The median survival was 27.1 months (95% CI, 22.24–31.97 months), and the 2-year OS was 48.5% (95% CI, 30.86%–66.1%). @*Conclusions@#Preoperative SEEOX is a safe and effective treatment for type 4 gastric cancer. Based on these preliminary data, a phase III study will be conducted to confirm the superiority of this regimen over standard treatment.Trial Registration: ClinicalTrials.gov Identifier: NCT02949258

Phase II Study of Preoperative IntraArterial Epirubicin, Etoposide, and Oxaliplatin Combined with Oral S-1 Chemotherapy for the Treatment of Borrmann Type 4 Gastric Cancer

Purpose@#A phase II study was conducted to evaluate the safety and efficacy of preoperative, intra-arterial perfusion of epirubicin, etoposide, and oxaliplatin combined with oral chemotherapy S-1 (SEEOX) for the treatment of type 4 gastric cancer. @*Materials and Methods@#A single-center, single-arm phase II trial was conducted on 36 patients with histologically proven type 4 gastric cancer without distant peritoneal or organ metastasis. Patients received 3, 21-day courses of SEEOX preoperative chemotherapy. The primary endpoint was overall survival (OS) and the secondary outcomes assessed were chemotherapeutic response, radical resection rate, pathological regression, toxicities, postoperative morbidity, and mortality. @*Results@#All patients were at an advanced stage of cancer (stage III or IV) and completed the entire course of treatment. Based on changes in tumor volume and peritoneal metastasis, the objective response rate was 55.6% (20/36; 95% confidence interval [CI], 38.5%–72.6%) and the disease control rate was 69.4% (25/36; 95% CI, 53.6%–85.3%). The radical resection rate was 75% (27/36; 95% CI, 60.1%–89.9%) and the proportion of R0 resections was 66.7% (21/36; 95% CI, 50.5%–82.8%). The pathological response rate was 33.3%, of which 13.9% showed complete pathological regression. The median survival was 27.1 months (95% CI, 22.24–31.97 months), and the 2-year OS was 48.5% (95% CI, 30.86%–66.1%). @*Conclusions@#Preoperative SEEOX is a safe and effective treatment for type 4 gastric cancer. Based on these preliminary data, a phase III study will be conducted to confirm the superiority of this regimen over standard treatment.Trial Registration: ClinicalTrials.gov Identifier: NCT02949258

Essence of early gastric cancer and confusion in clinical practic / 中国实用外科杂志

Staging is a subjective assessment of objective progress of gastric cancer by doctors.However, the progress of gastric cancer is the result of tumor breaking through the limitation of immunity according to its inherent characteristics.The subjective evaluation methods are difficult to fully reflect the progress of gastric cancer. From the beginning of the concept of early gastric cancer to the wide application of endoscopic submucosal dissection(ESD) in clinic, the biggest puzzle is how to exclude lymph node metastasis. So far, it has not been satisfactorily solved. Therefore, in all previous Japanese Gastric Cancer Treatment Guidelines, the indications of ESD must be accompanied by the evaluation and treatment after endoscopic resection for possible residual cancer. Comprehending the essence of early gastric cancer and the related factors affecting its progress will help us to improve the quality of treatment for early gastric cancer and benefit patients.

Prospects for gastric cancer treatment based on the revisions of Japanese Gastric Cancer Classification / 中国实用外科杂志

Japanese gastric cancer classification marks the lymph nodes associated with gastric cancer metastasis in groups, which allows the surgeons and pathologists to operate as per a uniform specification to obtain the distribution of metastatic lymph nodes in every case. Through a substantial number of cases, the rules and pathways of lymph node metastasis are summarized, thus laying a theoretical foundation for radical gastrectomy. From the simple to the complex, and then to the refined and expansive, the classification categorizes subgroup studies to better rationalize the lymph node dissection; and expands the researches on marker range to investigate the role of enlarged surgery.Researches over decades have explored the law of lymph node metastasis to the extreme, and the surgical efficacy of gastric cancer near limit. Thus, shortly after the mature treatment model was established as the Gastric Cancer Treatment Guidelines by Japanese experts, the revised classification in2010 altered the criterion for staging gastric cancer from the location of metastatic lymph nodes to the number of metastases. This indicates that the exploration of surgical approaches to gastric cancer is basically completed, and the`future efficacy improvement of gastric cancer depends on comprehensive therapy. The formation of radical gastrectomy is the result of multidisciplinary collaborative research.Surgery should still be performed in strict accordance with the specification. Postoperative grouped inspection of lymph nodes has great significance for determining the surgical outcome and prognosis.

Effect of Saropenia on Clinical Prognosis of Gastric Cancer Patients: A Prospective Cohort Study / 肠外与肠内营养

Objective: To investigate the effects of preoperative sarcopenia on postoperative clinical outcome in patients with gastric cancer. Methods: A prospective study was performed in 93 patients with gastric cancer and the skeletal muscle mass was examined by bioelectrical impedance. The primary outcome was postoperative complications. The secondary outcomes were postoperative length of stay, overall hospital costs, 60 days re-admission and mortality rate. Results: A significant difference (sarcopenia group vs. non-sarcopenia group) was observed in the rates of overall postoperative complications, incidence of pleural effusion and intra-abdominal infection, overall hospital stay and postoperative hospital stay (P ＜ 0. 05). The rates of 60 days readmission, 60 days mortality and hospital costs in sarcopenia group were not different between the two groups (P ＞ 0. 05). By univariate and multivariate analysis, preoperative sarcopenia and preoperative nutritional risk are the risk factors of postoperative complications. Conclusion: Sarcopenia is an independent risk factor for postoperative complications in patients with gastric cancer; preoperative patients with sarcopenia have a worse prognosis and should be screened and optimized before surgery.

Effects of monosulfuron-ester on metabolic processes of nitrogen-fixing cyanobacteria Anabaena flos-aquae and Anabaena azotica

Abstract Presence of the relatively new sulfonylurea herbicide monosulfuron-ester at 0.03-300 nmol/L affected the growth of two non-target nitrogen-fixing cyanobacteria (Anabaena flos-aquae and Anabaena azotica) and substantially inhibited in vitro Acetolactate synthase activity, with IC50 of 3.3 and 101.3 nmol/L for A. flos-aquae and A. azotica, respectively. Presenting in 30-300 nmol/L, it inhibited protein synthesis of the cyanobacteria with less amino acids produced as its concentration increased. Our findings support the view that monosulfuron-ester toxicity in both nitrogen-fixing cyanobacteria is due to its interference with protein metabolism via inhibition of branch-chain amino acid biosynthesis, and particularly Acetolactate synthase activity.

Diagnostic Performance of the GenoType MTBDRand MTBDRAssays to Identify Tuberculosis Drug Resistance in Eastern China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The WHO recently has recommended the GenoType MTBDRplus version 1.0 and MTBDRsl version 1.0 assays for widespread use in countries endemic with drug-resistant tuberculosis. Despite this, these assays have rarely been evaluated in China, where the burden of drug-resistant tuberculosis is among the highest globally.</p><p><b>METHODS</b>Mycobacterium tuberculosis clinical isolates were obtained between January 2008 and December 2008. Isolates were tested for drug resistance against rifampicin (RFP) and isoniazid (INH) using the GenoType MTBDRplus assay and drug resistance against ethambutol (EMB), ofloxacin (OFX), and kanamycin (KM) using the Genotype MTBDRsl assay. These results were compared with conventional drug-susceptibility testing (DST).</p><p><b>RESULTS</b>Readable results were obtained from 235 strains by GenoType MTBDRplus assay. Compared to DST, the sensitivity of GenoType MTBDRplus assay to detect RFP, INH, and multidrug resistance was 97.7%, 69.9%, and 69.8%, respectively, whereas the specificity for detecting RFP, INH, and multidrug resistance was 66.7%, 69.2%, and 76.8%, respectively. The sensitivity and specificity of the GenoType MTBDRsl assay were 90.9% and 95.2% for OFX, 77.8% and 99.5% for KM, 63.7% and 86.4% for EMB, respectively. Mutations in codon S531L of the rpoB gene and codon S315T1 of KatG gene were dominated in multidrug-resistant tuberculosis (MDR-TB) strains.</p><p><b>CONCLUSIONS</b>In combination with DST, application of the GenoType MTBDRplus and MTBDRsl assays may be a useful supplementary tool to allow a rapid and safe diagnosis of multidrug resistance and extensively drug-resistant tuberculosis.</p>

Perioperative cardiovascular abnormality in elder patients with silent coronary heart disease / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To explore the perioperative cardiovascular dysfunction and its relevance to age in patients with silent coronary heart disease (or silent myocardial ischemia), and explore the clinical treatment and recovery of perioperative arrhythmias.</p><p><b>METHODS</b>One hundred and eighty cases were selected from selective surgery patients with silent myocardial ischemia (SMI). Among the cases, 130 patients older than 51 years old were divided into 51 - 60 year-old group, 61- 70 year-old group and 71 - 80 year-old group. Control group was set up by other 50 patients younger than 51 years old. Electrocardiogram data of 24 h before the operation, 24 h after the operation and 48 h after the operation were continuously monitored by dynamic electrocardiogram (DCG). The electrocardiogram data of ST shifting, arrhythmia incidences of different type and at different time were analyzed by professional doctors. At the same time, the treatment and recovery of perioperative arrhythmia were recorded.</p><p><b>RESULTS</b>As the age increase, the magnitude and duration of ST shifting appeared upward trend compared to the control group (P < 0.05, P < 0.01). The incidence of ST elevation in 71 - 80 year-old group was higher than the control group (P < 0.05). The ST depression duration in 61 - 70 and 71 - 80 year-old group and ST elevation magnitude in 71 - 80 year-old group were higher than 51 - 60 year-old group (P < 0.05). Compared to the control group, the incidence of accelerated idioventricular rhythm (AIR) in 61 - 70 year-old group and the incidence of sinus bradycardia (SB), ventricular premature beat (VPB), ventricular tachycardia (VT) in 71 - 80 year-old group were higher (P < 0.05, P < 0.01). Compared to the 51 - 60 year-old group, the incidence of atrial fibrillation (AF) in 61 - 70 year-old group and the incidence of VP, VT, AF in 71 - 80 year-old group were higher (P < 0.05, P < 0.01). The arrhythmia incidences in 24 h after operation were higher than 48 h after operation and 24 h before operation (P < 0.01). As the age increase, the recovery incidence by removing inducement was decreased, but the recovery incidences by drug and electric-shock treatment were increased (P < 0.05).</p><p><b>CONCLUSION</b>Old SMI patients have high levels of perioperative myocardial ischemia and arrhythmia, and 24 h after operation is the period of high incidence.</p>

Effects of different anesthesia methods on perioperative hemodynamics and ECG in old CHD patients / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To explore an optimal anesthesia method with less impact on hemodynamics and electrocardiogram (ECG) of old patients with coronary artery disease (CHD) during abdominal operation.</p><p><b>METHODS</b>The 133 CHD patients waiting for abdominal operation were randomly divided into continuous epidural anesthesia (EA) group, general anesthesia group (GA) and combined spinal-epidural anesthesia (CSEA) group. Continuous monitoring was carried out during operation and mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SaO2), abnormal ECG were measured respectively at different time for comparison and the differences of the above hemodynamic parameters and abnormal ECG features were compared among the 3 groups.</p><p><b>RESULTS</b>At the 15 min and 30 min point after anesthesia, SaO2 in GA group was significantly increased compared to that in the EA group (P < 0.05). At 15 min, 30 min and 60 min point after anesthesia, MAP in CSEA group was significantly increased compared to that in the EA group (P < 0.05). At 30 min point after anesthesia, HR in CSEA group was increased significantly compared to the EA group (P < 0.05). At 15 min and 30 min point after anesthesia, SaO2 in the CSEA group was increased significantly compare to the EA group (P < 0.05). Compared with preanesthesia (T0) in EA group, MAP, HR and SaO2 decreased significantly at 15, 30 and 60 min after anesthesia (P < 0.05). The fluctuation of the three parameters in GA and CSEA groups were relatively small (P > 0.05). As well as the comparison of abnormal ECG among the 3 groups was concerned, the incidence of ST-T changes in GA and CSEA groups were significantly lower than that in EA group at the time of 15 min, 30 min and 60 min after anesthesia and at the time of surgery termination (P < 0.05, P < 0.01). The incidence of arrhythmia in GA and CSEA groups were significantly lower than that in EA group at the time of 15 min, 30 min and 60 min after anesthesia (P < 0.05, P < 0.01). Compared with T0 in the same group, the incidences of ST-T changes and arrhythmia in GA or CSEA group at the time of 15, 30 and 60 min after anesthesia and at the time of surgery termination were significantly lower than that before anesthesia (P < 0.05, P < 0.01).</p><p><b>CONCLUSION</b>GA and CSEA have less impact on hemodynamics and have smaller incidence of abnormal ECG of old CHD patients with abdominal operation.</p>

Puerarin enhances superoxide dismutase activity and inhibits RAGE and VEGF expression in retinas of STZ-induced early diabetic rats

OBJECTIVE@#To investigate the effects of puerarin on the activity of superoxide dismutase (SOD), and expressions of advanced glycation end-product (AGE) receptor (RAGE) and vascular endothelial growth factor (VEGF) in retinas of streptozotocin (STZ)-induced early diabetic rats.@*METHODS@#Diabetic rat models were established by inducing diabetes via intra-peritoneal injection of STZ. Rats were randomly divided into normal (control), diabetic (DM), and DM+ puerarin groups. After intra-gastric administration of puerarin (500 mg/kg/day for 4 weeks), levels of SOD and malondialdehyde (MDA) were determined in serum and retina. mRNA and protein expression levels of RAGE and VEGF in retinas were determined by real-time polymerase chain reaction (RT-PCR) (mRNA) and Western blot analysis (protein levels).@*RESULTS@#There was significantly lower SOD activity and significantly higher MDA in serum and retinas of the DM group compared with the two other groups (P<0.05). After treatment with puerarin, SOD activity increased and MDA content decreased in this group (P<0.05). mRNA and protein expression levels of RAGE and VEGF in the DM group were significantly higher than those of the other groups (P<0.05), and decreased after puerarin treatment (P<0.05).@*CONCLUSIONS@#Puerarin is able to enhance SOD activity, and inhibit RAGE and VEGF expressions in retinas of STZ-induced early diabetic rats.

Influence of Lipoplus fat emulsion on postoperative nutritional status and early inflammatory response in patients with gastrointestinal malignancies / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of Lipoplus on postoperative nutritional status and inflammatory response in patients with gastrointestinal malignancies.</p><p><b>METHODS</b>Sixty-four patients with gastrointestinal malignancies were randomized using random digit table to receive isonitrogenous, isocaloric total parenteral nutrition for 5 days including either Lipoplus or Lipofundin with 32 patients in each group. Blood samples were obtained before the surgery, postoperative days 1, 2, 3, and 6 to evaluate the nutritional status(prealbumin, retinol binding protein, and nitrogen balance) and inflammatory response [C-reaction protein(CRP), and leukotriene(LTB) 5, LTB4]. The incidence of postoperative systemic inflammatory response syndrome(SIRS), infection, postoperative complications, mortality, APACHEII score, length of hospital stay and other clinical indicators were recorded.</p><p><b>RESULTS</b>On postoperative day 1, prealbumin and retinol binding protein were significantly lower as compared to preoperative levels. These parameters increased significantly(P<0.05) on postoperative day 6 and the nitrogen balance was positive. On postoperative day 6, CRP was significantly lower in both groups as compared to postoperative day 3 (P<0.05), and the decrease was more prominent in Lipoplus than Lipofundin(P<0.05). There was a significant increase in LTB5/LTB4 as compared to postoperative day 1(P<0.05) in the Lipoplus group, however the increase was not statistically significant in the Lipofundin group(P>0.05). The incidence of postoperative infection was significantly lower in the Lipoplus group(3.1% vs. 6.3%, P<0.05), as was that of SIRS(9.4% vs. 15.6%, P<0.05). The APACHEII score was higher in the Lipoplus group but the difference was not statistically significant(3.6±2.0 vs. 3.3±2.1, P>0.05). The length of hospital stay was significantly shorter in Lipoplus group[(6.4±1.1) d vs. (8.2±1.3) d, P<0.05].</p><p><b>CONCLUSION</b>Lipoplus can improve the postoperative nutritional status and minimize the inflammatory response in patients with gastrointestinal malignancies.</p>

Retrospective analysis of 56 patients with advanced gastric cancer treated with combination of intravenous and intra-arterial intensified neoadjuvant chemotherapy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pre-operative chemotherapy has gained widespread interest while treating advanced gastric cancer in eastern countries. However, there is currently no established standard regimen for gastric cancer. The aim of this research was to explore the value of preoperative chemotherapy with a combination of intravenous and intra-arterial intensified chemotherapy in advanced gastric cancer.</p><p><b>METHODS</b>A total of 56 histologically proven gastric cancer patients, who were considered to be stage II or higher with metastatic lymph nodes and with or without distant metastasis (T2-4, N1-3, and M0-1), were treated with a neoadjuvant chemotherapy. Patients received a combination of intravenous 5-Fu (370 mg/m2) and leucovorin (200 mg/m2) on days 1-5, and intra-arterial etoposide (80 mg/m2) and cisplatin (80 mg/m2) on days 6 and 20. After two cycles of preoperative chemotherapy, patients with resectable tumors underwent laparotomy.</p><p><b>RESULTS</b>All patients finished two cycles of chemotherapy. The overall response rate was 78.57% (44 cases), of which 7.14% (four cases) clinical complete response. Forty-six patients underwent resection, including 21 initially unresectable diseases. R0 resection rate for prechemotherapy resectable and unresectable diseases was 96.15% (25/26 cases) and 66.67% (20/30 cases), respectively. Pathological complete response was observed in 8.70% of patients. Toxicity was moderate and there were no chemotherapy-related deaths. With a median follow-up of 31 months (range 6-76 months), the 5-year survival rate for the whole group and patients with initially resectable tumors were 21.8% and 42.3%, respectively. The median survival for initially resectable and unresectable patients were 41 months (95%CI, 31.006-50.994) and 18 months (95%CI, 13.399-22.601; P<0.01), respectively.</p><p><b>CONCLUSION</b>Preliminary results proved that the combined intensive chemotherapy was a safe and promising regimen for pre-operative treatment of advanced gastric cancer.</p>

Effect of neoadjuvant chemotherapy on the postoperative pulmonary infection of patients with advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of neoadjuvant chemotherapy on the postoperative pulmonary infection of patient with gastric cancer.</p><p><b>METHODS</b>Between January 2009 and January 2011, 139 patients with curable stage T2N2 or T3N2 gastric cancer were randomly assigned to group 1(69 cases, neoadjuvant chemotherapy with combined preoperative intraarterial infusion and intravenous chemotherapy before gastrectomy and D2 lymphadenectomy) and group 2(70 cases,gastrectomy and D2 lymphadenectomy alone). The morbidity of postoperative pneumonia in the two groups were recorded respectively.</p><p><b>RESULTS</b>The two groups were similar with respect to various clinical or pathological characteristics. All the patients underwent gastrectomy and D2 lymphadenectomy successfully. Eight patients in group 1 suffered from the postoperative pneumonia, accounting for 11.6%. Nine patients in group 2 suffered from the postoperative pneumonia, accounting for 12.9%. There was no significant difference between the two groups about the incidence of postoperative pneumonia.</p><p><b>CONCLUSION</b>Surgery following neoadjuvant chemotherapy with combined preoperative intraarterial infusion and intravenous chemotherapy is safe with similar morbidity of postoperative pneumonia to immediate surgery in patients with locally-advanced resectable gastric carcinoma.</p>

Expression and significance of Survivin and Smac in ovarian mucinous tumors / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate the expressions and significances of Survivin and Smac in ovarian mucinous tumors.</p><p><b>METHODS</b>A total of 55 paraffin-embedded specimens of primary ovarian mucinous tumors were collected. SABC was used to detect protein expression of Survivin and Smac genes. Immunoelectron microscopy using colloidal gold labeling was performed to determine the subcellular localization and patterns of Smac protein expression.</p><p><b>RESULTS</b>(1) The cytoplasmic expression rates of survivin in benign, borderline and malignant ovarian mucinous tumors were 2/20, 12/15 and 20/20 respectively, which presents an improving trend.There were significant differences of survivin expression between benign vs. borderline lesions (P < 0.01), and benign vs. malignant tumors (P < 0.01). The nuclear expression rates of survivin in benign, borderline and malignant ovarian mucinous tumors were 1/20, 6/15 and 5/20, respectively, which presents a.declining trend.There was significant difference of survivin expression between benign vs. borderline tumors (P < 0.05). The positive expression rates of Smac among the three groups were 19/20, 9/15 and 3/20, respectively. There was significant difference among the three groups (P < 0.01 or < 0.05). There was a negative correlation between Survivin and Smac (r = -0.153, P < 0.01). (2) Colloidal gold labeling study demonstrated that mitochondrion intramembranous storage of Smac granules in the three groups were 24.1 ± 7.2, 11.1 ± 1.9 and 5.2 ± 1.7, respectively, and there were significant differences among the three groups (P < 0.01 or < 0.05). The extramemebranous Smac granules were 4.7 ± 3.0, 2.9 ± 1.0 and 1.7 ± 1.3, although without significant difference among the three groups (P > 0.05).</p><p><b>CONCLUSIONS</b>With the malignant development of ovarian mucinous tumors, the expressions of Survivin are up-regulated, and the expressions of Smac are down-regulated. Smac proteins exist mainly in an inactive intramembranous storage form inside of mitochondria.</p>

Neoadjuvant chemotherapy of FLEEOX regimen for unresectable gastric cancer resulting from advanced abdominal lymph nodes metastases / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the therapeutic response of advanced gastric cancer with severe lymph nodes metastasis to FLEEOX regimen neoadjuvant chemotherapy that combined arterial and venous administration.</p><p><b>METHODS</b>Neoadjuvant chemotherapy was administered to 32 cases of gastric cancer with advanced abdominal lymph nodes metastases from January 2007 to October 2008. Of the 32 patients, 28 had severe local lymph nodes metastasis, such as No.3, 7, 9, 12 lymph nodes metastasis, one patient had No.16 lymph nodes metastasis, and the other 3 patients had both regional and No.16 lymph nodes metastasis under CT scan. Neoadjuvant chemotherapy was administered as follows: 5-Fu 370 mg/m(2), intravenous drip, day 1 - 5; Leukovorin 120 mg, intravenous drip, day 1 - 5; oxaliplatin 150 mg/m(2), epirubicin 30 mg/m(2) and epotoside 70 mg/m(2), intravascular infusion through arteria gastrica sinistra, day 6 and 20. The protocol was repeated every five weeks for two or three courses. After 2 or 3 cycles of chemotherapy, abdominal CT was taken to evaluate the radiological therapeutic response and calculate the reductive rate of the tumor.</p><p><b>RESULTS</b>The general conditions and symptoms was improved significantly in all the patients. Four cases got complete response (CR), 24 got partial response (PR) and 4 got no change under CT scan. For the 32 case, the radiological response rate (CR + PR) was 87.5%(28/32). Thirty patients underwent subtotal or total gastrectomy, even combined organ resection, with D2 or D2 + alpha lymphadenectomy.</p><p><b>CONCLUSIONS</b>The FLEEOX regimen which combines arterial and venous administration carries a satisfactory therapeutic effect in advanced gastric cancer with severe lymph nodes metastasis. The combined routes of drug administration may improve the effects of neoadjuvant chemotherapy in stomach cancer.</p>

Expressions of STAT3, VEGF and C-myc in seminoma and their significance / 中华男科学杂志

<p><b>OBJECTIVE</b>To understand the role of the JAK/STAT3 signal transduction pathway in the pathogenesis of seminoma by studying the expressions of signal transducers and activators of transcription-3 (STAT3), vascular endothelial growth factor (VEGF) and C-myc in seminoma.</p><p><b>METHODS</b>We examined 38 paraffin specimens of seminoma and 10 samples of normal human testes by immunohistochemical staining using the antibodies of STAT3, VEGF and C-myc, and observed the staining intensity under the light microscope.</p><p><b>RESULTS</b>The positive expression rates of STAT3, VEGF and C-myc were 76.3%, 71.1% and 84.2%, respectively, with statistically significant differences from the corresponding protein expressions in the normal testis tissues (P < 0.01), which gradually increased with the clinical stages of tumor, nodes and metastasis (TNM) classification. Different correlations were observed among the STAT3, VEGF and C-myc proteins in seminoma: STAT3 positively correlated with VEGF (r = 0.640, P < 0.01) and C-myc (r = 0.408, P < 0.05); C-myc positively correlated with VEGF (r = 0.459, P < 0.01).</p><p><b>CONCLUSION</b>The JAK/STAT3 signal transduction pathway can facilitate the development and metastasis of seminoma by activating the expression of VEGF and meanwhile induce the malignant proliferation of primary reproductive cells and promote the pathogenesis and progression of seminoma by activating the expression of C-myc.</p>

Arteriovenous neoadjuvant FLEOX chemotherapy with nutritional support improves the resectable rate for advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the resectable rate of advanced gastric cancer characterized by abdominal lymph node metastases with the arteriovenous neoadjuvant FLEOX chemotherapy plus appropriate nutritional support.</p><p><b>METHODS</b>Arteriovenous neoadjuvant FLEOX chemotherapy was administered to 50 patients of gastric cancer with advanced abdominal lymph node metastases. Of the 50 patients, 42 had never received any previous therapy and preoperative CT scanning revealed unresectable tumors because of advanced lymph node (station No.3, 7, 9, 12) or distant lymph node (No.14,16) metastases. The other 8 were characterized with relapse of severe lymph node metastases or with unresectable lymph node metastases demonstrated by exploratory laparotomy. Arteriovenous neoadjuvant FLEOX chemotherapy was conducted as follows: from day 1 to day 5, 5-FU 370 mg/m(2) and leukovorin 30 mg/kg intravenously, at day 6 and day 20, CDDP 70 mg/m(2) and epotoside 70 mg/m(2) intraarterially. This FLEOX regimen was repeated every five weeks for two or three courses. Out of the 50 patients,12 malnutritional cases received parenteral and/or enteral nutritional support according to the nutritional condition. Arteriovenous neoadjuvant FLEOX chemotherapy was then administered after the improvement of nutritional state. Their nutritional support methods were adapted to their chemotherapy as well.</p><p><b>RESULTS</b>All the patients' general conditions and symptoms were improved significantly. For the 50 cases, the imageological and histological response rate (CR+PR) was 84.0%, and curative resection rate was 78.0%. Thus, 39 patients underwent subtotal or total gastrectomy, even combined organ resection, with D(2)+alpha or D(3) lymphadenectomy. Despite neoadjuvant chemotherapy, all malnutritional cases had significant weight gain after nutritional support, and other nutritional indexes,such as serum albumin, also resumed to normal.</p><p><b>CONCLUSION</b>Arteriovenous neoadjuvant FLEOX chemotherapy proves favorable therapeutic effect for gastric cancer with advanced abdominal lymph node metastases, and downstages inoperable metastatic lymph nodes for radical operation. This combined modality regimen and nutritional support may play an important role in the treatment of advanced gastric cancer.</p>

Expression and clinical significance of Endostatin, vascular endothelial growth factor and fibroblast growth factor basic-2 in laryngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the expression and clinical significance of Endostatin, vascular endothelial growth factor (VEGF) and fibroblast growth factor basic-2 (FGF-2) in the laryngeal squamous cell carcinoma (LSCC).</p><p><b>METHODS</b>The expression of Endostatin, VEGF and FGF-2 in 50 specimens of LSCC, 40 specimens of para-carcinoma and 10 specimens of normal laryngeal tissues were examined by Flow cytometry.</p><p><b>RESULTS</b>Compared with para-carcinoma and normal laryngeal tissues, the expression level and positive rate of Endostatin, VEGF, FGF-2 in LSCC were different in statistics (P < 0.05); the expression level and positive rate of endostatin, VEGF, FGF-2 in LSCC are obviously higher than those in para-carcinoma and normal laryngeal tissues. The expression level and positive rate of Endostatin, VEGF, FGF-2 were no difference in statistics between para-carcinoma and normal laryngeal tissues (P > 0.05). The expression level and positive rate of Endostatin, VEGF, FGF-2 in LSCC were associated with lymphoid metastasis and clinical stage, not associated with age, sex and clinical group.</p><p><b>CONCLUSIONS</b>Endostatin, VEGF and FGF-2 play important role in the incidence, development and prognosis of the LSCC.</p>

The effects of angiotensin II on gene expression of hepatic stellate cells / 中华肝脏病杂志

<p><b>OBJECTIVE</b>Our previous investigation demonstrated that angiotensin II could induce proliferation and differentiation of hepatic stellate cells, and also could up-regulate its extracellular matrix synthesis. The objective of this study was to determine the effects of 10(-5) mol/L angiotensin II on gene expression of hepatic stellate cells.</p><p><b>METHODS</b>After incubation with 10(-5) mol/L angiotensin II for 48 hours, the cultured hepatic stellate cells were collected. The mRNA and total protein were obtained from cell lysate and then suppression subtractive hybridization (SSH), 2D-gel electrophoresis and MALDI-TOF mass spectrometry were used to identify these cDNAs and proteins.</p><p><b>RESULTS</b>A total of 36 clones from the subtracted cDNA library were sequenced and compared to sequences in the GenBank using BLAST. Of the 36 differentially expressed gene fragments from the subtracted library, 13 differentially expressed gene fragments showed significant homology to other known proteins, such as ribosomal protein, beta-actin FE-3, leucyl-tRNA synthetase, CD147, pyruvate kinase, peroxiredoxin 1, and BAT3, while 2 other gene fragments encoding protein BC097361 and BC057380 and their functions were not disclosed. About 1110 and 1008 protein spots were detected by employing the ImageMaster 2D Platinum 4.9 proteome image analysis system in angiotensin-treated hepatic stellate cells and control cells separately. Among these spots 108 proteins were up-regulated while the other 153 proteins were down-regulated. Several up-regulated proteins were chosen to be excised and in-gel digest MALDI-TOF-MS and Database analysis showed that among the high expression proteins, there were prohibitin, RBL-NDP kinase 1.8x10(4) subunit, electron transfer flavoprotein alpha-subunit, guanine nucleotide binding protein, alpha 15, and heat shock 7.0x10(4) protein 5.</p><p><b>CONCLUSION</b>Our results suggest that the up-regulation of hepatic stellate cell mRNA influences proliferation, differentiation and apoptosis of those cells. The proteins of signal transduction, metabolizing regulation, apoptosis suppression, and fibrogenesis regulation of hepatic stellate cells were up-regulated.</p>