Safety and feasibility of intrathoracic modified overlap esophagojejunostomy in laparoscopic radical resection of Siewert type Ⅱ adenocarcinoma of esophagogastric junction / 中华胃肠外科杂志

Objective: The study aimed to investigate the safety and feasibility of intrathoracic modified overlap method in laparoscopic radical resection of Siewert type II adenocarcinoma of the esophagogastric junction (AEG). Methods: A descriptive case series study was conducted. The clinical data of 27 patients with Siewert type II AEG who underwent transthoracic single-port assisted laparoscopic total gastrectomy and intrathoracic modified overlap esophagojejunostomy in Guangdong Provincial Hospital of Chinese Medicine from May 2017 to December 2020 were retrospectively analyzed. The intrathoracic modified overlap esophagojejunostomy was performed as follows: (1) The Roux-en-Y loop was made; (2) The jejunum side was prepared extraperitoneal for overlap anastomosis; (3) The esophagus side was prepared intraperitoneal for overlap anastomosis; (4) The overlap esophagojejunostomy was performed; (5) The common outlet was closed after confirmation of anastomosis integrity without bleeding; (6) A thoracic drainage tube was inserted into the thoracic hole with the diaphragm incision closed. The intraoperative and postoperative results were reviewed. Results: All 27 patients were successfully operated, without mortality or conversion to laparotomy. The operative time, digestive tract reconstruction time and esophageal-jejunal anastomosis time were (327.5±102.0) minute, 50 (28-62) minute and (29.0±7.4) minute, respectively. The blood loss was 100 (20-150) ml. The postoperative time to flatus and postoperative hospital stay were (4.7±3.7) days and 9(6-73) days, respectively. Three patients (11.1%) developed postoperative grade III complications according to the Clavien-Dindo classification, including 1 case of anastomotic fistula with empyema, 1 case of pleural effusion and 1 case of pancreatic fistula, all of whom were cured by puncture drainage and anti-infective therapy. Conclusions: The intrathoracic modified overlap esophagojejunostomy is safe and feasible in laparoscopic radical resection of Siewert type II AEG.

Expression of miR-486-3p and bioinformatics analysis of its potential target genes in human pterygium / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To detect the expression of miR-486-3p in human pterygium tissue and normal conjunctival tissue and explore the possible mechanism of miR-486-3p in the development of pterygium. <p>METHODS: Totally 69 patients 69 eyes with primary pterygium treat in Zhongnan Hospital of Wuhan University and Hankou Aier Eye Hospital from September 2018 to December 2019 were collected by excision of pterygium during surgery(experimental group). At the same time, a total of 69 patients with normal conjunctival tissue of their same eyes were taken as control group during surgery. The relative expression levels of miR-486-3p in the experimental group and the control group were quantitatively detected by RT-PCR. The Targetscan database, miWalk3.0 database and miRDB database were used to predict the potential target genes of miR-486-3p. DAVID database was used to analyse and enrich the function and pathway of the potential target genes of miR-486-3p. The String website performed an interactional analysis of the potential target genes of miR-486-3p. <p>RESULTS: The relative expression level of miR-486-3p in the experimental group(6.183±1.366)×10^-6 was significantly different from that in the control group(7.930±1.394)×10^-5(<i>P</i><0.0001). By the prediction of their target genes and bioinformatical analysis, a total of 436 potential target genes of miR-486-3p were found. The biological functions were mainly concentrated in the regulation of RNA polymerase II promoter transcription, vesicle-mediated transport, transcriptional regulation and the regulation of DNA-dependent RNA metabolism. The Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway was mainly enriched in the Axon guidance pathway and lysosomal pathway. And the Axon guidance pathway might play an important regulatory role in the occurrence and development of pterygium. PPI network analysis further elucidated that the key genes of ABL1 and PLXNA1(cell protein receptor A1)play an important role in the Axon guidance pathway for pterygium. <p>CONCLUSION: MiR-486-3p might be involved in the occurrence and development of pterygium through SLIT(neuro-targeting factor)/Robo(rotatory guide receptor)and SEMA3A(neuro-guiding factor Semaphorin 3A)/ PLXNA1 of Axon guidance pathways, which resulted in the abnormal new blood vessels of pterygium.

Safety and feasibility of laparoscopic double-flap technique in digestive tract reconstruction after proximal gastrectomy for esophagogastric junction tumors larger than 5 cm / 中华胃肠外科杂志

Objective: To investigate the safety and feasibility of laparoscopic double-flap technique (Kamikawa) in digestive tract reconstruction after proximal gastrectomy for esophagogastric junction (EGJ) leiomyoma and gastrointestinal stromal tumor (GIST) with the maximum diameter >5 cm. Methods: A descriptive case-series study was used to retrospectively analyze the data of patients with EGJ leiomyoma and GIST undergoing laparoscopic-assisted proximal gastrectomy and double-flap technique (Kamikawa) at the Department of Gastrointestinal Surgery, Guangdong Hospital of Traditional Chinese Medicine from September 2017 to March 2019. All the tumors invaded the cardia dentate line, and the maximum diameter was >5 cm. After the exclusion of patients requiring emergency surgery and complicating with severe cardiopulmonary diseases, a total of 4 patients, including 3 males and 1 female with age of 29-49 years, were included in this study. After laparoscopic-assisted proximal gastrectomy, the residual stomach was pulled out of the abdominal cavity and marked with methylene blue at the proximal end 3~4 cm from the anterior wall of the residual stomach in the shape of "H". The gastric wall plasma muscular layer was cut along the "H" shape, and the space between the submucosa and the muscular layer was separated to both sides along the longitudinal incision line to make the seromuscular flap. The residual stomach was put back into the abdominal cavity. Under laparoscopy, 4 stitches were intermittently sutured at the upside of "H" shape and 4-5 cm from the posterior wall of the esophageal stump. The stump of the esophagus was cut open, and the submucosa and mucosa were cut under the "H" shape to enter the gastric cavity. The posterior wall of the esophageal stump was sutured continuously with the gastric stump mucosa and submucosa under laparoscopy. The anterior wall of the esophageal stump was sutured continuously with the whole layer of the residual stomach. The anterior wall of the stomach was sutured to cover the esophagus. The anterior gastric muscle flap was sutured and embedded in the esophagus to complete the reconstruction of digestive tract. The morbidity of intraoperative complications and postoperative reflux esophagitis and anastomosis-related complications were observed. Results: All the 4 patients completed the operation successfully, and there was no conversion to laparotomy. The median operative time was 239 (192-261) minutes, the median Kamikawa anastomosis time was 149 (102-163) minutes, and the median intraoperative blood loss was 35 (20-200) ml. The abdominal drainage tube and gastric tube were removed, and the fluid diet was resumed on the first day after surgery in all the 4 patients. The median postoperative hospitalization time was 6 (6-8) days. Postoperative pathology revealed 3 leiomyomas and 1 GIST. There were no postoperative complications such as anastomotic leakage or stenosis, and no reflux symptoms were observed. The median follow-up time was 22 (11-29) months after the operation, and no reflux esophagitis occurred in any of the 4 patients by gastroscopy. Conclusion: For >5 cm EGJ leiomyoma or GIST, double-flap technique (Kamikawa) used for digestive tract reconstruction after proximal gastrectomy is safe and feasible.

Three-dimensional measurement and analysis of nasolabial soft tissue changes following maxillary anterior movement by Le Fort osteotomy / 上海交通大学学报（医学版）

Objective • To evaluate nasolabial soft tissue changes of Chinese patients with malocclusion after maxillary anterior movement by Le Fort osteotomy with three-dimensional measurement. Methods • From Jan. to Dec. 2017, 37 patients with skeletal Class III malocclusion from Department of Oral and Craniomaxillofacial Surgery of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, who underwent maxillary Le Fort osteotomy for anterior movement and bilateral sagittal split ramus osteotomy (bi-maxillary orthognathic surgery), were included. A full cranial spiral CT scan and three-dimensional facial soft tissue images were performed within 1 week before and 6 months after operation. Landmarks, relative distance and angle of nasolabial soft tissue were located and measured by 3dMD vultus software, and the differences before and after operation were compared. Results • After bi-maxillary orthognathic surgery, the alar width increased by an average of 0.82 mm, the subalar width increased by an average of 1.07 mm, the upper lip length increased by an average of 1.41 mm, the nasolabial angle increased by an average of 3.09, and the pronasal angle decreased by an average of 1.51(all P<0.05), while nasal height, nasal length and nasal frontal angle were basically stable. Conclusion • After the maxillary Le Fort I osteotomy for anterior movement, the face of patient with malocclusion is improved, and the nasolabial soft tissue is also changed.

Effects of orchinol on invasion, migration and Wnt3a/β-catenin signaling pathway of human gastric cancer SGC-7901 cells / 中国中药杂志

The purpose of this study was to investigate the inhibitory effect of the main 9,10-dihydrophenanthrene orchinol isolated from Spiranthes sinensis Radix et Herba on the invasion and migration of human gastric cancer SGC-7901 cells and its preliminary molecular mechanism. SGC-7901 cells were cultured in vitro, after the cells were treated with different final concentrations(5, 10, 20, 40, 80 μmol·L⁻¹) of orchinol for 24, 48 or 72 hours, the effect of orchinol on cell viability was measured by MTT assay. Wound healing and Transwell assays were performed to determine the effects of different final concentrations(5, 10, 20, 40 μmol·L⁻¹) of orchinol for 48 hour on invasion and migration abilities of SGC-7901 cells, respectively. The protein expression levels of β-catenin, Wnt-3α, DvL2, cyclinD1 and GSK-3β were detected by Western blot. The results showed that 5-80 μmol·L⁻¹ orchinol inhibited the viability of SGC-7901 cells in a dose-dependent and time-dependent manner, and the IC₅₈ values of 24, 48 and 72 hours were 77.79, 42.96 and 7.85 μmol·L⁻¹, respectively. Compared with the control group, the ability of invasion and migration of SGC-7901 cells was significantly inhibited after treated with 5, 10 and 20 μmol·L⁻¹ orchinol for 48 hours (<0.05, <0.01), and the dose-effect relationship was observed. The results of Western blot showed that orchinol could significantly down-regulate the protein expression levels of β-catenin, Wnt3a, DvL2 and cyclinD1, and up-regulate the protein expression level of GSK-3β(<0.05, <0.01, <0.001). The above results suggest that orchinol can obviously inhibit the invasion and migration of SGC-7901 cells, which may be related to its inhibition of Wnt3a/β-catenin signaling pathway and the proteins expression of downstream genes.