Comparison of clinical efficacy and quality of life between uncut Roux-en-Y and Billroth II with Braun anastomosis in laparoscopic distal gastrectomy for gastric cancer / 中华胃肠外科杂志

Objective: To compare the clinical efficacy and quality of life between uncut Roux-en-Y and Billroth II with Braun anastomosis in laparoscopic distal gastrectomy for gastric cancer patients. Methods: A retrospective cohort study was performed. Inclusion criteria: (1) 18 to 75 years old; (2) gastric cancer proved by preoperative gastroscopy, CT and pathological results and tumor was suitable for D2 radical distal gastrectomy; (3) postoperative pathological diagnosis stage was T1-4aN0-3M0 (according to the AJCC-7th TNM tumor stage), and the margin was negative; (4) Eastern Cooperative Oncology Group (ECOG) physical status score <2 points, and American Association of Anesthesiologists (ASA) grade 1 to 3; (5) no mental illness; (6) able to answer questionnaires independently; (7) patients agreed to undergo laparoscopic distal gastrectomy and signed an informed consent. Exclusion criteria: (1) patients with severe chronic diseases and American Association of Anesthesiologists (ASA) grade >3; (2) patients with other malignant tumors; (3) patients suffered from serious mental diseases; (4) patients received neoadjuvant chemotherapy or immunotherapy. According to the above criteria, clinical data of 200 patients who underwent laparoscopic distal gastrectomy at the Department of General Surgery of the First Affiliated Hospital of Army Medical University from January 2016 to December 2019 were collected. Of the 200 patients, 108 underwent uncut Roux-en-Y anastomosis and 92 underwent Billroth II with Braun anastomosis. The general data, intraoperative and postoperative conditions, complications, and endoscopic evaluation 1 year after the surgery were compared. Besides, the quality of life of two groups was also compared using the Chinese version of the European Organization For Research and Treatment of Cancer (EORTC) quality of life questionnaire-Core 30 (QLQ-C30) and quality of life questionnaire-stomach 22 (QLQ-STO22). Results: There were no significant differences in baseline data between the two groups (all P>0.05). All the 200 patients successfully underwent laparoscopic distal gastrectomy without intraoperative complications, conversion to open surgery or perioperative death. There were no significant differences between two groups in operative time, intraoperative blood loss, postoperative complications, time to flatus, time to removal of gastric tube, time to liquid diet, time to removal of drainage tube or length of postoperative hospital stay (all P>0.05). Endoscopic evaluation was conducted 1 year after surgery. Compared to Billroth II with Braun group, the uncut Roux-en-Y group had a significantly lower incidences of gastric stasis [19.8% (17/86) vs. 37.0% (27/73), χ(2)=11.199, P=0.024], gastritis [11.6% (10/86) vs. 34.2% (25/73), χ(2)=20.892, P<0.001] and bile reflux [1.2% (1/86) vs. 28.8% (21/73), χ(2)=25.237, P<0.001], and the differences were statistically significant. The EORTC questionnaire was performed 1 year after surgery, there were no significant differences in the scores of QLQ-C30 scale between the two groups (all P>0.05), while the scores of QLQ-STO22 showed that, compared to the Billroth II with Braun group, the uncut Roux-en-Y group had a lower pain score (median: 8.3 vs. 16.7, Z=-2.342, P=0.019) and reflux score (median: 0 vs 5.6, Z=-2.284, P=0.022), and the differences were statistically significant (all P<0.05), indicating milder symptoms. Conclusion: The uncut Roux-en-Y anastomosis is safe and reliable in laparoscopic distal gastrectomy, which can reduce the incidences of gastric stasis, gastritis and bile reflux, and improve the quality of life of patients after surgery.

Effect of duodenal stump reinforcement on postoperative complications in patients undergoing laparoscopic radical gastrectomy / 中华胃肠外科杂志

Objective: To evaluate the influence of duodenal stump reinforcing on the short-term complications after laparoscopic radical gastrectomy. Methods: A retrospective cohort study with propensity score matching (PSM) was conducted. Clinical data of 1204 patients with gastric cancer who underwent laparoscopic radical gastrectomy at the First Affiliated Hospital of Army Medical University from April 2009 to December 2018 were collected. The digestive tract reconstruction methods included Billroth II anastomosis, Roux-en-Y anastomosis and un-cut-Roux- en-Y anastomosis. A linear stapler was used to transected the stomach and the duodenum. Among 1204 patients, 838 were males and 366 were females with mean age of (57.0±16.0) years. Duodenal stump was reinforced in 792 cases (reinforcement group) and unreinforced in 412 cases (non-reinforcement group). There were significant differences in resection range and anastomotic methods between the two groups (both P<0.001). The two groups were matched by propensity score according to the ratio of 1∶1, and the reinforcement group was further divided into purse string group and non-purse string group. The primary outcome was short-term postoperative complications (within one month after operation). Complications with Clavien-Dindo grade ≥ III a were defined as severe complications, and the morbidity of complication between the reinforcement group and the non-reinforcement group, as well as between the purse string group and the non-purse string group was compared. Results: After PSM, 411 pairs were included in the reinforcement group and the non-reinforcement group, and there were no significant differences in baseline data between the two groups (all P>0.05). No perioperative death occurred in any patient.The short-term morbidity of postoperative complication was 7.4% (61/822), including 14 cases of anastomotic leakage (23.0%), 11 cases of abdominal hemorrhage (18.0%), 8 cases of duodenal stump leakage (13.1%), 2 cases of incision dehiscence (3.3%), 6 cases of incision infection (9.8%) and 20 cases of abdominal infection (32.8%). Short-term postoperative complications were found in 25 patients (6.1%) and 36 patients (8.8%) in the reinforcement group and the non-reinforcement group, respectively, without significant difference (χ2=2.142, P=0.143). Nineteen patients (2.3%) developed short-term severe complications (Clavien-Dindo grade ≥IIIa), while no significant difference in severe complications was found between the two groups (1.7% vs. 2.9%, χ2=1.347, P=0.246). Sub-group analysis showed that the morbidity of short-term postoperative complication of the purse string group was 2.6% (9/345), which was lower than 24.2% (16/66) of the non-purse string group (χ2=45.388, P<0.001). Conclusion: Conventional reinforcement of duodenal stump does not significantly reduce the incidence of duodenal stump leakage, so it is necessary to choose whether to reinforce the duodenal stump individually, and purse string suture should be the first choice when decided to reinforce.

Effect of Manual and Machine Decocting on Chemical Constituents in Bazhentang Based on Non-targeted Metabolomics / 中国实验方剂学杂志

Objective: To evaluate the effect of manual decocting and machine decocting on the chemical constituents in Bazhentang based on non-targeted metabolomics, and to find the differential chemical constituents of these two decocting methods. Method: Bazhentang was boiled by standardized manual decocting and machine decocting methods,respectively. Orthogonal partial least square-discriminate analysis(OPLS-DA) and other multivariate statistical methods, combined with variable importance in the projection(VIP) value and t-test, were employed to analyze the effect of two decocting methods on the chemical constituents in Bazhentang. The differential chemical constituents were analyzed by UPLC-LTQ-Orbitrap MS under positive and negative ion modes,mobile phase was acetonitrile-0.1%formic acid aqueous solution for gradient elution,the scanning range was m/z 50-1 500. Result: Under the positive and negative ion modes of high-resolution mass spectrometry, a total of 87 differential components were found,40 of them were identified according to the mass spectrometry data and literature reports, including senkyunolide A, glycyrrhizin, ferulic acid, etc. Conclusion: Based on the analysis of color and chemical compositions of Bazhentang, there are obvious differences between the standardized manual decocting and machine decocting. If the advantages of these two methods are combined,a standardized decoction process can be established on the basis of maintaining the advantages of manual decocting, the effectiveness of traditional Chinese medicine decoction will be maximized and it will be convenient for patients to take it.

Research progress on the effects of the tensile strain stimulation on proliferation differention and pericellular matrix of cartilage / 中国骨伤

Mechanical stimulation widely exists in the body and participates in adjusting biological behavior of many kinds of cells. As a common stress pattern in the body, the tensile strain widely exists in many organs, such as bone and cartilage, muscle tendon, cardiac and pulmonary vessels, and so on. In recent years, with the development of the researches of biomechanics, a variety of mechanical loading devices, which are used to simulate the complex mechanical stimulation in the body to provide the tensile strain including the isometric, uniaxial and various types of mechanical waveform, came into being. This is a huge boost to biomechanical research. Many researchers have found that the tensile strain stimulation can lead to the transformation of proliferation, differentiation and apoptosis of cells and change of cell matrix. However, for the same kind of cells, different kinds of tensile strain stimulation can lead to different and even the contrary results. In this paper, the effects of the tensile strain on the proliferation, differentiation and matrix of cartilage were reviewed. Understanding these characteristics will have important implications for the mechanism of cell proliferation and differentiation under the biomechanic stimulation and the prevention and treatment of diseases.

Diagnostic value of Blumensaat angle for anterior cruciate ligament injury / 中国骨伤

<p><b>OBJECTIVE</b>The receiver operator characteristic(ROC) curve was used to determine the best Blumensaat angle for the diagnosis of anterior cruciate ligament injury, so as to objectively evaluate the diagnostic value of Blumensaat angle for anterior cruciate ligament injury.</p><p><b>METHODS</b>Total 167 patients who had knee arthroscopic treatment in a hospital from January 2015 to January 2016 were retrospectively studied, and the patients' age, gender, left and right limb condition were recorded. The patients were divided into two groups according to Blumensaat angle measured on the MRI: group A(Blumensaat angle<=0°), and group B(Blumensaat angle >0°). The ROC curve was drawn from the statistical data of the group B to get the best critical value of the anterior cruciate ligament injury when the Blumensaat angle was more than 0°. According to the best critical value obtained by ROC curve, the coincidence rate of the total sample was obtained.</p><p><b>RESULTS</b>There were no significant differences in patients' age, gender, and affected limbs. There were 51 patients in group A, in which 49 patients were diagnosed as anterior cruciate injury under arthroscopy(gold standard for diagnosis of anterior cruciate ligament injury), and 2 patients were diagnosed as no anterior cruciate injury under arthroscopy. When the Blumensaat angle was<0°, the coincidence rate was 96.07%. In group B(116 cases), the area under the ROC curve was 0.910, the best cutoff corresponds to 15°; the sensitivity was 70.0%, and the specificity was 95.8%. When the Blumensaat angle was >=15°, the probability of anterior cruciate ligament injury was greater. When the Blumensaat angle was 0° to 15°, the anterior cruciate ligament was more likely to be not injured. The Blumensaat angle<=0°or>=15° were used to diagnose the injury of anterior cruciate ligament. Compared with the results of arthroscopy, the coincidence rate of the total sample was 92.8%.</p><p><b>CONCLUSIONS</b>Blumensaat angle is helpful to diagnose the ACL injuries. When the Blumensaat angle was <=0° or >=15°, the probability of ACL injury is greater.</p>

Research progress on tranexamic acid application strategy in total knee arthroplasty / 中国骨伤

Tranexamic acid(TXA) as an antifibrinolytic drugs used to reduce the total knee arthroplasty(TKA) postoperative blood loss is a hot issue in recent years. Such as blood loss, hemoglobin, transfusion rate and other relevant indexs effected by the impact of total knee replacement have been studied and investigated by many scholars. There is no a gold standard about how to safely and effectively apply the TXA. Depending on the dose, TXA may be used by body weight or using 1.5 g or 3.0 g directly. Depending on the different route of administration, TXA may be intravenous infusion, topical application and oral medication. Depending on the using opportunity, TXA can be used preoperative, intraoperative, postoperative or combined application with different times. Without any increase in the chances of thrombosis after TKA, choosing the more scientific instructions to play the greatest utility TXA is a hot issue recently.

A new classification of nevus of Ota / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The nevus of Ota, is a common benign pigmentary dermatosis, mainly involve innervation area of first and second branch of trigeminal nerve. The classification of nevus of Ota was proposed by Tanino, based on 26 cases of nevus of Ota from 1937 to 1940. Studies about its classification are rarely seen in last 70 years, while it is still practical today.</p><p><b>METHODS</b>Based on the clinical photographs, 1079 consecutive patients with nevus of Ota were verified and reclassified according to the innervation areas of the trigeminal nerve branches.</p><p><b>RESULTS</b>In these 1079 cases, 866 patients were in line with Tanino's classification (80.26%), and 213 patients were not (19.74%). We put forward a new clinical classification (Peking Union Medical College Hospital classification, PUMCH classification) of nevus of Ota based on the innervation area of the trigeminal nerve branches, composed of 5 types and 14 subtypes. The 5 types were as follows: Type I - pigmentation maculeses involving the innervation area of one of the three trigeminal nerve branches, of which there were 424 cases (39.3%), comprising 6 subtypes; Type II - pigmentation macules involving the innervation area of two branches of the three trigeminal nerve branches, of which there were 221 cases (20.48%), comprising 4 subtypes; Type III - pigmentation macules involving the innervation area of all three trigeminal nerve branches, of which there were 361 cases (33.45%), comprising 2 subtypes; Type IV - bilateral type, in which the pigmentation macules involves the bilateral cheek, of which there were 63 cases (5.84%), comprising 2 subtypes; and Type V - complications occurred in the patient, of which there were 10 cases (0.93%).</p><p><b>CONCLUSION</b>The new classification of nevus of Ota is based on the innervation area of the trigeminal nerve branches, and it covers all types of Tanino's classifications; on that basis, some new types and subtypes are brought in and cover almost every clinical condition.</p>

Detection of red fluorescence in the facial skin of healthy individuals and patients with seborrheic dermatitis / 中国医学科学院学报

<p><b>OBJECTIVE</b>To detect red fluorescence in the facial skin of healthy individuals and patients with seborrheic dermatitis (SD).</p><p><b>METHOD</b>Skin analysis was performed to obtain the ultraviolet images of the facial skins of 61 healthy individuals and 64 SD patients, and the detection rate of red fluorescence was calculated.</p><p><b>RESULTS</b>The detection rate of the red fluorescence was 36.06% in healthy individuals and 70.31% in SD patients (χ(2)=14.728, P<0.005). Additionally, it was significantly higher in T zone, where sebum secretion is high, than in U zone, where sebum secretion is lower (χ(2)=11.529,P<0.05;χ(2)=23.757,P<0.05,respectively).</p><p><b>CONCLUSIONS</b>Red fluorescence exist in both healthy individuals and SD patients, and the detection rate is especially high in the latter. Meanwhile, red fluorescence may be related with sebum secretion.</p>

Robotic-assisted radical gastrectomy using da Vinci robotic system: a report of 41 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of da Vinci robotic-assisted radical gastrectomy for gastric cancer.</p><p><b>METHODS</b>Forty-one patients with gastric cancer from Southwest Hospital between March 2010 and December 2011 underwent da Vinci robotic-assisted radical gastrectomy including total gastrectomy(n=12) and distal gastrectomy (n=29).</p><p><b>RESULTS</b>Conversion was required in two patients. One was converted to open surgery, and the other to conventional laparoscopic surgery. The remaining thirty-nine patients underwent da Vinci robotic-assisted radical gastrectomy successfully. The mean operative time was (285±61) min for total gastrectomy, and (225±39) min for distal gastrectomy. The mean blood loss was (180±157) ml in total gastrectomy, and (150±127) ml in distal gastrectomy. The mean number of harvested lymph nodes was 34.2±18.5. The mean time for gastrointestinal function recovery was (3.1±1.2) days. The time to ambulation was (2.7±1.5) days. The time to oral liquid intake was (3.7±1.5) days. Two patients had complication including wound infection and pneumonia. After follow up ranging from 1 to 21 months (median 11 months), 4 patients died from peritoneal metastasis, 1 survived with tumor, and the remaining 36 patients survived without disease.</p><p><b>CONCLUSIONS</b>da Vinci robotic-assisted radical gastrectomy is a feasible and safe surgical procedure with clear operation field, precise dissection, minimal trauma and fast recovery.</p>

Influence of CO2 pneumoperitoneum pressures on the expression of adhesion molecules of gastric cancer cells / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the effect of different CO2 pneumoperitoneum pressures on the expression of adhesion molecules of human gastric cancer cell line MNK-45.</p><p><b>METHODS</b>MKN-45 cells in the experimental groups were exposed to simulated CO2 environment maintained at different pressures (1.2, 1.6, 2.0 kPa) for 4 hours. Control groups were exposed to room air. At the 0, 24, 48, 72, 96 hours after treatment, CD44v6, ICAM-1 and E-cadherin were detected by flow cytometry method.</p><p><b>RESULTS</b>CD44v6 and ICAM-1 expressions showed pattern of firstly elevating, then descending to normal under the pressures of 1.2 kPa and 1.6 kPa. The expressions were different from control group significantly at 24 and 48 hours (P<0.01), while the 72 hours expression showed no difference compared with the controls (P>0.05). E-cadherin expression decreased significantly right after treatment compared to the control (P<0.01), but recovered to the level of control at 48 hours (P>0.05). In the 2.0 kPa group the expression changes of CD44v6, ICAM-1 and E-cadherin were more remarkable. CD44v6 and ICAM-1 expressions were increased significantly compared to control right after treatment (P<0.05). E-cadherin expression was significantly decreased even at 48 hours compared to the controls (P<0.01).</p><p><b>CONCLUSION</b>In vitro CO2 pneumoperitoneum pressures have transient influence on the adhesion molecules expression of gastric cancer cell MKN-45, then those expressions can recover in a short-time.</p>

Connexin 43 expression in intraperitoneal free gastric cancer cells in patients with gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To examine the association of connexin 43 (Cx43) in the intraperitoneal free gastric cancer cells and clinicopathological characteristics.</p><p><b>METHODS</b>Immunohistochemistry and immunofluorescence staining were used to detect connexin 43 in 75 paraffin-embedded gastric cancer tissues, matched paracancerous tissue, and intraperitoneal free gastric cancer cells.</p><p><b>RESULTS</b>The positive rates of Cx43 expression were 33.3% (25/75) in gastric cancer tissue specimens and 100% (75/75) in matched paracancerous tissue (P<0.01). The positive detection rate of free cancer cells in peritoneal lavage was 38.6% (29/75) and the positive rate of Cx43 in peritoneal free gastric cancer cells was 72.4% (21/29), which was significantly higher than that in gastric cancer tissue specimens (P<0.01). Significant association was observed of Cx43 expression of free gastric cancer cells with tumor infiltration and histological type (P<0.05).</p><p><b>CONCLUSION</b>Cx43 gene may be involved in the mechanism of peritoneal metastasis of gastric cancer.</p>

Effects of hypoxia-inducible factor-1α on human gastric cancer cell apoptosis under in vitro CO(2) pneumoperitoneum environment / 中华外科杂志

<p><b>OBJECTIVE</b>To study the effect of hypoxia-inducible factor-1α (HIF-1α) on human gastric cancer cells apoptosis in simulated CO2 pneumoperitoneum environment.</p><p><b>METHODS</b>Applied closed box to simulated CO2 pneumoperitoneum environment under the pressure of 0, 5, 10 and 15 mm Hg (1 mm Hg = 0.133 kPa). Compared HIF-1α mRNA and protein expression of MKN-45 cells before and after silencing HIF-1α by RT-PCR and Western blot. Study the changes of bcl-2/bax expression in MKN-45 cells before and after silencing HIF-1α by immunohistochemistry. The apoptosis ratio of MKN-45 was measured by using Annexin V-FITC/PI double labelled staining.</p><p><b>RESULTS</b>In 15 mm Hg group, HIF-1α mRNA and protein expression of MKN-45 cells (1.48 ± 0.22, 1.34 ± 0.09) and HIF-1α protein expression in 10 mm Hg group (1.25 ± 0.10) were significantly higher than those in control group (0.55 ± 0.17, 0.83 ± 0.04) (P < 0.05). But there was no significant differences among 0, 5, 10 mm Hg group and control group in HIF-1α mRNA (P > 0.05); and no obvious difference was found among 0, 5 mm Hg group and the control group in HIF-1α protein expression (P > 0.05). In 15 mm Hg CO2 pressure, bcl-2/bax expression (0.78 ± 0.05) was obviously lower than that in the control group (1.43 ± 0.15) (P < 0.05) and the apoptosis ratio (11.70 ± 0.12) was significantly higher than the control group (0.22 ± 0.07) (P < 0.01) before silencing HIF-1α. But once HIF-1α was silenced, HIF-1α mRNA (0.52 ± 0.11), HIF-1α protein expression (0.92 ± 0.02), bcl-2/bax ratio (1.57 ± 0.04) and apoptosis ratio (0.45 ± 0.11) in MKN-45 were not significantly different between 15 mm Hg group and the control group (P > 0.05).</p><p><b>CONCLUSIONS</b>The apoptosis ratios of MKN-45 under 0, 5, 10 mm Hg CO2 pneumoperitoneum are comparable with that in the control group before the silencing of HIF-1α. The apoptosis ratio of MKN-45 is increased under 15 mm Hg CO2 pneumoperitoneum environment and HIF-1α may be one of the important factor to improve the apoptosis of human gastric cancer cell.</p>

Expressions of RhoC, CD44v6 and ICAM-1 in human gastric cancer and its clinicopathological significance / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the expressions of RhoC, CD44v6 and ICAM-1 in gastric cancer and their correlations.</p><p><b>METHODS</b>SABC immunohistochemistry was used to detect the expressions of RhoC, CD44v6 and ICAM-1 in the specimens from 40 cases with gastric cancer. Their correlations were reviewed by clinicopathological data.</p><p><b>RESULTS</b>The expression of RhoC, CD44v6 and ICAM-1 were not correlated with tumor differentiation and invasion depth (P> 0.05), but significantly correlated with lymph metastasis and pTNM stage (P< 0.05). There was a significant correlation between the expression of RhoC and the expression of CD44v6 or ICAM-1 (r=0.355, P=0.006; r=0.354, P=0.003) respectively. If RhoC was positive-expressed, and either of CD44v6 or ICAM-1 was positive-expressed, the sensitivity and the specificity for predicting the lymphatic metastasis was 93.75%, 62.5% respectively.</p><p><b>CONCLUSIONS</b>The positive expressions of RhoC, CD44v6 and ICAM-1 are useful biological markers for predicting the metastatic potential of gastric cancer. The combined detection of three markers is a useful method for predicting lymphatic metastasis of gastric cancer.</p>