Totally laparoscopic Billroth II( gastrectomy without intracorporeal hand-sewn sutures / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of a novel totally laparoscopic Billroth II gastrectomy.</p><p><b>METHODS</b>Twelve gastric cancer patients underwent totally laparoscopic D2 dissection without intracorporeal hand-sewn sutures in the Xijing Hospital of Fourth Military Medical University between May 2011 and July 2011. In this technique, circular stapling device was used for gastrojejunostomy, and an Endo GIA was used to close the incision at the greater curvature of the stomach. After the completion of the anastomosis, a side-to-side anastomosis (jejunum-afferent loop or jejunum-efferent loop) was performed using an Endo-GIA.</p><p><b>RESULTS</b>No patients required conversion to laparoscopy-assisted or open surgery. The operative time was 196.0±19.3 min, and the blood loss was 169.5±28.8 ml. The number of lymph node harvested was 25.1±3.3. The proximal resection margin and distal resection margin were 8.8±2.4 cm and 6.9±5.5 cm, respectively. The mean time to the first postoperative flatus was 3.1±1.3 days. The length of hospital stay was 4.5±1.9 days.</p><p><b>CONCLUSION</b>This technique is simple and quick. There is no need for laparoscopic hand-sewn suturing. It is safe to perform for totally laparoscopic gastrectomy and reconstruction.</p>

Intracorporeal hand-sewn technique used in totally laparoscopic colectomy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of hand-sewn anastomosis in totally laparoscopic colectomy.</p><p><b>METHODS</b>Clinical data of 19 consecutive patients with benign(n=5) or malignant colonic diseases(n=14, 4 ascending colon cancers, 2 transverse colon cancers, and 8 sigmoid colon cancers) treated with totally laparoscopic colectomy with a hand-sewn anastomosis were reviewed. All the procedures were performed by the same surgeon team including totally laparoscopic resection and hand-sewn anastomosis, ileocolic anastomosis after right hemicolectomy, and hand-sewn purse-string sutures in the colon.</p><p><b>RESULTS</b>Hand-sewn anastomosis was performed for 11 patients and circular-stapled anastomosis with hand-sewn purse-string sutures was performed for other 8 patients. The mean hand-sewn anastomosis time was (49.5 ± 29.4) min, and the mean hand-sewn purse-string sutures time was (13.3 ± 5.5) min. No patients required conversion to laparoscopy-assisted or open surgery, and there were no postoperative complications related to anastomosis. One patient with transverse colon lipoma developed mild intra-abdominal infection after surgery and recovered after conservative treatment.</p><p><b>CONCLUSION</b>Totally laparoscopic intracorporeal hand-sewn anastomosis or hand-sewn purse-string sutures for colectomy is feasible and safe when performed by experienced laparoscopic surgeons.</p>

Reproducibility of RTVue retinal nerve fiber layer thickness and optic nerve head measurements in normal and glaucoma eyes / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>RTVue spectral-domain optical coherence tomography (OCT) is a new, ultra high-speed and high-resolution instrument, potentially to measure the presence of glaucoma or its progression accurately. The objective of this study was to evaluate its reproducibility of retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) measurements in normal and glaucoma eyes.</p><p><b>METHODS</b>This study was an observational clinical study. One eye was selected randomly from each of 89 normal individuals and 63 glaucoma patients in a range of severity. RNFL thickness and ONH were measured 3 times on the same day to determine intrasession variability. The same instrument was used by the same operator for all scans. Intrasession within-subject standard deviation (Sw), precision (1.96 x Sw), coefficient of variation (CVw, 100 x Sw/overall mean), and intraclass coefficient (ICC) were calculated to evaluate reproducibility.</p><p><b>RESULTS</b>RTVue OCT demonstrated double hump patterns in the RNFL profiles. High reproducibility was observed in all ONH parameters. For normal eyes, the value of ICC ranged between 0.98 and 1.00. For eyes with different extent of glaucoma, it ranged between 0.94 and 1.00. High reproducibility was also observed in RNFL thickness measurements. The values of ICC for averaged RNFL thickness ranged between 0.95 and 1.00 in all cases. For regional parameters, it ranged from 0.94 to 0.98 for normal eyes, 0.94 to 1.00 for mild glaucoma eyes, 0.87 to 1.00 for moderate glaucoma eyes, and 0.77 to 0.97 for severe glaucoma eyes. The nasal regions of severe glaucoma appeared to be most variable, as nasal lower region and inferior nasal region had the ICC values of 0.77 and 0.87.</p><p><b>CONCLUSION</b>Reproducibility of RTVue RNFL and ONH measurements was excellent in normal and glaucoma groups.</p>

Expression and significance of new candidate tumor suppressor gene N-Myc downstream-regulated gene 2 in colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To determine the expression of new candidate tumor suppressor gene N-Myc downstream-regulated gene 2(Ndrg2) in colorectal cancer with different differentiation, and analyze its clinical significance.</p><p><b>METHODS</b>Specimens of 50 colorectal cancer patients with different differentiation were collected. Immunohistochemistry and Western blot were used to examine the expression of Ndrg2. Colorectal cancer tissue array in large scale was applied to analyze the expression of Ndrg2 and the statistics analysis was performed referring to the patients information of the array.</p><p><b>RESULTS</b>Among 50 cases, Ndrg2 expression level of colorectal cancer was significantly lower in 32 cases as compared to adjacent and normal tissue of the same individual, while Ndrg2 expression of adjacent tissue was significantly lower than that of normal tissue. Ndrg2 protein levels increased from poor-differentiated to well-differentiated carcinomas(P=0.005).</p><p><b>CONCLUSIONS</b>The expression of Ndrg2 in different differentiated colorectal cancer tissues show a significant distinction. Ndrg2 may be involved in the regulation of differentiation in colorectal cancer.</p>

Construction of rat bowel transforming growth factor beta1 recombinant adenovirus vector / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To construct a recombinant adenovirus vector which regulates the expression of rat transforming growth factor beta (TGF-beta1).</p><p><b>METHODS</b>Total RNA was extracted from F344/N rat small intestine pre-treated with Con A to clone TGF-beta1. pTRE-shuttle vector was used as mediator to ligate TGF-beta1 gene and backbone of replication-incompetent adenoviral vector. The constructed recombinant adenovirus contained tetracycline-responsive element which could regulate the expression of inserted genes. After identification, the desired recombinant adenovirus was packaged in HEK 293 cells. Supernatant of high titer adenovirus was collected to detect the TGF-beta1 gene expression by green fluorescent protein(GFP).</p><p><b>RESULTS</b>The constructed recombinant adenovirus was identified by restriction endonucleases cutting, sequencing, PCR and GFP examination.</p><p><b>CONCLUSION</b>Rat TGF-beta1 recombinant adenovirus is established successfully, which provides material and evidence for further research of dendritic cell (DC) modified by TGF-beta1 to induce immune tolerance in rat heterotopic small bowel transplantation.</p>

Laparoscopy-assisted D2 total gastrectomy in advanced gastric cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the efficacy and advantages of laparoscopy-assisted total gastrectomy (LATG) with D2 dissection of lymph nodes versus conventional open D2 total gastrectomy (OTG) in advanced gastric cancer.</p><p><b>METHODS</b>One hundred and twenty-five patients with advanced gastric cancer in the middle or upper third of the stomach were operated on from July 2005 to March 2007. Of the patients, 59 cases received LATG and 66 OTG with D2 lymph nodes dissection. Clinical data were recorded and compared between the two groups.</p><p><b>RESULTS</b>No patient in the LATG group converted to conventional operation with laparotomy. No operation mortality and no severe morbidity occurred in LATG group. As compared with OTG group, in LATG group operation time was longer [(330 +/- 71) min vs. (261 +/- 54) min, P =0.005] in LATG group, but with similar number of lymph node retrieval (36 +/- 13 vs. 34 +/- 16, P =0.450), less operation blood loss [(175 +/- 101) ml vs. (359 +/- 210) ml, P =0.003], earlier recovery of bowel activity (P = 0.015), and a shorter duration of fever after operation (P = 0.024).</p><p><b>CONCLUSIONS</b>LATG with D2 lymph node dissection in advanced gastric cancer is safe and technically feasible with better operative access and visual field, less operation blood loss and earlier recovery.</p>

Effect of Intrathymic Injection of Allogene Bone Marrow on Small Intestine Transplantation of Rats / 中国康复理论与实践

@#ObjectiveTo investigate the immune tolerance function and significance of allogene bone marrow injection to the small intestines transplantation of rats.MethodsInbreeding line rat F344/N and Wistar/A were selected to perform heterotopic graft of the whole small intestine. 7 days before allogene transplantation, donator bone marrow cells (BMC) were injected into thymus of acceptor (the testing group). According to the isogene and allogene rat transplant model, it was comprehended whether injecting allogene donator marrow into acceptor thymus could decrease the acute rejection after transplantation.Results3, 5 or 7 days after allogeneic rat dystopia whole small intestine transplantation, typical reject reaction appeared, but there was no reject reaction in isogenome and testing group. 3 days after allotransplantation, serum soluble interleukin-2 receptor (sIL-2R) and tumor necrotic factor-α (TNF-α) levels were significantly higher than the other groups (P<0.01). The level of serum sIL-2R and TNF-α in the allogene marrow injecting group were only slight higher on the 3rd or 5th day, and getting downtrend, and there was no significant difference compared with isogenic transplantation group.ConclusionAllogenic donator bone marrow intrathymic injecting into acceptor 7 days before small intestina transplantation, can reduce the reject reaction after the grafting. The levels of serum sIL-2R and TNF-α can be selected as a sensitive early diagnosis index of acute rejection after small intestine transplantation.

Development of apoptosis after small bowel transplantation in rats / 中国康复理论与实践

@#ObjectiveTo investigate the development of apoptosis during ischemia/reperfusion (IR) injury and acute rejection, and to explore the significance of apoptosis in the Graft Mesenteric Lymph Node (GALT) in a rat heterotopic small bowel transplant (SBT) model.MethodsSBT was performed in F344/N rats with either freshly harvested or preserved (4 h, in ringer lactate solution at 4 ℃) syngeneic and allogeneic (Wistar/A-F344/N) grafts. Bowel and GALT samples were collected 2 h after reperfusion and on small bowel transplant postoperative days (POD) 1, 4, and 7. Histopathology assessment of the graft and GALT were prepared for hematoxylin-eosin (H&E) staining. Apoptosis was detected by the TUNEL and the electron microscope. ResultsThe number of apoptotic cells 2 h after reperfusion increased profoundly in association with preservation. After a significant decrease on POD 1, the apoptotic cells rose again between POD 3 and 7 only in allogeneic grafts. On the other hand, the apoptotic cells in allogeneic GLAT markedly increased from POD 1 to day 3; at that time point, neither histological findings of rejection nor increase in apoptotic crypt cells were present in the graft jejunum. ConclusionIR injury and acute rejection may both induce extensive apoptosis. The graft jejunum distinct second increase in apoptosis may be an early and specific sign of acute rejection. Apoptosis of GLAT cells was well correlated with and ahead of progression of acute rejection.

Expression of mucosal addressin cell adhesion molecule-1 during small bowel graft rejection in rat / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expression of mucosal addressin cell adhesion molecule-1(MAdCAM-1) during small bowel graft rejection and the effects of MAdCAM-1 on the development of acute rejection.</p><p><b>METHODS</b>Rat heterotopic small bowel transplantation (SBT) was performed in F344/N rats with syngeneic and allogeneic (BN-F344/N) grafts. Bowel and gut-associated lymphoid tissue(GALT) samples were collected from small bowel transplants on postoperative day(POD) 1, 3, 5 and 7. Histopathology assessment of the grafts was conducted to identify the rejection. MAdCAM-1 was detected by immunohistochemistry and Western blot.</p><p><b>RESULTS</b>During acute rejection, MAdCAM-1 was highly-expressed on gut lamina propia and GALTs, particularly on vascular endothelial cells in the gut lamina propia. There were no change of MAdCAM-1 expression in syngeneic grafts from POD1 to POD7. In allogeneic grafts, MAdCAM-1 expression in mesenteric lymph nodes was down-regulated, while up-regulated on the vascular endothelial cells in the lamina propria during acute rejection.</p><p><b>CONCLUSION</b>Alteration of MAdCAM-1 expression may be associated with the development of SBT graft rejection.</p>