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Objective:To explore the application value of enhanced recovery after surgery (ERAS) in colorectal cancer patients.Methods:From January 2017 to December 2018, 60 patients with colorectal cancer who admitted to the Second People′s Hospital of Lianyungang were selected and divided into ERAS group and control group according to the random digital table method, with 30 patients in each group.The inflammation, nutritional indicators, immune indicators and clinical manifestations before and after surgery in the two groups were compared.Results:At 1 d and 3 d after surgery, the C-reactive protein (CRP) levels in the ERAS group were (70.2±10.3)mg/L, (82.5±8.2)mg/L, respectively, which were lower than those in the control group [(81.5±9.9)mg/L, (110.2±12.9)mg/L] ( t=4.324, 9.911, all P<0.05). On the third day after operation, the levels of albumin and prealbumin in the ERAS group were (31.6±4.8)g/L, (196.8±40.6)g/L, respectively, which were higher than those in the control group [(28.0±5.8)g/L, (172.1±38.8)g/L]( t=2.621, 2.409, all P<0.05). The immune parameters(IgA, IgM, IgG, CD 4+, CD 4+ /CD 8+) in the ERAS group were higher than those in the control group( t=2.132, 2.223, 6.063, 4.253, 2.828, all P<0.05). The number of cases with thirsty and hunger on the day of surgery in the ERAS group was 3 cases and 7 cases, respectively, which were less than 21 cases and 25 cases of the control group(χ 2=22.500, 21.696, all P<0.05). The first exhaust time, defecation time and hospital stay time in the ERAS group were (36.2±12.1)h, (63.4±13.4)h and (9.5±3.2)d, respectively, which were shorter than those in the control group [(54.7±13.8)h, (96.5±18.8)h and (12.1±4.0)d] ( t=5.513, 7.845, 2.761, all P<0.05). The incidence of complications between the two groups had no statistically significant difference ( P>0.05). Conclusion:ERAS can significantly reduce the physical and psychological traumatic stress of patients with colorectal cancer, achieve rapid recovery, improve the treatment effect, shorten the length of hospital stay, reduce social and family burden, and provide a basis for the choice of clinical treatment program.
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Objective:To study the expression of FOXP3 in gastric cancer and its prognostic significance.Methods:One hundred and six specimens of gastric adenocarcinoma confirmed by pathology from the Department of Gastrointestinal Surgery of the Second People′s Hospital of Lianyungang in Jan. 2005 to Dec. 2015 were selected as the observation group and 85 normal para-cancer tissues as the control group. The expression of FOXP3 in 106 cases of gastric cancer was detected by tissue microarray and immunohistochemical technology. Cox regression model was used to analyze the correlation between survival data and prognosis, and Kaplan-Meiers was used to analyze the relationship between FOXP3 expression and the prognosis of gastric cancer patients.Results:The positive rate of FOXP3 expression was 53.8% (57/106) in gastric cancer tissues and 28.2% (24/85) in paraneoplastic tissues, and the difference was statistically significant ( χ2=12.597, P<0.001). The level of FOXP3 expression in gastric cancer tissues was significantly correlated with the TNM stage of patients′ tumors ( χ2=4.402, P<0.05). Single-factor Cox survival analysis showed that age, tumor pathological grade, tumor size, whether it invaded lymph nodes, TNM stage, FOXP3 expression level and prognosis were correlated.Kaplan-Meier survival analysis showed that the survival rate of tumor cell FOXP3-positive group was lower than that of FOXP3-negative group; in the subgroup type, among the subgroups, any age group, any sex group, stage Ⅲ and Ⅳ tumor cell subgroups, low- and undifferentiated groups, tumor size <16 cm 3 group, and tumor cell FOXP3 expression-positive group invading lymph nodes had lower survival than tumor cell FOXP3 expression-negative group. Conclusions:The expression of FOXP3 is up-regulated in gastric cancer. The expression of FOXP3 in gastric cancer may be a prognostic factor, and the positive expression of FOXP3 may indicate a worse prognosis.
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Objective@#To compare the effects of laparoscope and open complete mesocolic excision (CME) in the treatment of right colon cancer.@*Methods@#The retrospective case-control study was adopted.The clinical data of 139 patients with right colon cancer who underwent CME at the Second People's Hospital of Lianyungang from January 2014 to November 2017 were collected.The patients were divided into laparoscopy group(55 cases) and open group(84 cases). The postoperative recovery and oncology efficacy were compared.@*Results@#The operation time in the laparoscopy group[(172.8±25.9)min]was longer than that in the open group[(142.3±20.6)min](t=7.387, P<0.05), but the blood loss of the laparoscopy group[(111.6±36.7)mL] was less than that in the open group[(150.1±61.1)mL](t=4.017, P<0.05). There was no statistically significant difference in numbers of lymph nodes harvested.Compared with open group, there were advantages in the laparoscopy group such as less anal exhaust time, less postoperative eating liquid diet time and shorter hospitalization time, the differences were statistically significant (t=4.695, 5.517, 4.642, all P<0.05). There was no statistically significant difference in postoperative complication rate (P>0.05). There were no statistically significant differences in the cumulative recurrence rate, cumulative survival rate and cumulative survival rate between the two groups after 3 years (all P>0.05).@*Conclusion@#Laparoscopic CME is minimally invasive and quick recovery, and laparoscopic CME has the same oncologic clearance effects, and is worthy of clinical application.
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Objective@#To explore the application effect of preoperative administration of immunomodulating enteral nutrition for gastric cancer.@*Methods@#From January 2016 to December 2017, 90 cases with gastric cancer in the Second People′s Hospital of Lianyungang were selected and randomly divided into observation group, control group A and control group B, with 30 cases in each group.The observation group was given enteral nutrition emulsion(TPFT, Ruineng) before and after operation, the control group A was given Ruineng before operation and the enteral nutrition emulsion(TP, Ruisu) after operation, the control group B was given Ruisu before operation and Ruineng after operation.The recovery, serum markers of nutritional status and immune function were evaluated and compared, and the postoperative situations were observed.@*Results@#There were no statistically significant differences in the total protein, albumin, prealbumin and transferrin among the three groups during admission, 1 day before operation and 5 days after operation(all P>0.05). There was no statistically significant difference in immune indicators among the three groups during admission and 1 day before operation(all P>0.05). At 5 days after operation, IgA, IgM, IgG, CD4+ and CD4/CD8 in the observation group were (2.9±0.6)g/L, (1.4±0.4)g/L, (12.4±0.9)g/L, (37.4±5.1)%, (2.2±0.7), respectively, which were significantly higher than those in the control group A[(2.3±0.8)g/L, (1.1±0.6)g/L, (10.8±0.8)g/L, (34.2±4.8)%, (1.7±0.8), respectively, t=3.324, 2.250, 7.100, 2.506, 2.660, all P<0.05], the IgA and CD4/CD8 in the observation group were higher than those in the control group B[(2.6±0.8)g/L, (1.9±0.7), t=2.021, 2.127, all P<0.05]. The postoperative exhaust time of the observation group, control group A and control group B were (56.4±7.8)h, (78.6±10.4)h, (60.7±10.6)h, respectively, and the postoperative exhaust time of the observation group was significantly shorter than that of the control group A(t=9.323, P<0.05). There was no statistically significant difference in the gastrointestinal symptoms and postoperative complications among the three groups (P>0.05).@*Conclusion@#In perioperative period, immunomodulating enteral nutrition has little effect on the nutritional indicators of patients with gastric cancer and the incidence of postoperative complications, but it can improve the immune function.
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Objective To investigate the application value of split type tubercle on the surgical treatment of unilateral thyroid benign nodules.Methods 180 cases of unilateral benign thyroid nodules were selected,and they were randomly divided into split type tubercle resection group(group A,n =90) and hemithyroidectomy group(group B,n =90) according to the digital table.The clinical effects were compared in the two groups.Results There was no complication such as hypocalcaemia and postoperative hemorrhage.1 case of group A and 2 cases of group B had transient vocal cord palsy,there was no statistically significant difference (P ＞ 0.05).There were 6 cases postoperative nodule recurrences in group A,and 5 cases in group B during 6 months to 5 years follow-up,there was no statistically significant difference(P ＞0.05).The thyroid stimulating hormone(TSH) levels of the two groups showed no statistically significant difference before operation (P ＞ 0.05).However,the TSH level of group A (2.76 ± 1.34)IU/mL was lower than (4.31 ± 2.01)IU/mL of group B 1 year after operation,and the difference was significant between the two groups (t =9.235,P ＜ 0.05).Conclusion The split type tubercle resection is worthy to properly applied in surgical treatment of unilateral benign thyroid nodules.
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Objective To analyze the clinical efficacy of endovenous laser treatment combined with transilluminated powered phlebectomy for great saphenous varicosity and summarize the experiencein order to achieve better results.Methods From January 2014 to June 2015,45 patients (52 limbs,including 17 males and 28 females,aged 36 to 68 years) diagnosed as great saphenous varicosity received endovenous laser treatment combined with transilluminated powered phlebectomy.Thirty-eight cases was unilateral great saphenous vafcose veins,7 cases was bilateral large saphenous varicose veins.The clinical efficacy was analyzed.Results All cases were performed successfully.The mean operation time was (68.4 ± 15.1) minutes,the average bleeding volume was (23.5 ± 10.7) ml,the number of mean operative incision quantity was (5.8 ± 1.9) and the average hospitalization time was (5.9 ± 1.6) days.All patients had no serious complications.During a mean follow-up time of 22 months (12 to 30 months),only one patient recurred.Conclusions Endovenous laser treatment combined with transilluminated powered phlebectomy for great saphenous varicosity is effective and safe.It also has the advantages of shorter operation time,less bleeding,shorter hospitalization time,small trauma and better cosmetic results.
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Objective To study the expression of BRG1 gene in colon cancer and its relationship with histological grade and clinicopathological stages characteristics.Methods The expression of BRG1 -positive cancer cells were detected by immunohistochemistry in 100 cases of colon cancer,and the relationship with histological grade and clinicopathological stages characteristics was analyzed.Results Of the 100 colon cancer specimens analyzed,the positive expression rate was 82.0%.The expression of BRG1 in colon cancer tissue with histological grade and TNM staging was significantly different (χ2 =23.509,P =0.024;χ2 =25.659,P =0.002).The higher the histological grade,the stronger the BRG1 expression in colon cancer tissue.BRG1 expression in advanced colon cancer tissue was significantly enhanced in the early stage.Conclusion The appearance of BRG1 -positive cancer cells is associated with histological grade and clinicopathological stages characteristics.BRG1 might play an important role in the development of colon cancer.
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Objective To compare the efficacy of endovenous laser treatment combined with transilluminated powered phlebectomy and traditional surgical treatment for great saphenous varicosity. Methods From January 2014 to January 2015,77 patients diagnosed as great saphenous varicosity were enrolled. They were randomly divided into two groups, 37 patients received endovenous laser treatment combined with transilluminated powered phlebectomy and the other 40 patients underwent traditional surgical treatment. The related indicators were compared.Results The mean operation time,average bleeding volume,operative incisionquantity and average hospitalization time of EVLT+ TIPP group were (66.1±14.7) min,(24.4±10.5) ml,5.7±1.7,(5.6±1.4) d respectively,of control group were (84.3±18.5) min,(59.0±15.6) ml,8.0±1.8,(10.1±3.1) d respectively,there were significant differences between the two groups(t =-4.749,-11.460,-5.714;P0.05).During a mean follow?up time of (18±7) months(12 months to 24 months),1 patient recurrence in theEVLT+ TIPP group,2 cases recurrence in the traditional operation group.The recurrence rates of the two groupswere similar,the difference was not significant between them(P=1.000) .Conclusion Endovenous lasertreatment combined with transilluminated powered phlebectomy for great saphenous varicosity is effective andsafe.It also has the advanta and better cosmetic results.
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<p><b>OBJECTIVE</b>To investigate the factors which may influence the imatinib plasma concentration in Chinese patients with gastrointestinal stromal tumor(GIST), and to illuminate the significance of monitoring imatinib plasma concentration in adjuvant therapy for patients with GIST.</p><p><b>METHODS</b>A cross-sectional study with 60 GIST patients who accepted the imatinib therapy after surgery was conducted. They were respectively administrated in 10 domestic hospitals from December 2014 to April 2016, including The First Affiliated Hospital of Nanjing Medical University(n=28), The Affiliated Hospital of Nantong University(n=9), The Affiliated Hospital of Xuzhou Medical College(n=6), Nanjing Drum Tower Hospital(n=5), The Second Affiliated Hospital of Nanjing Medical University (n=2), Jingling Hospital (n=2), The Second People's Hospital of Lianyungang(n=2), Shandong Provincial Hospital(n=2), Jiangsu Province Tumor Hospital(n=2), and The First Affiliated Hospital of Zhejiang University(n=2). Some specific time points for collecting blood sample before and after taking imatinib were determined, then liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was used for monitoring imatinib plasma concentration in patients with GIST. Linear regression analysis was used for the correlation analysis of imatinib plasma concentration with dosage, clinicopathologic feature and side effect.</p><p><b>RESULTS</b>Patients who could not tolerate 400 mg imatinib per day(n=3) received 300 mg per day. There was no significant difference in imatinib plasma concentration between patients with 300 mg and those with 400 mg imatinib(n=53)(P=0.527). However, the imatinib plasma concentration in patients with 600 mg imatinib per day (n=4) was significantly higher as compared to those with 400 mg(P=0.000). Linear regression analysis indicated a negative correlation between the imatinib plasma concentration in patients with 400mg imatinib per day for 90 days continuously and body surface area(R=0.074, P=0.035), but no significant correlations of with age, creatinine clearance and serum albumin concentration were observed (all P>0.05). The differences in imatinib plasma concentration were not statistically significant between patients of different gender and those taking proton-pump inhibitor (PPI) or not (both P>0.05). Difference in imatinib plasma concentration between patients with different surgery was significant (P=0.026). Compared to patients who underwent wedge resection, enterectomy and other surgeries, the imatinib plasma concentration of patients with subtotal gastrectomy or total gastrectomy decreased significantly (all P<0.05). After 90 days of taking imatinib continuously, linear regression analysis revealed a negative correlation between imatinib plasma concentration in patients with 400 mg imatinib per day and white blood cell count (R=0.103, P=0.013), and a positive correlation with serum alanine aminotransferase (ALT) concentration (R=0.076, P=0.033).</p><p><b>CONCLUSIONS</b>The imatinib plasma concentration in patients with larger body surface area, subtotal gastrectomy or total gastrectomy may be lower. For these patients, dosage of imatinib should be considered to increase in order to achieve effective plasma concentration. Excessive imatinib plasma concentration can result in some side effects, such as decrease of white blood cells and liver damage. Therefore, it is significant for receiving optimal clinical therapeutic efficacy to monitor imatinib plasma concentration, adjust imatinib dosage timely and keep imatinib plasma concentration in effective and safe range.</p>