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Objective:To investigate clinical efficacy of conformal sphincter preservation operation (CSPO) versus intersphincteric resection (ISR) in the treatment of low rectal cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 183 patients with low rectal cancer who were admitted to two medical centers (117 in the Changhai Hospital of Naval Medical University and 66 in the Huashan Hospital of Fudan University) from August 2011 to April 2020 were collected. There were 110 males and 73 females, aged (57±11)years. Of 183 patients, 117 cases undergoing CSPO were allocated into CSPO group, and 66 cases undergoing ISR were allocated into ISR group, respectively. Observation indicators: (1) surgical situations of patients with low rectal cancer in the two groups; (2) postoperative complications of patients with low rectal cancer in the two groups; (3) follow-up; (4) influencing factors for prognosis of patients with low rectal cancer; (5) influencing factors for satisfaction with the anal function of patients with low rectal cancer. Follow-up was conducted using outpatient examination, questionnaire and telephone interview to determine local recurrence, distal metastasis, survival, stomal closure, satisfaction with the anal function of patients. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Comparison of ordinal data was analyzed using the rank sum test.The Kaplan-Meier method was used to draw survival curves, and life table method was used to calculate survival rates. Log-rank test was used for survival analysis. Univariate analysis was performed using the linear regression. Variables with P<0.10 in the univariate linear regression analysis were included for multivariate analysis. Multivariate analysis was performed using the COX stepwise regression model and linear regression analysis. Results:(1) Surgical situations of patients with low rectal cancer in the two groups: cases with laparoscopic surgery, operation time, volume of intraoperative blood loss, distance from tumor to distal margin, cases with postoperative chemotherapy, duration of postoperative hospital stay were 44, (165±54)minutes, (142±101)mL, (0.6±0.4)cm, 76, (6.6±2.5)days for the CSPO group, respectively, versus 55, (268±101)minutes, (91±85)mL, (1.9±0.6)cm, 9, (7.9±4.7)days for the ISR group, showing significant differences between the two groups ( χ2=35.531, t=8.995, -3.437, -3.088, χ2=44.681, t=2.267, P<0.05). (2) Postoperative complications of patients with low rectal cancer in the two groups: 19 patients in the CSPO group had complications. There were 6 cases with grade Ⅰ complications, 12 cases with grade Ⅱ complications, 1 case with grade Ⅲb complication. Fourteen patients in the ISR group had complications. There were 4 cases with grade Ⅰ complications, 7 cases with grade Ⅱ complications, 1 case with grade Ⅲa complication, 2 cases with grade Ⅲb complications. There was no significant difference in the postoperative complications between the two groups ( χ2=0.706, P>0.05). Patients with complications in the two groups were improved after symptomatic and supportive treatment. There was no perioperative death in the postoperative 30 days of the two groups. (3) Follow-up: 183 patients received follow-up. Patients of the CSPO group and ISR group were followed up for (41±27)months and (37±19)months, respectively, showing no significant difference between the two groups ( t=-1.104, P>0.05). There were 2 cases with local recurrence and 9 cases with distal metastasis of the CSPO group, respectively, versus 3 cases and 4 cases of the ISR group, showing no significant difference between the two groups ( χ2=1.277, 0.170, P>0.05). The 3-year disease-free survival rate and 3-year total survival rate were 84.0% and 99.0% for the CSPO group, versus 88.6% and 92.8% for the ISR group, showing no significant difference between the two groups ( χ2=0.218, 0.002, P>0.05). The stomal closure rate was 92.16%(94/102) and 96.97%(64/66) for 102 patients of CSPO group and 66 patients of ISR group up to postoperative 12 months,respectively, showing no significant difference between the two groups ( χ2=1.658, P>0.05). Of the 8 cases without stomal closure in the CSPO group, 2 cases refused due to advanced age, 4 cases subjectively refused, and 2 cases were irreducible due to scar caused by radiotherapy. Two cases in the ISR group had no stomal closure including 1 case of postoperative liver metastasis and 1 case of subjective refusal. There were 92 and 61 patients followed up to 12 months after stomal closure, of which 75 cases and 38 cases completed questionnaires of satisfaction with the anal function. The satisfaction score with the anal function was 6.8±2.8 and 5.4±3.0 for CSPO group and ISR group, respectively, showing a significant difference between the two groups ( t=-2.542, P<0.05). Fifty-four cases in the CSPO group and 21 cases in the ISR group had satisfaction score with the anal function >5, showing no significant difference between the two groups ( χ2=3.165, P>0.05). (4) Influencing factors for prognosis of patients with low rectal cancer: results of COX stepwise regression analysis showed that gender and pT staging were independent influencing factors for disease-free survival rate of patients with low rectal cancer ( hazard ratio=2.883, 1.963, 95% confidence interval as 1.090 to 7.622, 1.129 to 3.413, P<0.05). Gender and pT staging were independent influencing factors for total survival rate of patients with low rectal cancer ( hazard ratio=10.963,3.187, 95% confidence interval as 1.292 to 93.063, 1.240 to 8.188, P<0.05). (5) Influencing factors for satisfaction with the anal function of patients with low rectal cancer: results of univariate analysis showed that surgical method and tumor differentiation degree were related factors for satisfaction with the anal function of patients with low rectal cancer (partial regression coefficient=1.464, -1.580, 95% confidence interval as 0.323 to 2.605, -2.950 to -0.209, P<0.05). Results of multivariate analysis showed that surgical method, tumor differentiation degree and preoperative radiotherapy were independent influencing factors for satisfaction with the anal function of patients with low rectal cancer (partial regression coefficient=1.637, -1.456, -1.668, 95% confidence interval as 0.485 to 2.788, -2.796 to -0.116, -2.888 to -0.447, P<0.05). Conclusion:Compared with ISR, CSPO can safely preserve the anus in the treatment of low rectal cancer, without increasing the incidence of postoperative complications, which can also guarantee the oncological safety and improve the postoperative anal function.
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It has been 20 years since Intersphincteric resection(ISR) was used as a supplement to Abdominoperineal resection(APR) for ultra-low rectal cancer. With the help of removing conjointed longitudinal muscle and total or partial internal sphincter, R0 resection is achieved under the condition of preserving external sphincter, levator ani muscle, and part of internal sphincter, thereby retaining part of the anal function. This article reviews the indications, anatomy, physiology and treatment outcomes of ISR.
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The anorectum is a complex region, whose anatomic structure is the basis and premise of intersphincteric resection (ISR) for low rectal cancer. With the development of pelvic surgery and minimally invasive surgery, the anatomic approaches, surgical planes, extent of excision and reconstruction strategies of ISR have been better understood. Surgeons can furthest preserve anal function as well as adhere to the principles of radical resection. However, the anatomy of the anorectum has not been fully understood. We hope further exploration of the anal canal anatomy, including the perirectal fascia, rectourethral muscle, anococcygeal ligament, hiatal ligament, levator ani muscle, internal and externals phincter, intersphincteric nerves, conjointed longitudinal muscle, intersphincteric spaces and the surgical approaches, by reviewing relevant literatures combined with the experiences of our clinical practice and applied anatomy, will help to improve the accuracy of the surgeries and increase the oncologic and functional outcomes of ISR.
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Objective To investigate the clinical efficacy of liver resection combined intraoperative choledochoscope for intra‐hepatic biliary calculi .Methods A retrospective analysis of clinical data in seventeen patients with intrahepatic biliary calculi ,who have been received liver resection combined intraoperative choledochoscope in the department of hepatobiliary surgery during 2005 to 2014 was conducted .According to the distribution of intrahepatic bile duct stones ,six cases located in left liver lobe ,five cases lo‐cated in left half liver ,three cases located in liver section Ⅵ ,one case located in liver section Ⅶ ,one case located in liver section Ⅷ , one case located in left liver lobe associated with right posterior lobe lower segment .Seventeen cases were treated with hepatolobec‐tomy or segmental liver resection (single clamp method combined first hilar occlusion) ,among which six cases received hepatic left lateral lobectomy ,five cases received left hemihepatectomy ,three cases received partial hepatic resection in paragraph Ⅶ ,one case received partial hepatic resection in paragraph Ⅶ and one in Ⅷ ,one case received the left lateral lobe combined right posterior lower segmental resection ,ten cases at the same time received choledocholithotomy and T tube drainage .Results All patients were cured without serious complications ,no long term stone recurrence .Conclusion Liver resection combined intraoperative choledochoscope is positive and effective treatment for intrahepatic biliary calculi patients .
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Nucleobindin2protein(NUCB2)isanewlydiscoveredneuropeptideprecursorprotein, which has a comprehensive cytology function and is expressed in the hypothalamus nucleus and many peripheral tissues.There aren′t many studies about its signaling pathway,where neuroendocrine regulation,cell survival growth,tumor suppressor,cytokine secretion were found to involve in it.Besides,it has also been confirmed that breast cancer,lung cancer,ovarian cancer and prostate cancer are closely related to NUCB2.Therefore, several downstream pathways of NUCB2 may be related to the formation and progression of tumor.Further stud-ies are still needed to clarify the signal pathways of NUCB2 to provide a reliable basis for clinical cancer preven-tion.
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Objective To detect the nucleation-promoting potency of retinol binding protein (RBP) in the simulated bile system,and observe the process of cholesterol nucleation and crystallization.Methods Small and synthetic bile systems were synthesized.RBP (RBP group),α1-acid glycoprotein (AAG,AAG group) and albumin ( Alb,Alb group) were added into the Small bile respectively.The derived indices of nucleation time,crystal growth rate and final concentration of crystal were studied by Busch method.Alb ( control group) and RBP (experimental group) were added into the Small and synthetic bile systems respectively.The nucleation time was detected by polarizing microscopy according to the Holan method and the nucleation-promoting potency was calculated according to the Holzbach method. The morphological dynamics of cholesterol nucleation and crystallization were observed under a light microscope.All data were analyzed by using the analysis of variance or the t test.Results The derived indices of nucleation time,crystal growth rate and final concentration of crystal were 0.66,1.29 and 1.01 in the AAG group,and 0.73,1.02,0.95 in the RBP group,respectively.In the Small bile system,the average nucleation time of cholesterol monohydrate crrystals were ( 12.2 ± 1.2 )days in the control group and (8.2 ± 1.5)days in the experimental group,respectively,with a significant difference between the 2 groups (t =2.97,P ＜ 0.05 ).The nucleation activity of RBP was 0.67 in the Small bile system.In the synthetic bile system,the average nucleation time of cholesterol monohydrate crystals were (9.5 ± 1.1 ) days in the control group and (7.5 ± 1.1 )days in the experimental group,respectively,with a significant difference between the 2 groups ( t =2.35,P ＜ 0.05 ).The nucleation activity of RBP was 0.79 in the synthetic bile system.The process of cholesterol nucleation and crystallization was divided into 4 stages,and the split phenomenon appeared in the bile system at day 21.Conclusion RBP is a pro-nucleation factor in simulated bile system.
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The PIK3CA gene codes p100α,the catalytic subunit of phosphatidylinositol 3-kinase (PI3K) and is involved in the initiating the PI3K/AKT pathway.PIK3CA plays its biological roles through.downstream PI3K pathway. PIK3CA gene mutants can be detected in many kinds of tumors. The mutant PIK3CA gene can abnormally activate PI3K pathway,leading to the abnormal cell cycle,decreased cell adhesion,down regulated apoptosis and neovascularization,and then promotes tumor genesis and development.Recent researches have found that mutant PIK3CA gene is closely correlated with the genesis,development,differentiation,metastasis and drug resistance of colorectal cancer.Research of PIK3CA in colorectal cancer may provide significant evidence for the early diagnosis,gene screen,therapeutic regimen making,recurrence and follow up.
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Objective Brain metastasis(BM) is unusual in colorectal carcinoma(CRC) patients.This study was to evaluate the characteristics and prognosis of brain metastasis of colorectal carcinoma patients.Methods Twenty-eight consecutive CRC patients underwent surgical resection for BM between January 2001 and December 2008.The clinical data were analyzed by univariate (logrank) and Cox regression test.Results The median age at BM diagnosis from CRC was 57 years(41-75 years).Median survival after neurosurgical intervention was 9.4 months.The 1-year and 5-year survival rates were 28.9%and 7.1%,respectively.Seventeen patients(61%)had concurrent systemic metastasis.All patients were symptomatic with neurologic deficits and symptoms.On multivariate analysis,gender,infratentorial location of lesions and characteristics of primary CRC had no significant impact on survival.Two factors were signitlcandy associated with better survival:single brain metastases and absence of extracranial metastases.Perioperative mortality was zero.There were no difference of survival among patients undergoing resection alone and resection combined with whole brain radiotherapy (WBRT) or stereotactic radiosurgery(SRS). Conclusions Brain metastases from colorectal cancer is an evil omen of poor prognosis of CRC patients.Sursical resection of symptomatic brain metastases from colorectal cancer is relatively safe and provides the opportunity for prolonged survival.
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Objective To investigate the prognostic factors of gastrointestinal stromal tumors.Methods From Nov.1999 to Dec.2006,a total of 85 patients were diagnosed by postoperative pathology as gastrointestinal stromal tumors.The relationship between the prognosis of GIST and demographic factors、tumor location、operation style、preoperative metastasis、lymphadenectomy、grading of Fletcher were analyzed retrospectively.Results The 1 year、3 year and 5 year survival rate of these 85 patients were 94%,60%,57%respectively,Univariate analysis indicated that tumor location、operation style、grading of Fletcher and preoperative metastasis were significant predictors of survival(P<0.05),while demographics and lymphadenectomy were not statistically related with prognosis.Multivariate analysis showed that preoperative metastasis was the independent factor predicting the prognosis(P=0.020,β=4.226).Conclusion Radical surgical excision is still the therapy of choice for primary gastrointestinal stromal tumors.Preoperative metastasis is the independent factor predicting poor prognosis,therefore early diagnosis and treatment are very important for GIST.Fletcher grading is also a simple recalls to predict the prognosis of GIST.
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Colorectal cancer is one of the malignant tumors that endangers human health. Nowadays the surgery is the primary therapy for colorectal cancer. Laparescopic surgery has developped for more than ten years. It consolidates its position in the field of colorectal surgery gradually. We now make a comparison of laparoscopic surgery and open surgery about the safety, the pathophysiological influence and the effective-ness, etc, in order to discuss the value of the laparoscopic surgery in the therapy of colorectal cancer.
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Hepatic stellate cells(HSCs) are the mesenchymal cells in the liver. In the process of tumori-genesis and metastasis, the interactions between HSCs and tumor ceils play an important role in promoting tumor invasion through extracellular matrix remodelling. Here we review the latest investigative advances a-bout the tumor-stromal interactions.
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Gastrointestinal stromal tumors are rare tumors of alimentary tract and originated from the interstitial Cajal cells,with acquired mutation of KIT(CD117).Surgery is the main therapy for resectable tumors,while imatinib,a small-molecule inhibitor of receptor of tyrosine kinase,plays an important role in treating metastatic and recurrent tumors.
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Apoptosis is great advancement in sphere of biology,it is characteristic death form at physiological state.Rencent researchs discover that apoptosis take important role in transplantation immunity.That graft is rejected is the major obstruction in transplantation.Allogeneic transplantation rejection is because of immune response that is mediated by T lymphocyte and aimed directly at allogenic antigen.Apoptosis of activated T lymphocyte through some pathways can induce immune tolerance.Some immune suppressant produce effect just by cell apoptosis.This review mainly presents recent advance in transplantation tolerance induced by apoptosis of T lymphocyte.
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OBJECTIVE: To establish a rapid and precise detective method of 33.5 kd vesicular protein and to screen an effective treatment of cholelithiasis. METHODS: Specific antibody of the biliary vesicular protein was obtained by immunizing rabbits and enzyme-linked immunosorbent assay (ELISA) kit was developed. The concentrations of 33.5 kd vesicular protein in serum and bile of gallstone patients and control were examined respectively. The effects of Cholagogue Dry Syrup and Eulektrol Capsule on decreasing 33.5 kd vesicular protein were also studied by ELISA kit. RESULTS: One-step ELISA equation was Y=0.035 X (r=0.99). The vesicular protein concentrations in serum and bile of cholesterol gallstone group [(179.8+/-97.9) mg/L and (213.4+/-70.1) mg/L respectively] were significantly (P<0.05) higher than in the pigment stone group and control. Data showed that, with 2-week administration, Cholagogue Dry Syrup significantly decreased both biliary and serum 33.5 kd vesicular protein of cholesterol gallstone patients, while Eulekrol Capsule and control groups didn't have the same results. CONCLUSION: The concentrations of 33.5 kd protein are different in cholesterol gallstone patients and healthy groups which might be related to cholesterol nucleation process. Cholagogue Dry Syrup is of cholagogic and litholytic effect by decreasing biliary lithogenesis.
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<p><b>OBJECTIVE</b>To evaluate the pro-nucleating activity in 33.5 x 10(3) vesicular protein.</p><p><b>METHODS</b>The model biles were established according Kibe and Zhu. The pro-nucleating activity of 33.5 x 10(3) vesicular protein were examined by polarized light microscopy. The protein and its enzymatic deglycosylation and proteolysis fractions nucleation promoting activity were detected by cholesterol crystal growth assay.</p><p><b>RESULTS</b>33.5 x 10(3) vesicular protein displayed apparent potency of pro-nucleation with activity of 0.310, and derived crystal growth curve indices It, Ig, Ic were presented as 0.57, 1.52, 1.63 respectively, but after treated by N-glycanase enzyme and pronase, no promoting activity were found.</p><p><b>CONCLUSION</b>The 33.5 x 10(3) vesicular protein may be involved in the nucleation process of gallstone formation, which is regulated by its peptide and sugar chain.</p>
Subject(s)
Humans , Bile , Metabolism , Cholelithiasis , Cholesterol , Metabolism , Macromolecular Substances , Microscopy , Models, Biological , Protein Transport , Proteins , MetabolismABSTRACT
Objective To explore the structure and type of sugar chain in 33 500 pro-nucleating protein, and its role in gallstone formation. Methods The 33 500 vesicular protein was examined by dot-immunobinding assay of lectin coupled to a peroxidase (HRP-DSA,HRP-ConA,HRP-WGA). The morphology of biliary vesicles was observed under transmission electron microscopy in process of massive vesicular aggregation, culmination and crystal formation. The protein and its enzymatic deglycosylation fractions nucleation promoting activity were detected by cholesterol crystal growth assay. Results 33 500 vesicular protein with multiantennary and complicated glycan displayed apparent potency of nucleation promotion, which clearly reflected by HRP-DSA immunobinding, and derived crystal growth curve indices. It, Ig, Ic were presented as 0.57, 1.52, 1.63 respectively, but after treated by N-glycanase enzyme, no promoting activity was found. Conclusions Our data suggest the sugar chain play an important role in pro-nucleating process, and may be involved in the gallstone formation.
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Objective To evaluate the diagnostic accuracy of ELISA kit for cholesterol gallstone. Methods The ELISA kit of 33?500 vesicular protein was established by sandwich method, and the concentrations of the protein in gallbladder bile were examined among cholesterol, pigmental gallstone patients and control groups. Results The gallbladder 33?500 vesicular protein (213?70) ?g/ml is much higher in cholesterol gallstone patients than in pigmental gallstone patients (72?55) ?g/ml and control groups (65?52) ?g/ml (F=60.9, P