The change of platelet mitochondrial ATPase-6 gene in patients with benzene induced chronic myeloid leukemia / 中国职业医学

OBJECTIVE: To investigate the changes of platelet mitochondrial adenosine triphosphate synthase 6( ATPase-6)gene in patients with occupational chronic myeloid leukemia( CML) caused by benzene. METHODS: Five occupational benzene induced CML patients were selected as the case group and 21 healthy workers without benzene exposure were selected as the control group,venous blood were drew from these study subjects. The number of platelet was counted. The level of mitochondrial ATPase-6 gene was examined by quantitative polymerase chain reaction. RESULTS: The platelet count in case group was lower than that of control group [( 135. 2 ± 32. 6) ×10~9/ L vs( 239. 7 ± 77. 5) ×10~9/ L,P < 0. 05]. The ratio of ATPase-6 gene / platelet was higher than that of control group( median: 3. 43 ×10~(-4)copies vs 1. 87 ×10~(-4)copies,P < 0. 05). The ATPase-6 gene level in case group showed no significant difference when compared with that of control group( median: 4. 83 ×10~7 copies / L vs 3. 24 ×10~7 copies / L,P > 0. 05). CONCLUSION: The benzene induced CML patients shows more sensitive change in ratio of ATPase-6 gene / platelet than in ATPase-6 gene level.

Consideration of therapy for colorectal cancer with synchronous unresectable liver metastasis / 中华胃肠外科杂志

A variety of managements, including systemic and local chemotherapy, radiofrequency ablation and others, are used after multidisciplinary team discussion to improve the survival of patients with unresectable liver metastasis, and to enlarge the cohort of patients who can be managed with curative intent. Patients should be divided into different clinical groups according to characteristics of the patient and tumor, and then receive different treatments. For the patients who may be converted to be resectable after chemotherapy, we should choose efficient convertible chemotherapy with short courses to get the best response rate. For KRAS wild-type patients, cetuximab combined with FOLFOX/FOLFIRI, in which 5-fluorouracil is continuously infused, is recommended. In addition, resection of the primary tumor is recommended at the right time for asymptomatic patients with unresectable liver metastases. There is no consensus on the preferred treatment modality for systemic and local therapies.

A study of sympathetic skin response to the damage of autonomic nerves function in patients with chronic N-hexane poisoning / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the sympathetic skin response (SSR) to the effects of N-hexane on autonomic nerves function in patients with chronic N-hexane poisoning.</p><p><b>METHODS</b>The subjects in present study included 30 controls and 37 cases with chronic N-hexane poisoning. Also 37 patients were divided into 3 subgroups (mild, moderate and severe poisoning) according to diagnostic criteria of occupational diseases. All subjects were examined by SSR test and nerve conduction velocity (NCV) test. All patients were reexamined by SSR and NCV every 1 ∼ 2 months. The differences in SSR parameters (latency, amplitude) among groups were observed. In the severe poisoning subgroup, the changes of SSR and NCV parameters (conduction velocity, amplitude) in different poisoning stages were observed.</p><p><b>RESULTS</b>There were significant differences in SSR latency of upper extremity among groups and the significant differences in SSR amplitude of upper and lower extremity among groups (P < 0.05). No significant differences in SSR parameters were found between the adjacent groups (P > 0.05). There were significant differences in SSR latency of upper extremity during different periods and the significant differences in SSR amplitude of upper and lower extremity during different periods among all groups (P < 0.05). The change of SSR parameters consistent with that in NCV. The longest SSR latency of upper extremity and the smallest SSR amplitudes of upper and lower extremity appears 1 - 2 months earlier than that of the smallest action potential amplitude.</p><p><b>CONCLUSION</b>The damage of autonomic nerves induced by N-hexane increased with poisoning progresses. The damage of autonomic nerves corresponded with the damage of myelin sheath of large myelinated nerves, but which appeared 1 - 2 months earlier than the damage of axon of large myelinated nerves. SSR test may serve as a method to detect the damage of autonomic nerves function in patients with chronic N-hexane poisoning.</p>

Application of enhanced recovery program after surgery(ERAS) in patients undergoing radical resection for colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the enhanced recovery program after surgery (ERAS) with conventional perioperative management in patients undergoing radical resection for colorectal cancer.</p><p><b>METHODS</b>The ERAS protocol included a combination of evidence-based and consensus methodology. A total of 597 consecutive patients undergoing elective colorectal resection were randomized to either the ERAS(n=299) or the control group(n=298). Outcomes related to nutrition and metabolism index, stress index, and recovery index were measured and recorded.</p><p><b>RESULTS</b>Demographics and operative parameters were similar between the two groups(P>0.05). The nutritional status of patients in the ERAS group was improved after surgery compared with that of the control group. On postoperative day (POD) 1, the HOMA-IR in the ERAS group was significantly lower than that in the control group(P<0.01). The cortisol level in the control group was elevated on both POD 1(P<0.01) and POD 5(P<0.01) compared to the preoperative level. However, the cortisol level was not increased until POD 5(P<0.01) in the ERAS group. The levels of TNF-α, IL-1β, IL-6, and IFN-γ were reduced in the ERAS group, indicating less postoperative stress responses compared with the control group. In addition, ERAS group was associated with accelerated recovery of gastrointestinal function. The postoperative length of stay [(5.7±1.6) d vs. (6.6±2.4) d, P<0.01] and expense[(15 998±2655) RMB vs. (17 763±3059) RMB, P<0.01] were reduced in the ERAS group. Twenty-eight patients(9.4%) in the control group and 29(9.7%) in the ERAS group developed complications, while the difference was not statistically significant(P>0.05).</p><p><b>CONCLUSION</b>ERAS protocol alleviates surgical stress response and accelerates postoperative recovery without compromising patient safety.</p>

Study on relationship of the K-ras mutation with the occurrence of colorectal liver metastasis and survival outcomes / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To analyze the relationship of K-ras mutation with the development of liver metastasis in colorectal cancer patients and the survival outcomes.</p><p><b>METHODS</b>From 2003 to 2008, 300 patients who underwent colorectal cancer surgery in the Department of General Surgery of Zhongshan Hospital, Fudan University were assigned to different groups, according to the diagnosis and follow-up results. The mutation of exon 2 of K-ras was detected in primary paraffin-embedded lesions by PCR and Pyrosequencing. The association of gene mutation with the development of liver metastasis and its prognosis was studied.</p><p><b>RESULTS</b>Among 300 cases, the mutations of exon 2 were present in 120 cases(40%). The G13D mutation was more common in metachronous metastasis group than that in synchronous group(17.0% vs. 8.0%, P=0.041). Multivariable regression analysis showed that G13D mutation was an independent risk factor(HR=1.108, 95%CI:1.032-5.062, P=0.048) for metachronous metastasis. Patients with mutated K-ras had a poorer overall survival compared to those without mutated K-ras for patients without liver metastasis(median overall, 65 vs. 72 months, P=0.039), and for patients who received metastasis resection(median disease-free survival 18 vs. 24 months, P=0.048). Multivariable analysis showed that K-ras mutation was an independent risk factors of overall survival(HR=1.561, 95%CI:1.022-6.422, P=0.045) in patients without liver metastasis.</p><p><b>CONCLUSION</b>Detection of K-ras mutation may predict the development of liver metastasis and prognosis.</p>

Establish predictive model of colorectal cancer by using surface enhanced laser desorption/ionization-time of flight-mass spectrometry / 中华外科杂志

<p><b>OBJECTIVE</b>To establish serum proteome fingerprinting predictive models and search for proteins associated with colorectal cancer.</p><p><b>METHODS</b>Thirty-six randomly selected colorectal cancer patients and 36 cases with hernia or gall bladder diseases scheduled for elective operation were enrolled as cancer group and control group respectively. Peripheral venous blood samples were collected before the operations. Special serum protein or peptide fingerprint was investigated by using surface enhanced laser desorption/ ionization-time of flight-mass spectrometry (SELDI-TOF-MS) measurement after blood sample had been treated with weak cation exchange protein chip (CM10) for each case. The obtained data were analyzed by Biomarker Wizard software to screen serum proteome tumor markers and set up diagnosis predictive model for colorectal cancer. Blind validation of the model with 44 healthy controls and 88 colorectal cancer patients were carried out by using Biomarker Patterns Software.</p><p><b>RESULTS</b>In comparing colorectal cancer group with control group, 5 specific protein peaks (P < 0.05) were found. The predictive model had a sensitivity of 100% and a specificity of 97.2%. A sensitivity of 71.6% and a specificity of 72.7% was got with the blind validation. The specific protein peaks with a mass-to-charge ratio (m/z) of 8908 and 13,707 showed in all the results and it showed their strong relationship with colorectal cancer.</p><p><b>CONCLUSIONS</b>The predictive models built by the differences of serum proteome fingerprint could be a very useful diagnostic tool in colorectal cancer. Proteins with m/z of 8908 and 13,707 would possibly be the tumor markers of colorectal cancer.</p>

Application of SELDI-TOF-MS in detection of liver metastasis from colorectal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To establish a serum protein fingerprint model for prediction of liver metastasis from colorectal cancer by SELDI-TOF-MS analysis, and to determine the differentiatial proteins associated with the metastatic liver cancers.</p><p><b>METHODS</b>Data were collected from the Department of General Surgery in Zhongshan Hospital. A group of patients with colorectal cancer (CRC) without liver metastasis (n = 36) and another group with liver metastasis (n = 36) were included in this study. Serum samples were collected from peripheral venous blood before operation. Special serum protein or peptide fingerprint was determined by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS). The obtained data were analyzed by Biomarker Wizard software to screen the serum protein markers discriminating colorectal cancer patients with and without liver metastasis. A serum protein fingerprint model was established. This model was blindly verified in of CRC patients with and 44 cases without liver metastasis.</p><p><b>RESULTS</b>Comparing the characteristic proteins in those two groups of patients, 10 specific protein peaks were identified with statistical significance (P < 0.05). According to m/z growing from small to large, they were: 2398, 2814, 4084, 4289, 4465, 6422, 6619, 11 482, 11 649 and 13 714. The predictive model had a sensitivity of 91.7% and a specificity of 97.2%. The validation showed a sensitivity of 75.0% and a specificity of 81.8%.</p><p><b>CONCLUSION</b>A predictive model based on differentiatial serum protein fingerprint with high sensitivity and specificity has been successfully established. It should be a very useful tool in detection and diagnosis of liver metastasis in colorectal cancer patients.</p>

Application of the protocol of enhanced recovery after surgery in colorectal surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate enhanced recovery after surgery(ERAS) protocol in colorectal surgery.</p><p><b>METHODS</b>From september 2006 to February 2007, 74 patients with colorectal cancer were randomly assigned to ERAS group and control group. The stress index, nutrition and metabolism index, intraoperative index and postoperative index were evaluated.</p><p><b>RESULTS</b>Six patients were excluded, 3 in ERAS group (2 cases received hepatectomy concomitantly and 1 case received partial ileum resection), and 3 in control group (1 case received hepatectomy and 1 case received colorectomy concomitantly, another presented asthma paroxysm). So there were 34 cases in ERAS group and 34 cases in control, with no statistical differences in sex, age, BMI index and operation types. Deviation of HOMA-IR index of ERAS was lower than the control (P>0.05), the same as plasma cortisol at the 1st day after operation (P<0.05), but plasma glucagons in the operation of ERAS group was higher than that of control (P<0.05). Plasma glucose 1st day after operation of ERAS group was lower than control (P<0.05), while plasma triglyceride intraoperation, at 1st day, 2nd day after operation of ERAS was higher than control (P<0.05). Nitrogen negative balance of ERAS group was higher than control at 2nd day after surgery, but is lower intraoperation and at 6th day after operation (P<0.05). The time of exhaust gas and stool, time to eat fluidity and semi-fluidity, out-of-bed time and exercise time per-day, residual time and complication rate in ERAS group were better than those of control (P<0.05). Post-operative expenses of ERAS was lower than that of control (P<0.05).</p><p><b>CONCLUSION</b>ERAS can decrease surgical stress, increase functional recovery and reduce complication rate.</p>

Therapeutic effects of hepatic resection in liver metastasis of colorectal cancer / 中华外科杂志

<p><b>OBJECTIVES</b>To evaluate therapeutic effects of hepatic resection in liver metastasis of colorectal cancer (LMCC).</p><p><b>METHODS</b>The clinical data of 133 cases of LMCC received hepatic resection from January 1, 2000 to December 31, 2005 in Zhongshan Hospital were analyzed retrospectively. The relationship between hepatic resection and survival rate was also concerned.</p><p><b>RESULTS</b>One hundred and thirty-three cases received curative hepatic resection in all 470 LMCC cases, of which 30 cases from synchronous liver metastasis (SLM) group (totaled 196 cases) and 103 cases from metachronous liver metastasis (MLM) group (totaled 274 cases). Mortality rate during operation was 3.3% in SLM and 1.9% in MLM (P < 0.05). All patients were followed-up till June 31, 2006, the 1, 3, 5 year survival rates and median survival time of SLM were similar to those of MLM, but its recurrence rate was higher (36.7% vs 20.4%, P = 0.030). The 1, 3, 5 year survival rate in the 49 patients who were operable but received non-operation treatment were significantly lower than those in operated patients (P = 0.003). In 30 SLM cases, 22 received I stage resection of their primary and liver metastasis tumor and 8 received liver metastasis resection after the primary surgery (II stage operation), 1, 2, 3 year survival and the median survival time were similar in the two groups. With COX multivariate analysis, incision margin > or = 1 cm (P = 0.036) and reoperation after recurrence (P = 0.041) were protective survival factors, and post-operation recurrence (P = 0.023) was survival risk factor.</p><p><b>CONCLUSIONS</b>Curative hepatic resection is the first choice of therapy in liver metastasis of colorectal cancer and it can improve survival.</p>