Comprehensive treatment of colorectal cancer / 中华消化外科杂志

At present, surgical resection remains as the main treatment for patients with colorectal cancer (CRC). Alongside the progress in oncologic surgical technique, minimally invasive approaches, such as laparoscopy and transanal total mesorectal excision (taTME), and individualized surgical options, such as lateral lymph node dissection and multivisceral resection, the patient mortality associated with traditional surgical approaches has been improved. Neoadjuvant therapy can decrease local recurrence and distant metastasis, and improve the survival of patients. The optimization of adjuvant therapy shortens treatment cycle, reduces treatment risk and toxicities. Recently, neoadjuvant immunotherapy has become the new standard of the treatment for mismatch repair-deficient or microsatellite instability high CRC. However, it shows unsatisfactory outcomes in patients with mismatch repair-proficient/microsatellite stable CRC, which needs overcoming the limi-tation of CRC genephenotype. With more researches on CRC, the more biomarkers predicting the response to treatment will be found and the novel comprehensive treatment of CRC will be developed, which will make the treatment of CRC more individualized and accurate, and finally benefit more patients.

Lateral lymph node dissection and key technical points in 4K laparoscopic surgery for rectal cancer / 中华消化外科杂志

Lateral lymph node metastasis (LLNM) is the main metastatic mode and the major cause of locoregional recurrence of mid-low rectal cancer. Single chemoradiotherapy cannot achieve good local control for LLNM, while the argument against performing lateral lymph node dissection (LLND) is the increased rate of urinary and sexual dysfunction after surgery. Ultra-high definition surgical field and delicate resolution by 4K laparoscopic surgical system will be helpful to achieve good tumor clearance and function preservation by identification and exposure of the important anatomic structures such as pelvic autonomic nerve and internal iliac vessels. Therefore, selective LLND can reduce local recurrence rates, particularly in the pelvic sidewall. LLND with autonomic nerve preservation by 4K laparoscopic system is expected to further decrease the risk of perioperative complications and urinary and sexual dysfunction in appropriate patients with neoadjuvant chemoradiotherapy.

Diagnosis and treatment of lateral lymph node metastasis in 4K laparoscopic surgery for middle and low rectal cancer / 中华消化外科杂志

Lateral lymph node metastasis (LLNM) is one of the major causes for post-operative local recurrence of middle and low rectal cancer. At present, there are still controversies on the diagnosis and treatment of LLNM. The radiological assessment of LLNM generally relies on morphological criteria such as the size or shape of the node or the response to therapy, in which the diagnostic accuracy of MRI is superior to that of other imaging techniques. Neoadjuvant chemoradiotherapy could not achieve good local control for suspicious LLNM. Lateral lymph node dissection (LLND) can reduce tumor local recurrence significantly, but the clinical value of LLND in survival and quality of life of patients has been questioned. 4K laparoscope can decrease the incidence of perioperative complications and urinary and sexual dysfunction to a certain extent. Thus, selective LLND should be undertaken to patients with suspicious LLNM after neoadjuvant chemoradiotherapy, in order to reduce tumor local recurrence and improve the prognosis of patients. The authors elaborate on diagnosis and treatment including surgery or chemoradiotherapy of LLNM in 4K laparoscopic surgery for middle and low rectal cancer combined with their own experiences.

The status analysis of diagnosis and treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China: a report of 1 003 cases in 16 domestic medical centers / 中华外科杂志

Objective@#To analyze the status of domestic surgical treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China.@*Methods@#Clinicopathological data of patients who underwent surgery from October 2003 to October 2018 in 16 domestic medical centers was retrospectively analyzed. Excel database was created which covered 77 fields of 7 parts: baseline information of patients, laboratory tests, imaging tests, chemoradiotherapy information, intra-operative findings, postoperative pathology and follow-up data. The Wilcoxon rank-sum test was used for comparison of the measurement data between groups. The χ2 test was used for comparison of the categorical data between groups. The survival curve was calculated by the Kaplan-Meier method.@*Results@#Of the 1 003 patients, there were 575 male and 428 female patients with the age of (58.5±14.1) years (range: 18 to 92 years). In a total of 920 patients, the carcinoma of sigmoid colon was performed in 292 cases (31.8%) with the highest ratio. The proportion of patients with liver metastasis and lung metastasis were 27.9% (219/784) and 8.3% (64/769). Preoperative detection of carcino-embryonic antigen level was the most common method in China (87.74%, 880/1 003), and the positive rate was 64.5% (568/880). The correct rate of preoperative imaging tests was 40.7% (280/688). The ratio of peritoneal carcinomatosis index (PCI) scores between 0 and 10 was the highest (59.6%, 170/285). Two hundred and sixty-two (27.0%) patients were performed by totally laparoscopic operation in 971 patients. The resection of primary tumor was performed in 588 of the 817 patients (72.0%). In a total of 457 cases, 253 (55.4%) patients were performed cytoreduction which group scored completeness of cytoreduction (CCR) 0. The postoperative hyperthermic intraperitoneal chemotherapy was implemented in 70 of the 334 cases (21.0%). Among 1 003 cases, 562 cases (56.03%) had complete follow-up data and the median overall survival was 15 months. The primary tumor resection and the CCR scores were affected by the PCI scores. The patients underwent primary tumor resection (187/205 vs. 26/80, χ2=105.085, P=0.000) and the patients were performed cytoreduction which scored CCR 0 or CCR 1 (162/204 vs. 8/78, Z=-10.465, P=0.000) had significant difference between the groups of PCI<20 and ≥20. There was a close correlation between the surgical method and the CCR scores (Z=-3.246,P=0.001).When the maximum degree of tumor reduction was planned, most surgeons would choose laparotomy. The overall survival time was longer in patients with primary tumor resection (P=0.000). The median survival time was 18.6 months in the group of primary tumor resection.@*Conclusions@#It is difficult to diagnose the synchronous peritoneal carcinomatosis from colorectal cancer before the operation. Primary tumor resection has an obvious effect to prolong the survival time. It is necessary to standardize the treatment of peritoneal metastasis.

Analysis on efficacy and safety of total neoadjuvant therapy in patients with locally advanced rectal cancer with high risk factors / 中华胃肠外科杂志

Objective@#To evaluate the safety and preliminary efficacy of total neoadjuvant therapy (TNT) in patients with locally advanced rectal cancer (LARC) with high risk factors.@*Methods@#Data of 101 patients who were diagnosed with stage II-III rectal cancer with high risk factors and received TNT between March 2015 and January 2018 at West China Hospital of Sichuan University were analyzed retrospectively. Inclusion criteria: (1) patients were diagnosed with stage II-III rectal cancer by high-resolution MRI combined with CT and endorectal ultrasound; (2) at least one high risk factor: cT4a, cT4b, cN2, EMVI+, CRM+ and lateral lymph node+; (3) distance from tumor to anal verge was within 15 cm; (4) Eastern Collaborative Oncology Group (ECOG) performance status score was 0-1; bone marrow function, liver function and kidney function were suitable for chemoradiotherapy; (5) patients were treated with TNT strategy; (6) the follow-up data and postoperative pathological data were complete. Patients with previous rectal cancer surgery (except prophylactic colostomy), pelvic radiotherapy, and systemic chemotherapy, those with distant metastases, those without neoadjuvant radiotherapy, those receiving less than 4 cycles of neoadjuvant chemotherapy were excluded. The regimen of TNT: 3 cycles of induction CAPOX (oxaliplatin plus capecitabine) were followed by pelvic radiotherapy and concurrent CAPOX, then 3 cycles of consolidation CAPOX were delivered after radiotherapy. Total mesorectal resection (TME) or watch-and-wait strategy was selected according to the therapeutic effect and patients' wishes. Short-term efficacy, including tumor regression grade (TRG), pathological complete response (pCR), clinical complete response (cCR), postoperative complications within 30 days of surgery, and adverse events (AE) to radiotherapy and chemotherapy (measured using CTCAE 4.0) was analyzed.@*Results@#The 101 patients included 68 males (67.3%) and 33 females (32.7%) with a median age of 54 years. The proportion of patients with cT4a, cT4b, cN2 and enlarged lateral lymph node was 13.9%, 29.7%, 56.4% and 43.6%, respectively. The mean cycle of neoadjuvant chemotherapy was 6.0±1.3. Seventy-five patients (74.3%) received at least 6 cycles of neoadjuvant chemotherapy and 100 (99.0%) completed radiotherapy. The mean cycle of induction and consolidation chemotherapy was 2.0±0.9 and 2.8±1.0 respectively. Most common grade 3 AE was leucopenia (n=13, 12.9%) and thrombocytopenia (n=7, 6.9%). Grade 3 diarrhea and radiation dermatitis were observed in 5 cases (5.0%) respectively. Grade 3 anemia and rectal pain were observed in 4 cases (4.0%) respectively. And rectal mucositis was observed in 2 cases (2.0%). Most of the AE was observed during concurrent chemoradiotherapy. No grade 4 or higher AE was observed. After TNT, 32 patients (31.7%) achieved pCR or cCR, and 62 patients (60.4%) achieved partial response (PR). Only 2 patients (2.0%) developed distant metastasis after chemoradiotherapy, while the other patients did not show disease progression. Seven patients (6.9%) with cCR refused surgery and selected watch-and-wait, while 7 patients without cCR still refused surgery. The other 87 patients (86.1%) underwent TME successfully. The mean interval from the completion of chemoradiotherapy to surgery was (20.1±8.5) weeks. The R0 resection rate was 97.7% (85/87).The morbidity of surgical complication was 16.1% (14/87), including pelvic infection or abscess in 6 cases (6.9%), anastomotic leakage in 3 (3.4%), hemorrhage in 2 (2.3%), and gastrointestinal dysfunction in 3 (3.4%). Pathological findings revealed that 24 cases (27.6%) had TRG 0, 20 (23.0%) had TRG 1, 30 (34.5%) TRG 2, and 13 (14.9%) TRG 3.@*Conclusion@#TNT is safe and has good short-term efficacy for locally advanced rectal cancer patients with high risk factors.

Text analysis of China′s family physicians contracted service policy based on policy tools / 中华医院管理杂志

Objective To analyze the policy texts related to the contracted service of family physicians, and probe into the key points and existing problems of the policy in the process of promoting the contracted service of family physicians in China, for the purpose of providing references for the optimization and perfection of the system. Methods A total of 54 relevant policy texts issued by the Central Government from 2011 to 2019 were selected, for establishing a two-dimensional analysis framework based on policy tools and stakeholders.By means of quantitative analysis of policy text and literature research method, we analyzed the relevant policy texts. Results Study of the 54 texts found 52.8% (124/235)mentioned commands and regulatory tool use, 27.2% (64/235) mentioned capacity building tool use, 13.2% (31/235) mentioned information and exhortation tool use, 5.1% (12/235)only mentioned incentive tool use, and 1.7% (4/235) only mentioned system change tool use; while most of them(34.3% and 32.7% )mentioned government and physicians, and only a few(17.6% and 15.4% )mentioned patients and medical entities. Conclusions It is suggested to optimize the policy tools mixture, and increase the use of incentive tools to physicians, and explore new forms of system change tools.It is also proposed to pay more attention to resource allocation of primary medical institutions, and to patient awareness and satisfaction.

Early diagnosis and treatment of anastomotic leak after rectal cancer surgery / 中华胃肠外科杂志

Anastomotic leakage is the most common major complication after mid-low rectal cancer surgery. Due to lack of knowledge regarding the virtual mechanisms of anastomotic leakage, not much can be done to prevent its development. The aim of the present review was to discuss the prevention, early diagnosis, and treatment of anastomotic leakage after rectal cancer surgery. For patients with risk factors, such as anastomotic site within 4 cm from anus, obese men, lack of blood supply of the anastomotic site, neoadjuvant chemo radiotherapy, or patients with severe comorbidity, aggressive preventive strategy should be adopted. The effectiveness of diverting stoma, preoperative bowel preparation, and transanal decompression are still in debate. The combination of fluorescence imaging to assess anastomotic perfusion and selective preservation of the left colic artery can be used in the future to prevent anastomotic leakage intraoperatively. With increasing use of neoadjuvant chemo radiotherapy and diverting stoma, more than half of the leaks present in a more subtle and insidious manner, including ileus, diarrhea, anal discharge of pus, mild fever, accelerated heart rate, tachypnea, and oliguria. Surgeons should be more cautious regarding these insidious clinical presentations. Computed tomography scan and endoscopy are among the most important diagnostic workups that can early diagnose leakage and indicate the size of the defect and extent of infection. For patients presenting with diffuse peritonitis, emergency surgical exploration is mandatory along with fluid resuscitation. For those with limited infection, appropriate treatment plan should be made after consideration of the extent of infection, methods to eradicate the infectious source, strategies following adjuvant therapy, and the possibility and necessity of re-establishing bowel continuity.

Origin Determination of Sika Deer Bones by Restriction Fragment Length Polymorphism / 中国药师

Objective: To establish a method of restriction fragment length polymorphism (RFLP) to determine the origin of sika deer bones.Methods: The DNA in the bone samples was extracted after decalcification, and then amplified using polymerase chain reaction (PCR).The origin of the samples was further identified using RFLP analysis.Results: The bone samples of sika deer and red deer could be distinguished from those of pig, bovine and dog by PCR.And the samples of sika deer and red deer could be further distinguished by RFLP through the analysis of the length of restriction enzyme XbaI.Conclusion: A RFLP method is established to determine the origin of sika deer bones.

Analysis of drug free for patients with severe mental illness and follow -up of 82 cases / 中国基层医药

Objective Toanalyzedrugfreeforpatientswithseverementalillnessandfollow-upof82cases, inordertoprovidebasisforthedivisionoffreedelivery.Methods 82severementalillnesspatientswhowereincon-formity with the conditions of rescue,were given free drug and followed up for 2 years.Before the admission and fol-lowed up for 2 years,the social function evaluation(SDSS)and compliance were evaluated,the recurrence rate was compared.Results Comparisonofcompliance:beforetheadmission,thecompletecompliancein33cases,thepartial compliance in 27 cases,22 cases of non-compliance;After 2 years follow-up,the complete compliance in 52 cases, the partial compliance in 21 cases,9 cases of non-compliance.The difference was statistically significant(u=3.34, P<0.01).Comparison of social function:social withdrawal:before the admission (1.32 ±0.75)points,after 2 years follow-up (0.96 ±0.34)points,the difference was statistically significant(t=3.93,P<0.001 );Family activities:before the admission (1.44 ±0.69)points,after 2 years follow-up (0.87 ±0.31)points,the difference was statisti-cally significant (t=6.78,P<0.001);Personal care:before the admission (1.29 ±0.68)points,after 2 years follow-up (0.95 ±0.62)points,the difference was statistically significant(t=3.33,P<0.001);Interest in the outside world:before the admission (1.23 ±0.63)points,after 2 years follow-up (0.97 ±0.41)points,the difference was statistically significant(t=3.05,P<0.025);The total score:before the admission (15.42 ±7.23)points,after 2 years follow-up (9.56 ±6.89)points,the difference was statistically significant(t=5.28,P<0.001).Compari-son of the recurrence rate:2 years before the admission,the recurrence in 33 cases (40.2%),after 2 years follow-up the recurrence in 15 cases(18.3%),the difference was statistically significant (χ2 =10.64,P<0.001).Conclusion Drug free for patients with severe mental illness and follow-up can improve the social function and the implementation of free administration of patients with severe mental illness,and reduce the recurrence rate and improve compliance.

Clinical efficacy of laparoscopic extralevator abdominoperineal excision for low rectal cancer without turning position / 中华消化外科杂志

Objective To explore the clinical efficacy of laparoscopic extralevator abdominoperineal excision (laparoscopic ELAPE) for low rectal cancer with modified Lloyd-Davies lithotomy position and without turning position.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 27 patients with low rectal cancer who underwent laparoscopic ELAPE without turning position in the West China Hospital of Sichuan University from September 2013 to January 2015 were collected.The modified Lloyd-Davies lithotomy position was used in perineal resection.Observation indicators:(1) surgical situation;(2) postoperative recovery situation;(3) postoperative pathological examination situation;(4) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications,survival of patients and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Results (1) Surgical situation:A total of 27 patients received laparoscopic ELAPE without turning position,and operation time and volume of intraoperative blood loss were (198±51)minutes and (85±66)mL.Among 5 of 27 patients with intraoperative complications,1 with intestinal perforation received successful intraoperative repair,1with presacral haemorrhage received successful hemostasis by intraoperative gauze pressing,1 with left and right pelvic plexus injury didn't receive special treatment,1 with left pelvic plexus injury + left internal iliac vein injury didn't receive special treatment and were repaired in vascular injury repair,1 with right neurovascular bundle injury didn't receive special treatment of nerve injury and received successful hemostasis by ultrasonic scalpel.There was no perforation in the site of the tumor.Number of lymph node dissected was 14 (range,9-22),and number of lymph node dissected ≥ 12 and ＜ 12 were detected in 15 and 12 patients,respectively.(2)Postoperative recovery situation:time to anal exsufflation and time for fluid diet intake in 27 patients were respectively (78±21)hours and (83±21)hours.Of 27 patients,8 with postoperative complications were improved by conservative treatment,including 1 in Clavien-Dindo Ⅰ (volume of perineal exudation ＞ 100 mL) and 7 in Clavien-Dindo Ⅱ (3 with pulmonary infection,2 with chylous fistula,1 with perineal incision infection and 1 with hematuria).There was no death within 30 days postoperatively.The median duration of hospital stay of 27 patients was 7 days (range,6-8 days).(3) Postoperative pathological examination situation:of 27 patients,1 and 26 had respectively positive and negative circumferential margins and median distance of circumferential margin was 0.7 cm (range,0.1-1.1 cm).T stage:14,12 and 1 patients were respectively detected in T2,T3 and T4.N stage:18,6 and 3 patients were respectively found in N0,N1 and N2.(4) Follow-up and survival situations:25 of 27 patients were followed up for 2-32 months,with a median time of 24 months.During the follow-up,5 had complications after discharge from hospital.Of 5 patients,2 with persistent anal pain didn't receive special treatment and were not relieved,and 3 with sexual dysfunction didn't receive special treatment and were followed up or observed.Of 25 patients,2 died of tumor-related diseases,1 died of non-tumor-related disease and other 22 had survival.No local tumor recurrence was detected.Eight patients had tumor distant metastases,including 4 with pulmonary metastases,3 with hepatic metastases and 1 with brain metastasis.Conclusion Laparoscopic ELAPE by modified Lloyd-Davies lithotomy position without turning position is safe and feasible,with closing pelvic floor peritoneum in stage Ⅰ.

Overexpression and characterization of endo-cellulase A10 from Aspergillus nidulans in Pichia pastoris / 生物工程学报

Endo-cellulases are important to efficiently hydrolyze cellulose, and widely used in biotechnology. In this study, we overexpressed and characterized an endo-cellulase from Aspergillus nidulans. This endo-cellulase was successfully overexpressed in flasks and fermentor, and its concentration in fermentor reached 0.89 mg/mL. The optimal pH and temperature of the were 4.0 and 80 ℃ respectively, and it was very stable between pH 2.0 and 12.0. It was thermally stable below 60 ℃, whereas it was inactivated very quickly above 70 ℃. Its CMCase activity could be enhanced by Co²⁺, Mn²⁺ and Fe²⁺, whereas it was inhibited by Pb²⁺, Ni²⁺ and Cu²⁺. Therefore, this endo-cellulase exhibited good pH stability and thermostability below 60 ℃, and has the potential as commercial enzymes.

Pay attention to the selective lateral pelvic lymph node dissection in mid-low rectal cancer / 中华胃肠外科杂志

Lateral pelvic lymph node metastasis is an important metastatic mode and a major cause of locoregional recurrence of mid-low rectal cancer. Recently, there is an East-West discrepancy in regard to the diagnosis, clinical significance, treatment and prognosis of lateral pelvic lymph node metastasis. In the West, lateral nodal involvement may represent systemic disease and preoperative chemoradiotherapy can sterilize clinically suspected lateral nodes. Thus, in many Western countries, the standard therapy for lower rectal cancer is total mesorectal excision with chemoradiotherapy, and pelvic sidewall dissection is rarely performed. In the East, and Japan in particular, however, there is a positive attitude in regard to lateral pelvic lymph node dissection (LPND). They consider that lateral pelvic lymph node metastasis is as regional metastasis, and the clinically suspected lateral nodes can not be removed by neoadjuvant chemoradiotherapy. The selective LPND after neoadjuvant chemoradiotherapy may be found to be promising treatment for the improvement of therapeutic benefits in these patients. Therefore, the large-scale prospective studies are urgently required to improve selection criteria for LPND and neoadjuvant treatment to prevent overtreatment in the near future. Selective LPND after neoadjuvant treatment based on modern imaging techniques is expected to reduce locoregional recurrence and improve long-term survival in patients with mid-low rectal cancer.

Comparative study of bovine and porcine derived materials in hydrolysate samples by real-time fluorescence quantitative PCR and general PCR / 中国生化药物杂志

Objective To compare real-time fluorescence quantitative PCR with general PCR in detecting bovine and porcine derived materials in hydrolysate samples.Methods DNA were extracted from hydrolysate samples which prepared by different steps by real-time fluorescence quantitative PCR and general PCR.Results DNA of bovine and porcine could be detected by real-time fluorescence quantitative PCR and general PCR in samples prepared in the processes before enzymolysis solution, but not detected in samples from supermatant to the fourth ultrafiltrate.Conclusion Both real-time fluorescence quantitative PCR and general PCR can be applied to detect the fragments in hydrolysate samples.And real-time fluorescence quantitative PCR has the advantage such as rapid,convenient, non-environment-polluted, good repeatability, which improves the quality and efficiency.

Treatment choice of locally advanced low and middle rectal cancer after neoadjuvant chemoradiation / 中华胃肠外科杂志

Close observation or local excision have developed to be acceptable choices of managing rectal cancer patients who had a complete or major response to neoadjuvant chemoradiation. Indications of these rectum-preserving strategies, however, remain debatable due to inaccurate tumor staging after chemoradiation, apparent discrepancy between pathological and clinical complete responses, and uncertain lymph node status. Both responses to chemoradiation and original tumor staging must be considered to decide the treatment plan. For patients with major response to chemoradiation and with an original staging of cTis-2, a local excision is now acceptable with close postoperative observation or additive radical surgery according to pathological results. Otherwise, a standard radical surgery is still the treatment of choice. Post-radiation tumor evaluation can be employed for decision on sphincter preservation. A longer waiting time of 6-12 weeks before surgery is suggested.

Characters and influential factors of vascular remolding after native arteriovenous fistula / 中华肾脏病杂志

Objective To finding out the characters of vascular remolding after the establishment of native arteriovenous fistula on the wrist,and exploring the influential factors.Methods Doppler ultrasound was used to monitor the diameter of cephalic vein,brachial artery,radial artery and ulnar artery at the time before the surgery and one day,one week,two weeks,four weeks and eight weeks after the surgery respectively.The tendency of the diameter change was analyzed.Results Twenty eight patients completed the whole monitor session,in which eleven were female.The average age of those patients was (53.68 ± 2.61) years old.Twelve of them were diabetic nephropathy.The diameters of all vessel were increased more rapidly at the first day than any other days after surgery(all P ＜ 0.01).The patients were divided into two groups depending on whether diabetic nephropathy.No significant difference was found between the two groups on the tendency of diameter change in cephalic vein and brachial artery (all P ＞ 0.05).However,the tendency of diameter change in radial artery and ulnar artery was statistically significant difference between the two groups (all P ＜ 0.05).Conclusions Cephalic vein,brachial artery,radial artery and ulnar artery are all apparently dilated on the first day after the surgery.The vascular dilation and diameter increasing become much slower after the period,the diameter tend to be stable.The primary diseases may affect the tendency of the diameter change in radial artery as well as ulnar artery.

Effect of Notch1 signaling pathway activation on pancreatic cancer cell proliferation in vitro / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of activation of Notch1 signaling pathway by Notch intracellular domain (NICD) plasmid transfection on pancreatic cancer cell proliferation and explore the underlying mechanism.</p><p><b>METHODS</b>The transfection rates were observed under microscope with fluorescence stimulation, and mRNA expression levels of Hes1 were detected by real-time PCR. Cell proliferation changes were evaluated by CCK-8 after NICD and control plasmid transfection in pancreatic cancer cells. Caspase 3 activity was examined using a caspase 3 detection kit.</p><p><b>RESULTS</b>The transfection rates of NICD plasmid were up to 80% by fluorescence stimulation observation. Hes1 expression was significantly increased after NICD plasmid transfection, suggesting the activation of Notch1 signaling pathway. NICD plasmid transfection significantly promoted cancer cell proliferation compared to control plasmid transfeciton. The activities of caspase 3 were obviously decreased after NICD plasmid transfection in 3 pancreatic cancer cell lines.</p><p><b>CONCLUSION</b>Activation of Notch1 signaling pathway by NICD plasmid transfection can promote the proliferation of pancreatic cancer cells by inhibiting the apoptosis pathway.</p>

Observation on the effect of seculin combined with traditional Chinese medicine on the treatment of depression / 中国基层医药

Objective To observe the effect of sertraline combined with traditional Chinese medicine in the treatment of depression.Methods 80 patients with major depression by the order of lottery were randomly divided into two groups,each 40 cases.The control group were treated with sertraline.The treatment based on the control group were treated with traditional Chinese medicine.The two groups were observed for 6 weeks.Bafore treatment and 1 week,2 weeks,4 weeks,6 weesk,after treatment.the antidepressant efficacy was evaluated by HAMD score.Adverse effects were recorded.Results Total effectiveness of the treatment group and the control group were 82.5％,60.0％,respectively two groups had statistical significance(x2 =4.943,P ＜ 0.05).Compared with before treatment the HAM D score of treatment group 1 weekend were significantly decreased (t =10.627,P ＜ 0.01),the control group after 2 weeks treatment decreased significantly.Two groups of adverse reaction rate had a significant difference(x2 =5.952,P ＜ 0.05).Conclusion Yangxin spleen,soothe the nerves of Chinese medicine combined with western medicine in the treatment of depression relieving effect is better than that of single use of sertraline,faster onset of action,with less adverse reactions.

Screening of bone-related microRNAs in serum of patients with osteogenesis imperfect / 生物工程学报

We screened differential expression bone-related microRNAs (miRNAs) in serum of patients with osteogenesis imperfect (OI). First, we selected the reference gene (s) fit for quantitative detection of serum miRNAs by using geNorm and several other programmes. Then real-time fluorescent quntitative PCR was used to detect the expression level of bone-related miRNAs gained by means of miRanda, Targetscan and Pictar softwares caculation and reading literature. Then, the results were analyzed with the matched t test. All 6 candidate reference genes had a stable expression level in serum of healthy controls and patients with different characters, and the optimal number of reference genes is 4 (miR-16, let-7a, snRNAU6, miR-92a) after Pairwise Variations analysis (V4/5 = 0.133 < 0.15). For validating the universality of expression stability, we detected the relative expression value of miR-16, let-7a, snRNAU6 and miR-92a in another 8 healthy controls and 16 patients with OI and the result revealed that the expression of 4 genes remained stable (M < 1.5). After measuring serum levels of more than 100 bone-related miRNAs in patients with real-time qPCR, 11 miRNAs showed differential expression, and bioinformatic analysis suggested these altered expressional mioRNAs had possibilities to participate in the process of OI. So the experiment indicated that there existed many differential expression bone-related miRNAs in serum of patients with OI, and these miRNAs had potentials to be promising biomarkers for serologic tests and diagnosis of OI.

Laparoscopic transabdominal hiatal extended gastrectomy for type Ⅱ and m esophagogastric junction cancer / 中华消化外科杂志

The incidence of esophagogastric junction cancer (EGJC) is rising dramatically both in western countries and in China.For type Ⅱ EGJC,controversies over the optimal surgical approach still remain.More and more studies support the abdominal transhiatial extended gastrectomy to be superior to the abdominothoracic combined approach.The aim of this report is to evaluate the feasibility and safety of laparoscopic transabdominal hiatal extended gastrectomy for surgical treatment of type Ⅱ and Ⅲ esophagogastric junction cancer.Based on clinical experience of 95 patients who underwent laparoscopic tansabdominal hiatal extended gastrectomy,we conclude that laparoscopic transabdominal hiatal extended gastrectomy is feasible and safe,offering a safer and simpler way of intramediastinal dissection and digestive tract reconstruction at experienced hands as compared with open surgery.This procedure also offers the merit of longer esophageal resection length without entering the pleural cavity.

Strategies of multidisciplinary treatment of rectal cancer / 中华消化外科杂志

The incidence of rectal cancer has been increasing over past decades in China, making it the third most common malignant tumor. Multidisciplinary treatment plays a fundamental role in the successful treatment of rectal cancer.Total mesorectal excision has been wildly accepted as the standard technique, however, this procedure has not been standardized in China. Neoadjuvant radiation has been accepted as a standard regimen for patients with an advanced rectal cancer at a higher risk of local recurrence, even though controversies remain, such as the selection of patients for preoperative radiation and the optimum regimen for radiation. Combination of chemotherapeutic agents and targeted therapies is recommended according to updated results of randomized controlled trials (RCTs). In the future, multidisciplinary treatment should be adjusted according to the socioeconomic status of China and RCTs results in Chinese population. Standardization of surgery and surgery quality control also continue to play a core role in improving treatment results of rectal cancer in China.