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Locally advanced tumor with involvement of surrounding tissues and organs is a common situation in pelvic malignancies. Up to 10% of newly diagnosed rectal cancer cases infiltrate to adjacent tissues and organs. Satisfactory resection margins obtained by pelvic exenteration can achieve a 5-year survival rate similar to cases that without adjacent tissue invasion. The 5-year survival rate of patients with locally recurrent pelvic malignancies is almost zero if they are treated only with radiotherapy and chemotherapy. To obtain negative margins through pelvic exenteration is the only chance for a long-term survival of these patients. However, pelvic exenteration is a complicated procedure with higher morbidity and mortality. The development of fascia anatomy enables surgeons to have a deeper understanding and comprehensive application of pelvic fasciae. Meanwhile, the improvement of laparoscopic technology provides a clearer view for surgeons and enables the application of minimally invasive techniques in complex pelvic exenteration. The fascial space priority approach is based on the fascia anatomy of pelvis and giving priority to the separation of the pelvic avascular fascial spaces, which provides a reproducible surgical approach for complex pelvic exenteration.
Subject(s)
Humans , Pelvic Exenteration/methods , Pelvic Neoplasms , Neoplasm Recurrence, Local/surgery , Rectal Neoplasms/surgery , Pelvis/pathology , Retrospective StudiesABSTRACT
Objective To evaluate the significance of liver biopsy and B ultrasonograpgy in the diagnosis of fatty liver. Methods The results of 62 patients with liver steatosis diagnosed by liver puncture biopsy but not by B-ultrasonograpgy were contrastively analyzed and combined with liver function, blood lipids, blood glucose, and body mass index. Results The 62 cases which were not diagnosed as fatty liver by B-ultrasonograpgy were proved to be 5％-33％liver steatosis after liver puncture biopsy. Among the 62 cases, 23 cases were indicated by the B-ultrasonograpgy that the liver parenchyma echo did not see abnormalities, 18 cases showed the liver parenchyma echo slightly was enlarged, 17 cases showed the liver parenchyma echo density was a bit enhanced and 4 cases were diffuse liver damage,which respectively were 37.01％、29.03％、27.42％and 6.45％. Pathologically it indicated that 45 cases were 5％≤liver steatosis≤19％. Among the 45 cases, 18 cases were indicated by the B-ultrasonograpgy that the liver parenchyma echo was not seen abnormalities, 8 cases showed the liver parenchyma echo slightly was enlarged, 17 cases showed the liver parenchyma echo density was a bit enhanced, and 2 cases were diffuse liver damage, and the change of ultrasound was mainly showed by the liver parenchyma echo not seen abnormalities and the enhanced liver parenchyma echo density. Pathologically it indicated that 17 cases were 20％≤liver steatosis≤33％, 6 cases were indicated by the B-ultrasonograpgy that the liver parenchyma echo did not see abnormalities, 5 cases showed the liver parenchyma echo slightly was enlarged, 5 cases showed the liver parenchyma echo density was a bit enhanced, and 1 case was diffuse liver damage, and the change of ultrasound was mainly showed by the liver parenchyma echo not seen abnormalities, the slightly enlarged liver parenchyma echo and the enhanced liver parenchyma echo density. By analyzing the influence to the ultrasound changes by patients' liver function, body mass index, blood fat and blood sugar, and with logistic regression analysis through a disorderly classification, it was found that the larger value of the glutamine transferase, alkaline phosphatase, body mass index, triglyceride and low density lipoprotein cholesterol, the higher possibility of diffuse liver damage, and the higher level of fatty degeneration, the higher possibility of diffuse liver damage. Conclusion In the diagnosis of fatty liver, when the fatty degeneration is below 1/3, B-ultrasonic examination can't show characteristic changes of fatty liver. It should be closely observed or take liver puncture biopsy to make a definite diagnosis of fatty liver.
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<p><b>Background</b>The sigma receptors are a relatively novel receptor group with respect to knowledge of their effect on health. Although the sigma-1 receptor agonist PRE-084 exhibits a cardioprotective effect in some studies, the benefits in cases of myocardial ischemia/reperfusion (I/R) are not clear. The aim of this study was to explore the mechanism of action and assess the effect of PRE-084 on myocardial I/R injury in rats.</p><p><b>Methods</b>In this study, rats were assigned randomly to three groups with computer (n = 14 for each group): a sham group, an I/R group, and a PRE-084 group. In the PRE-084 group, rats were administered PRE-084 1 h before operation. In the myocardial I/R model, the left anterior descending branch of rats was ligated and opened half an hour later. Cardiac function was assessed, and the apoptosis index was evaluated. The mechanisms of the cardioprotective effects of PRE-084 were explored.</p><p><b>Results</b>PRE-084 pretreatment preserved cardiac function and reduced myocardial apoptosis (F = 86.0, P < 0.01) with Western blotting analysis, showing significantly reduced expression of Bax (F = 75.7, P < 0.01) and cleaved-caspase 3 (F = 44.7, P < 0.01), along with increased expression of the Bcl-2 protein (P < 0.01) and phosphorylated protein kinase B (p-Akt) (P < 0.01) and phosphorylated-endothelial nitric oxide synthase (p-eNOS; P < 0.01).</p><p><b>Conclusion</b>PRE-084 preserved cardiac function and reduced myocardial apoptosis through the activation of Akt and eNOS.</p>
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AIM To explore the protective effects of Huoxue Kangnao Granules (Astragali Radix,Morindae officinalis Radix,Puerariae lobatae Radix,etc.) on cerebral ischemia-reperfusion injury in rats.METHODS The rat model for middle cerebral artery occlusion (MCAO) was established,SD rats were randomly divided into sham operation group,model group,positive control group,Huoxue Kangnao Granules low-,middle-and highdose groups.Nerve function score was tested.Volume of cerebral infarction was calculated by TTC staining.SOD,MDA,6-keto-PGF1α,TXB2,IL-1 β and TNF-α were detected by ELISA.The expression levels of MMP-9 and ICAM-1 were detected by RT-PCR.To observe the influence of Huoxue Kangnao Granules on platelet aggregative function,clotting time was analyzed by automatic blood coagulation analyzer,plasma T-PA and PAI activities were determined by ELISA,and hemorheology indices were detected by automatic biochemical analyzer.RESULTS Huoxue Kangnao Granules could significantly decrease cerebral infarction volume,improve nerve function,reduce MDA content,increase SOD activity;increase 6-keto-PGF1 α level,reduce TXB2 content;decrease TNF-α and IL-1β expressions;inhibit MMP-9 and ICAM-1 expressions;extend KPTT and PT;elevate t-PA activity,inhibit PAI activity;decrease whole blood viscosity,enhance erythrocyte deformation ability.Each dosage group of Huoxue Kangnao Granules had a positive correlation between dose and response.CONCLUSION Huoxue Kangnao Granules can protect cerebral ischemia-reperfusion injury in rats,whose mechanisms may be related to anti-free radical injury,anti-thrombus,anti-cerebral vasospasm,improving cerebrovascular permeability,anti-inflammatory,anti-coagulation and improving abnormal changes of hemorheology.
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AIM To explore the anti-heart failure effects of compatibility of glycyrrhetinic acid,liquiritin and hypaconitine on apoptotic pathway in rats with chronic heart failure and the possible mechanism of action.METHODS Sixty rats were operated through transverse aortic constriction to create the chronic heart failure models.After four weeks,these rats were randomly divided into seven groups:sham group (n =6),model group (n =7),digoxin group (n =8),hypaconitine group (n =9),glycyrrhetinic acid + hypaconitine group (n =9),liquiritin + hypaconitine group (n =9),glycyrrhetinic acid + liquiritin + hypaconitine group (n =9).Then the rats were given medicines or saline perfusion by oral gavage for one week.On the 7th day,the rats were executed.Before the rats were killed,the blood samples were obtained and echocardiographic were carried on to get the ejection fraction (EF) and fractional shortening (FS) data;and the ELISA test was done for type B natriuretic peptide (BNP) changes;and myocardial histopathological examinations were performed on Bcl-2,Bax and Caspase-3.And the protein expressions of Fas and Fas-L were detected by Western blot.RESULTS Compared with the model group,the expression of Bcl-2 of all the compatibility groups except the hypaconitine group was higher than that of the model group;the expressions of Bax,Caspase-3,Fas and Fas-L,besides with the measurements of EF,FS and BNP were lower than those of the model group,and the glycyrrhetinic acid + liquiritin + hypaconitine group showed the best effect.CONCLUSION The compatibility of hypaconitine,glycyrrhetinic acid and liquiritin could down-regulate the levels of EF,FS and BNP,together with the protein expressions of pro-apoptosis,meanwhile,up-regulate the protein expressions of anti-apoptosis.This might be one of the mechanisms for the anti-apoptosis effects on chronic heart failure by compatibility of Glycyrrhizea radix et rhizoma (Gancao) and Acontti lateralis Radix praparata (Fuzi).
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AIM To explore the anti-heart failure effects of compatibility of glycyrrhetinic acid,liquiritin and hypaconitine on apoptotic pathway in rats with chronic heart failure and the possible mechanism of action.METHODS Sixty rats were operated through transverse aortic constriction to create the chronic heart failure models.After four weeks,these rats were randomly divided into seven groups:sham group (n =6),model group (n =7),digoxin group (n =8),hypaconitine group (n =9),glycyrrhetinic acid + hypaconitine group (n =9),liquiritin + hypaconitine group (n =9),glycyrrhetinic acid + liquiritin + hypaconitine group (n =9).Then the rats were given medicines or saline perfusion by oral gavage for one week.On the 7th day,the rats were executed.Before the rats were killed,the blood samples were obtained and echocardiographic were carried on to get the ejection fraction (EF) and fractional shortening (FS) data;and the ELISA test was done for type B natriuretic peptide (BNP) changes;and myocardial histopathological examinations were performed on Bcl-2,Bax and Caspase-3.And the protein expressions of Fas and Fas-L were detected by Western blot.RESULTS Compared with the model group,the expression of Bcl-2 of all the compatibility groups except the hypaconitine group was higher than that of the model group;the expressions of Bax,Caspase-3,Fas and Fas-L,besides with the measurements of EF,FS and BNP were lower than those of the model group,and the glycyrrhetinic acid + liquiritin + hypaconitine group showed the best effect.CONCLUSION The compatibility of hypaconitine,glycyrrhetinic acid and liquiritin could down-regulate the levels of EF,FS and BNP,together with the protein expressions of pro-apoptosis,meanwhile,up-regulate the protein expressions of anti-apoptosis.This might be one of the mechanisms for the anti-apoptosis effects on chronic heart failure by compatibility of Glycyrrhizea radix et rhizoma (Gancao) and Acontti lateralis Radix praparata (Fuzi).
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<p><b>BACKGROUND</b>Microalbuminuria (MAU) is a key component of metabolic syndrome (MetS) and is an early sign of diabetic nephropathy as well. Although routine Western medicine treatments are given to MetS patients to control high blood pressure, hyperglycemia and dyslipidemia, some patients still experience progressive renal lesions and it is necessary to modify and improve the treatment strategy for MetS patients.</p><p><b>OBJECTIVE</b>To investigate the efficacy of Yiqi Huaju Qingli Herb Formula, a compound traditional Chinese herbal medicine, in MetS patients with MAU when it is combined with routine Western medicine treatment.</p><p><b>DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS</b>Sixty patients with MetS were randomized into the Chinese herbal formula group (CHF, Yiqi Huaju Qingli formula treatment in combination with Western medicine) and control group (placebo in combination with Western medicine). All treatments were administered for 12 weeks.</p><p><b>MAIN OUTCOME MEASURES</b>Urinary microalbumin (MA), urinary albumin-to-creatinine ratio (UACR), 24-hour total urine protein (24-hTP), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2-hPPG), glycosylated hemoglobin (HbA1c), homeostasis model assessment for insulin resistance (HOMA-IR), blood lipid profile and blood pressure were observed.</p><p><b>RESULTS</b>Compared with the control group, CHF treatment significantly decreased BMI (P<0.05), WC (P<0.01) and WHR (P<0.01). Both groups had significant decreases in FPG, 2-hPPG, HbA1c, HOMA-IR, MA, and UACR, with CHF treatment showing better effects on these parameters compared with the control treatment (P<0.05). Both treatments significantly reduced the levels of total cholesterol, low-density lipoprotein cholesterol and triacylglycerol (TAG), and a greater reduction in TAG was observed with CHF treatment (P<0.05). The level of high-density lipoprotein cholesterol did not change in the control group after treatment (P>0.05), whereas it significantly increased with CHF treatment (P<0.01). Compared with before the treatment, significant decreases in systolic blood pressure, diastolic blood pressure and mean arterial blood pressure were observed in both groups (P<0.01). However, there was no significant difference between the two groups (P>0.05).</p><p><b>CONCLUSION</b>Combined treatment of Yiqi Huaju Qingli Formula and Western medicine significantly alleviated MAU, which may correlate with the improvement of insulin sensitivity and glucose and lipid metabolism. TRIAL REGISTRATION IDENTIFIER: This trial was registered in the Chinese Clinical Trial Registry with the identifier ChiCTR-TRC-11001633.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Albuminuria , Drug Therapy , Metabolism , Blood Glucose , Metabolism , Drugs, Chinese Herbal , Therapeutic Uses , Glycated Hemoglobin , Metabolism , Lipids , Blood , Metabolic Syndrome , Drug Therapy , Metabolism , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To evaluate the necessity of defunctioning stoma in low anterior resection for rectal cancer below peritoneal reflection.</p><p><b>METHODS</b>The databases of Medline, Embase, Cochrane Library, Wanfang and CNKI were searched. The eligible studies were identified for pooled analyses.</p><p><b>RESULTS</b>Six randomized controlled trials with 648 cases(332 patients with defunctioning stoma and 316 without stoma) and 25 retrospective controlled trials with 10,722 cases(4,470 patients with defunctioning stoma and 6,252 without stoma) were included. Combined analyses showed that defunctioning stoma was effective for decreasing risk of postoperative anastomotic leakage (RR=0.33 and 95% CI:0.21-0.53 for RCTs, OR=0.60 and 95% CI:0.42-0.85 for retrospective studies), reoperation (RR=0.30, 95% CI:0.16-0.53 for RCTs, OR=0.26 and 95% CI:0.21-0.32 for retrospective studies) and mortality(OR=0.41, 95% CI:0.27-0.62 for retrospective studies).</p><p><b>CONCLUSION</b>Defunctioning stoma should be routinely performed in low anterior resection for high-risk patients.</p>
Subject(s)
Humans , Anastomotic Leak , Enterostomy , Methods , Postoperative Complications , Randomized Controlled Trials as Topic , Rectal Neoplasms , General SurgeryABSTRACT
<p><b>OBJECTIVES</b>To evaluate the relationship between epithelial-mesenchymal transition and basal cell-like phenotype breast cancer (BLBC).</p><p><b>METHODS</b>Three hundred and eighty two cases of breast cancers including basal cell-like, luminal A, luminal B and Her-2 subtypes were collected from 458 cases of invasive breast cancers based on their immunophenotypes. They were then stained immunohistochemically with FOXC-2, vimentin, Syndecan-1 and E-cadherin. The relationship of these markers with the basal cell-like phenotype of breast cancer was studied.</p><p><b>RESULTS</b>Of the 41 BLBC cases, FOXC-2, vimentin and Syndecan-1 were positive in 14 cases (34.1%), 18 cases (43.9%) and 36 cases (87.7%) respectively; E-cadherin expression was reduced in 26 cases (63.4%). The positive rates of FOXC-2 and vimentin were higher in BLBC than in other subtypes of breast cancer (P < 0.01). The expression of E-cadherin was the lowest among the 4 subtypes of breast cancers (P < 0.01). Syndecan-1 was positive in the stromal cells adjacent to cancer cells in 17 cases (41.5%) BLBC and the expression was higher than that in other subtypes (P = 0.007). There existed a correlation between FOXC-2 and vimentin expression in BLBC (r = 0.607, P < 0.01). The rates of positive lymph nodes in FOXC-2 and vimentin positive BLBC cases were 71.4% and 66.7% respectively, and both were higher than those of FOXC-2 and vimentin negative BLBC cases (P = 0.002 and P = 0.001).</p><p><b>CONCLUSION</b>Epithelial-mesenchymal transition is probably related to the basal cell-like phenotype of breast cancers, and this may be one of the reasons accounting for the different biological behavior of BLBC from other subtypes of breast cancer.</p>
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Biomarkers, Tumor , Metabolism , Breast Neoplasms , Classification , Metabolism , Pathology , Cadherins , Metabolism , Carcinoma, Ductal, Breast , Classification , Metabolism , Pathology , Carcinoma, Lobular , Classification , Metabolism , Pathology , Epithelial-Mesenchymal Transition , Forkhead Transcription Factors , Metabolism , Immunophenotyping , Lymphatic Metastasis , Phenotype , Syndecan-1 , Metabolism , Vimentin , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To study the clinicopathologic characteristics of basal-like immunophenotype breast cancer (BLBC).</p><p><b>METHODS</b>458 cases of female infiltrative breast cancer were studied using immunohistochemical staining with an antibody panel of ER, PR, HER2, Ki-67, CK5/6, CK14 and epidermal growth factor receptor (EGFR) and were classified basing on the immunophenotypes. The clinicopathologic characteristics were compared with other immunophenotypes of breast cancer. 228 of 458 cases of breast cancer were followed up.</p><p><b>RESULTS</b>46 cases of BLBC were screened out among the 458 breast cancers. And histological features of BLBC were analysed including the larger diameter of cancer foci (average 3.3 cm), appearance of squeezing phenomenon of neighboring cell borders (58.7%, 27/46), geography-like distribution of necrosis (52.2%, 24/46), central zone fibrosis (30.4%, 14/46) and lymphoplasmacytic infiltration at the margin and stroma (63.0%, 29/46). There were nuclear pleomorphism with numerous mitoses. The cancer cells were closely arranged, forming irregular solid architectures. There was a high expression (> 25%) of Ki-67 (43.5%, 20/46). CK5/6, CK14 and EGFR were positive in 58.7% (27/46), 43.5% (20/46) and 65.2% (30/46) respectively. 3-year survival rate of BLBC was 66.9%, lower than the luminal A breast cancer and similar to HER2 over-expression breast cancer.</p><p><b>CONCLUSIONS</b>The proportion of BLBC in the group of breast cancers is 10%. BLBC has its distinct histological and cytological features. Currently, it is still necessary to depend on immunophenotyping in making a BLBC diagnosis. BLBC is the one of breast cancer subtypes with the poorest prognosis.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Biomarkers, Tumor , Allergy and Immunology , Breast Neoplasms , Diagnosis , Allergy and Immunology , Metabolism , Pathology , Immunophenotyping , Methods , Prognosis , ErbB Receptors , Allergy and Immunology , Receptor, ErbB-2 , Allergy and Immunology , Receptors, Estrogen , Allergy and Immunology , Receptors, Progesterone , Allergy and Immunology , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To observe the therapeutic effect of combined therapy of modified Kangjia Recipe (KR) and western medicine propylthiouracil (PTU) on hyperthyroidism and to assess its advantage.</p><p><b>METHODS</b>Ninety patients with hyperthyroidism were divided into the treatment group (TG) and the control group (CG). The 60 patients in TG treated with KR and PTU, and the 30 patients in CG treated with PTU alone. The treatment course of both groups was 3 months. The serum thyroid hormone (TH) level, clinical symptoms and signs, and adverse reaction were observed before and after treatment.</p><p><b>RESULTS</b>The serum TH level, clinical symptoms and signs were significantly improved after treatment in both groups (all P < 0.01). The total effective rate was 93.3% in TG, which was higher than that in CG (83.3%, P < 0.01); and the efficacy in improving palpitation, fidget, aversion to heat, sweating and insomnia was better in the TG than that in the CG respectively (P < 0.05). As for the incidence of adverse reaction, it that was lower in the TG than in the CG.</p><p><b>CONCLUSION</b>KD has good efficacy in treating hyperthyroidism, and the combined treatment of Chinese and Western medicine shows obvious advantages.</p>