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.

Surgical key points of 4K laparoscopic D 3 radical resection of right colon cancer / 中华消化外科杂志

In the implementation of laparoscopic D 3 radical resection of right colon cancer, the principle of tumor-free and complete mesenteric excision should be strictly followed. The whole lesion and lymph drainage area should be removed, and precise anatomy along the Toldt space should be performed to ensure sufficient incisional margin and complete lymph node dissection. Using 4K laparoscopy, the ultra-high definition picture is presented on the super large screen, which is more conducive to the surgeons to distinguish the anatomical plane and conduct accurate anatomy.

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.

Survival comparison of Siewert II adenocarcinoma of esophagogastric junction between transthoracic and transabdominal approaches:a joint data analysis of thoracic and gastrointestinal surgery / 中华胃肠外科杂志

OBJECTIVE@#To compare the long-term survival outcomes of Siewert II adenocarcinoma of esophagogastric junction (AEG) between transthoracic (TT) approach and transabdominal (TA) approach.@*METHODS@#The databases of Gastrointestinal Surgery Department and Thoracic Surgery Department in West China Hospital of Sichuan University from 2006 to 2014 were integrated. Patients of Siewert II AEG who underwent resection were retrospectively collected.@*INCLUSION CRITERIA@#(1) adenocarcinoma confirmed by gastroscopy and biopsy; (2) tumor involvement in the esophagogastric junction line; (3) tumor locating from lower 5 cm to upper 5 cm of the esophagogastric junction line, and tumor center locating from upper 1 cm to lower 2 cm of esophagogastric junction line; (4)resection performed at thoracic surgery department or gastrointestinal surgery department; (5) complete follow-up data. Patients at thoracic surgery department received trans-left thoracic, trans-right thoracic, or transabdominothoracic approach; underwent lower esophagus resection plus proximal subtotal gastrectomy; selected two-field or three-field lymph node dissection; underwent digestive tract reconstruction with esophagus-remnant stomach or esophagus-tubular remnant stomach anastomosis above or below aortic arch using hand-sewn or stapler instrument to perform anastomosis. Patients at gastrointestinal surgery department received transabdominal(transhiatal approach), or transabdominothoracic approach; underwent total gastrectomy or proximal subtotal gastrectomy; selected D1, D2 or D2 lymph node dissection; underwent digestive tract reconstruction with esophagus-single tube jejunum or esophagus-jejunal pouch Roux-en-Y anastomosis, or esophagus-remnant stomach or esophagus-tubular remnant stomach anastomosis; completed all the anastomoses with stapler instruments. The follow-up ended in January 2018. The TNM stage system of the 8th edition UICC was used for esophageal cancer staging; survival table method was applied to calculate 3-year overall survival rate and 95% cofidence interval(CI); log-rank test was used to perform survival analysis; Cox regression was applied to analyze risk factors and calculate hazard ratio (HR) and 95%CI.@*RESULTS@#A total of 443 cases of Siewert II AEG were enrolled, including 89 cases in TT group (with 3 cases of transabdominothoracic approach) and 354 cases in TA group. Median follow-up time was 50.0 months (quartiles:26.4-70.2). The baseline data in TT and TA groups were comparable, except the length of esophageal invasion [for length <3 cm, TA group had 354 cases(100%), TT group had 44 cases (49.4%), χ²=199.23,P<0.001]. The number of harvested lymph node in thoracic surgery department and gastrointestinal surgery department were 12.0(quartiles:9.0-17.0) and 24.0(quartiles:18.0-32.5) respectively with significant difference (Z=11.29,P<0.001). The 3-year overall survival rate of TA and TT groups was 69.2%(95%CI:64.1%-73.7%) and 55.8% (95%CI:44.8%-65.4%) respectively, which was not significantly different by log-rank test (P=0.059). However, the stage III subgroup analysis showed that the survival of TA group was better [the 3-year overall survival in TA group and TT group was 78.1%(95%CI:70.5-84.0) and 46.3%(95%CI:31.0-60.3) resepectively(P=0.001)]. Multivariate Cox regression analysis revealed that the TT group had poor survival outcome (HR=2.45,95%CI:1.30-4.64, P=0.006).@*CONCLUSION@#The overall survival outcomes in the TA group are better, especially in stage III patients, which may be associated with the higher metastatic rate of abdominal lymph node and the more complete lymphadenectomy via TA approach.

Establishment and preliminary application of tissue response grading system following neoadjuvant chemotherapy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To establish the tissue response grading (TRG) system following neoadjuvant chemotherapy and to investigate its application in the gastric cancer patients who received neoadjuvant chemotherapy.</p><p><b>METHODS</b>Data of 30 cT3-4N0-3M0 gastric cancer cases who received neoadjuvant chemotherapy and operation from May 2017 to February 2018 at Department of Gastrointestinal Surgery, West China Hospital were analyzed retrospectively. The edema degree of gastrointestinal tract and perigastric tissues, intraoperative effusion, and fibrosis of tumor and lymph nodes bearing tissues which could be divided into 4 categories constituted the core parameters of the TRG system following neoadjuvant chemotherapy. Four categories of edema: grade 0, no obvious tissue edema; grade 1, slight tissue edema and swelling, no obvious effusion when dissecting the capsule of connective tissues; grade 2, moderate tissue edema and swelling, a few effusion when dissecting the capsule of connective tissues; grade 3, severe tissue edema and swelling with high tension on the capsule of connective tissues, tension blister could be observed in some patients, continuous effusion when dissecting the capsule of connective tissues. Four categories of intraoperative effusion: grade 0, no obvious effusion; grade 1, slight effusion and a few intraperitoneal exudation; grade 2, moderate effusion and continuous intraperitoneal exudation necessitating interrupted suction; grade 3, severe effusion and continuous intraperitoneal exudation necessitating constant suction. Four categories of fibrosis: grade 0, no fibrosis; grade 1, slight fibrosis with threadiness fibrous bands, clear dissecting space could be found between the fibrous tissues and adventitia/normal tissues; grade 2, moderate fibrosis with flaky fibrous tissues, the difficulty of tissue and lymph nodes dissection increased although dissecting space could be found between the fibrous tissues and adventitia/normal tissues; grade 3, severe fibrosis with hard and flaky fibrous membrane, the difficulty of tissue and lymph nodes dissection increased extremely and the fibrous tissues merges with adventitia/normal tissues without dissecting space. The relationships of TRG system with tumor response evaluation by computed tomography (CT), tumor regression score, surgical duration, number of retrieved lymph nodes, number of metastatic lymph nodes, number of enlarged lymph nodes seen in the preoperative CT scans as well as postoperative complications were analyzed using t test, χ² test and logistic regression model.</p><p><b>RESULTS</b>Nineteen male and 11 female patients with a mean age of(59.1±9.4) years were enrolled. There were 17 cases of grade 1, 12 cases of grade 2 and 1 case of grade 3 for tissue edema, while the corresponding number was 14, 15 and 1 for intraoperative effusion and 15, 14 and 1 for fibrosis respectively. There were no significant differences among the different degrees of tissue edema, intraoperative effusion and fibrosis in terms of the tumor response evaluation by CT and tumor regression score (all P>0.05). The results of logistics regression showed that tumor response evaluation by CT was related with the degree of tissue edema (P=0.012) and intraoperative effusion (P=0.007), rather than the degree of fibrosis (P=0.527). However, tumor regression score was not related with the degree of tissue edema(P=0.345), intraoperative effusion (P=0.159) and fibrosis (P=0.207). Surgical duration of one case with all grade 3 in tissue edema, intraoperative effusion and fibrosis was 408 minutes, which was longer than those with grade 1 and grade 2 patients [(295.9±40.1) minutes and (293.1±34.3) minutes, respectively]; the number of retrieved lymph nodes, metastatic lymph nodes, and enlarged lymph nodes seen in the preoperative CT scans of this case with all grade 3 were 25, 4 and 1, which were all less than those with grade 1 and grade 2 (42.3±11.9 and 38.5±18.2, 7.3±9.1 and 8.1±9.7, 1.8±1.6 and 2.3±1.3, respectively). There were no significant differences between grade 1 and grade 2 of tissue edema, intraoperative effusion and fibrosis in terms of surgical duration, retrieved lymph nodes, metastatic lymph nodes and enlarged lymph nodes seen in the preoperative CT scans(all P>0.05). Four patients suffered from pulmonary complications and 2 patients experienced slight lymphatic, and all leakage were cured by conservative therapies. There were no significant differences among the different grades of tissue edema, intraoperative effusion and fibrosis in terms of the operation-associated complications (all P>0.05).</p><p><b>CONCLUSION</b>The tissue response grading system can assist the judgment of operation difficulty and reflect the effectiveness of neoadjuvant chemotherapy to some extent, which has the possibility of applications.</p>

Application of clockwise modularized lymphadenectomy in laparoscopic gastrectomy for gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and efficacy of clockwise modularized lymphadenectomy in laparoscopic gastrectomy for gastric cancer.</p><p><b>METHODS</b>Clinical data of 19 cases who underwent the laparoscopic clockwise modularized lymphadenectomy for gastric cancer (clockwise group) from July 2016 to September 2016 were analyzed retrospectively. The clockwise modularized lymphadenectomy included the fixed operative order, detailed procedure and requirement of lymphadenectomy, which mainly reflected in assisting the exposure of operative field and dissection of lymph nodes through suspending the liver and banding the greater omentum, as well as proposing the requirements and attentions for the dissections of each station of lymph nodes to facilitate the quality control of lymphadenectomy. The operative time, intraoperative complications, intraoperative estimate blood loss, number of total harvested lymph nodes, morbidity and postoperative recovery, were compared with the data of another 19 cases who received traditional lymphadenectomy from January 2016 to June 2016 (control group).</p><p><b>RESULTS</b>The baseline data were comparable between two groups. All the patients were performed successfully by laparoscopy without conversion and intraoperative complications. The operative time, intraoperative estimated blood loss and number of total harvested lymph node were (278.4±29.9) min, (91.1±41.6) ml and 38.2±15.1 in clockwise group, and were (296.7±30.3) min, (102.2±32.2) ml and 37.0±12.3 in control group without significant differences (all P>0.05). However, the mean number of retrieved No.11p lymph nodes was 2.2±1.8 in clockwise group, which was significantly higher than that in control group (0.8±1.0) (P=0.013). Four patients in each group suffered from pulmonary infections, who were cured by conservative therapies. There was no anastomotic leakage, intraperitoneal hemorrhage, intraperitoneal infection or intestinal obstruction in each group.</p><p><b>CONCLUSION</b>The clockwise modularized lymphadenectomy can contribute to the facilitation of the retraction and exposure, decrease of the surgical duration and intraoperative blood loss, and radicalization of lymph node dissection, especially for the lymph nodes dissection around the celiac trunk.</p>

Current study and application of human colorectal cancer cell lines / 中华胃肠外科杂志

Colorectal cancer(CRC) cell lines are ideal in vitro models for colorectal cancer study. Although the number of colorectal cell lines increases hence provides diversified choices for research, several problems occur including the uneven quality control, insufficient attention to the origin and biological characteristics of CRC cell lines, resulting in inappropriate selection of CRC cell lines for study. In this paper, we classify the current CRC cell lines for study, review the biological characteristics, current problems of experiment choices, and discuss the exact choice of cell lines for CRC study.

Potential therapeutic effect of paracrine factors from bone marrow-derived mesenchyme stem cells in the treatment of severe acute pancreatitis / 生物医学工程学杂志

Bone marrow-derived mesenchymal stem cell (BMSC) transplantation is one ot the most popular therapeutic measures in severe acute pancreatitis (SAP). However, technical challenges and ethical concern have hindered its clinical application. Paracrine factor, as a new safe and easy handing therapeutic measure, can work comparably effective as BMSC transplantation in SAP therapy, but bio-safe risks could be greatly reduced. In this paper, we reviewed the therapeutic effect and potential mechanism of paracrine factors in the treatment of SAP. The injection of paracrine factors yielded from cultured cell suspension will be a new cell therapeutic measure for SAP.

Detection of fecal peroxisome proliferator-activated receptor delta and cyclooxygenase 2 mRNA in screening of colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the detection of fecal PPAR-delta and COX-2 mRNA in screening of colorectal cancer.</p><p><b>METHODS</b>Fifty-one patients with colorectal cancer and 21 healthy controls were included in this study. Total RNA was isolated from the fecal samples. Expression of PPAR-delta and COX-2 mRNA was determined by RT-PCR, and its value in screening of colorectal cancer was investigated.</p><p><b>RESULTS</b>The positive detection rate of fecal PPAR-delta and COX-2 mRNA in colorectal cancer patients was significantly higher than that in healthy controls. In 47 colorectal cancer patients and 19 healthy controls with positive fecal ACTB mRNA expression, the sensitivity of fecal PPAR-delta mRNA, COX-2 mRNA and PPAR-delta mRNA plus COX-2 mRNA detection in diagnosing colorectal cancer was 76.6%(36/47), 80.9%(38/47) and 91.5%(43/47) respectively; the specificity was 63.2%(12/19), 84.2%(16/19) and 89.5%(17/19) respectively.</p><p><b>CONCLUSION</b>The combination detection of fecal PPAR-delta and COX-2 mRNA is effective in screening human colorectal cancer and is better than detection of single marker alone.</p>

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.

Meta-analysis of ABCB1 3435C>T polymorphism and colorectal cancer

Objective: Many studies have focused on the association between the ABCB1 3435C>T polymorphism and colorectal cancer [CRC] risk. However, the results were conflicting. The aim of this meta-analysis is to evaluate the precise association between this polymorphism and CRC risk

Methods: We formally reviewed the literature at Pubmed, EMBASE and the Cochrane Library with the key words as follows: ABCB1/MDR1/P-glycoprotein, polymorphism, colorectal and cancer/neoplasm/tumor. This meta-analysis was assessed by Review manager 5.0. The fixed-effects model was used to pool the odds ratios [OR] with 95% confidence intervals [CI] for CRC risk

Results: There were 8 studies identified. The pooled OR with 95% CI of CC+CT versus TT genotype of the ABCB1 3435C>T polymorphism for CRC risk was 1.01 [0.90-1.13]. The sensitivity analysis further confirmed the result. Heterogeneity and publication bias were not observed in this meta-analysis

Conclusions: In summary, there was no significant association between the ABCB1 3435C>T polymorphism and CRC risk

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>

The set-up of an in vitro model for stable knockdown of MyD88 by lentivirus-based RNAi in IEC-6 cell line and the study on its early apoptosis / 生物医学工程学杂志

Intestinal inflammatory disease is a kind of non-specific disease with morbidity increasing yearly. It has been proved that the Toll like receptor 4 (TLR4) signaling pathways are closely related to intestinal inflammatory diseases. Myeloid differentiation protein 88 (Myd88) is a critical adaptor protein of TLR4 signaling and critical for the study of intestinal inflammatory disease, but stable Myd88 knockdown in vitro models of cell line are still very few. In the present study, an HIV-1-based lentivirus three-plamid packaging system was used for the construction of a lentivirual vector mediating RNA interference (RNAi) against Myd88 in intestinal fossae epithelial cell line-6 (IEC-6). Real-time PCR and Western blot were used to detect Myd88 expression. Annexin V staining and flowcytometry (FLM) were applied to detect and evaluate the early apoptosis. The results showed that lentiviral vectors containing the shRNA expression cassette specifically targeting Myd88 were constructed and efficiently stably knocked down Myd88 expression in IEC-6 cell line. Early apoptosis was significantly decreased after Myd88 knockdown. This study successfully constructed a lentivirus-based RNAi for Myd88 and detailed the key technique combined with characteristics of the early apoptosis after the Myd88 knockdown, provided a novel, stable and repeatable in vitro model for the pathogenesis, targeting therapeutic study for the intestinal inflammatory diseases.

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.

The expression of X-linked inhibitor of apoptosis protein and cell apoptosis in caerulein-stimulated rat pancreatic acinus AR42J cell lines / 生物医学工程学杂志

To study the expression of X-linked inhibitor of apoptosis protein (XIAP) and cell apoptosis in vitro model of acute pancreatitis (AP), we carried out experiments to stimulate AR42J cell line with caerulein (10(-8) mol/L) for 12 hours, then collected cells at various time points (0 h, 4 h, 8 h, 12 h, and 24 h, respectively). We then observed the morphologic changes of AR42J cells with the stimulation of caerulein with electronic microscope. The gene expression of XIAP, caspase-3 and caspase-9 was detected using real-time fluorescence quantitative polymerase chain reaction (FQ-PCR), and the protein expression of XIAP was assessed by western blot. The activation of nuclear factor-kappa B (NF-kappaB) was measured by flow cytometry (FCM). With the stimulation of caerulein, the expression of XIAP and the NF-kappaB activation could first decrease and then increase, but the change of caspase-3 and caspase-9 expressions were opposite. XIAP may inhibit the cell apoptosis in rat pancreatic acinus AR42J cell lines at first with the stimulation of caerulein, then NF-kappaB can upgrade the expression of XIAP and increase the cell apoptosis.

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.

Construction of a lentiviral vector of RNA interference against PPARS gene and the establishment of colon cancer cell line KM12C with stable knockdown of PPARdelta expression / 生物医学工程学杂志

Peroxisome proliferator-activated receptordelta (PPARdelta), as a downstream target of adenomatous polyposis coli (APC) signaling pathway, has been presumed to play some roles in colorectal carcinogenesis. However, the exact role of PPARdelta in colorectal cancer remains unclear. An HIV-1-based lentivirus packaging system was used for the construction of a lentiviral vector (lentivector) mediating RNA interference against PPARB. The direct sequencing demonstrated that the resulting lentivector containing the short-hairpin RNA expression cassette specifically targeting PPARdelta (sh-PPARdelta) was successfully constructed, and designated as pLVshPPARdelta. The control vector was designated as pLVControl. After the transduction, we observed highly efficient transduction (> 90%) of lentivirus in KM12C cells by fluorescent microscopy and fluorescence-activated cell sorting. Quantitative RT-PCR showed that pLVshPPARdelta lentivirus reduced PPARdelta mRNA expression by about 70.0% in KM12C cells as compared with that of the untreated cells (P < 0.05), while pLVControl had no significant effect on the PPARdelta mRNA level (P > 0.05). Western blot revealed an obvious reduction of PPARdelta protein expression in pLVshPPARdelta treated cells and showed no obvious difference between the control group and the untreated group. The results demonstrated that the lentivector mediating RNAi against PPARdelta was successfully constructed, which could stably knock down the PPARdelta expression in KM12C cells. This study finally provided a new cell model for the study of PPARdelta's function in colorectal cancer.

Effects of endothelin-1 on the proliferation of human HCT-116 cells / 中华消化外科杂志

Objective To investigate the effects of endothelin-1 on the proliferation of HCT-116 cells. Methods The expression of endothelin-1 and endothelin receptors A and B in the HCT-116 cells was detected by RT-PCR and immunohistochemistry method.The effects of endothelin-1 at different concentrations and action time points on HCT-116 cells were measured by MTT assay and were analyzed by variance analysis.Results The expression of endothelin-1 and endothelin receptors A and B at the gene and protein levels in HCT-116 cells was detected.Endothelin-1 had significant effects on the proliferation of HCT-116 cells.The proliferation peak of HCT-116 cells was reached when the concentration of endothelin-1 was 1×10-7mol/L and the action time was 48 hours.Conclusions Endothelin-1 promotes proliferation of HCT-116 cells in a dose-and time-dependent manner,and the process is mediated by endothelin receptors.

Molecular Switch of T Cell Factor-4 in Carcinogenesis of Colorectal Cancer / 中国普外基础与临床杂志

Objective To investigate the role of T cell factor-4 (TCF-4) in the carcinogenesis of colorectal cancer. Methods Relevant references about TCF-4 and the carcinogenesis of colorectal cancer, which were published recently domestic and abroad, were collected and reviewed. Results For TCF-4 gene, multiple isoforms are generated by way of alternative splicing, which encode different proteins. TCF-4 protein is sequence-specific DNA binding protein and is incapable of activating or repressing transcription independently, but it can interact with distinct partners to lead to different effects through multiple domains. Conclusion TCF-4 might be viewed as nuclear vehicles targeting other auxiliary proteins to a specific set of promoters and functions as molecular switch during the carcinogenesis of colorectal cancer.