Clinical effect of surgical treatment of stricturing Crohn's disease / 中华消化外科杂志

Objective To explore the clinical effect of surgical treatment of stricturing Crohn's disease (CD).Methods The retrospective cross-sectional study was conducted.The clinical data of 28 patients with stricturing CD who were admitted to the First Affiliated Hospital of Zhejiang University School of Medicine between June 2013 and April 2016 were collected.After improving the patients' nutritional status by preoperative corresponding treatment and optimizing the risk factors of complications,patients received individualized therapy according to their conditions.The intestinal one-stage resection and anastomosis or ostomy were performed at the stenotic locus causing sypmtoms,and no treatment or angioplasty for stenosis was performed at the gentle stenotic locus.Patients received regularly postoperative outpatient reexaminations.The medication was used to prevent recurrence according to the individual conditions.Observation indicators:surgical procedures (open or laparoscopic surgery),operation time,volume of intraoperative blood loss,number of patients with intraoperative blood transfusion,length of intestine resected,anastomosis methods,angioplasty for stenosis,duration of postoperative hospital stay,postoperative complications and follow-up.Follow-up using outpatient examination,telephone interview and wechat was performed to detect the abdominal pain,diarrhea,symptoms of clinical recurrence and endoscopic recurrence situations up to July 2016.Results All the 28 patients with stricturing CD underwent the selective operations,including 8 undergoing laparoscopic surgery (3 receiving conversion to open surgery) and 20 undergoing open surgery.Of 28 patients,2 underwent partial upper jejunum resection,10 underwent partial terminal ileum resection,15 underwent right hemicolectomy and 1 underwent colectomy.Operation time and volume of intraoperative blood loss were 33-288 minutes with an average time of 122 minutes and 50-650 mL with an average volume of 200 mL,respectively.One patient had intraoperative blood transfusion.Length of intestine resected of 28 patients was 10-150 cm,with an average of 54 cm and a total length of 1 510 cm.Of 28 patients,26 received the side-to-side anastomosis using linear closures (1 received the end-to-side anastomosis using pipe stapler,1 with multiple lesions and rectovaginal fistula received colectomy and ileostomy).Two patients with multiple stenosis of the small intestine underwent intestinal resection combined with angioplasty for stenosis in 3 loci.Duration of postoperative hospital stay was 7-45 days,with an average duration of 15 days.No patient died of surgery.Three patients had postoperative complications,including wound infection,incisional hernia and anastomotic leakage.Twenty-one patients were followed up for 3 months to 2 years,with a median time of 11 months,and there was no recurrence during the follow-up.Conclusions Surgical treatment should be performed to the patients with non-symptom,chronic and fibrous stricturing CD and anastomotic stenosis after ineffective medical treatment,with a satisfactory outcome.Meanwhile,it need follow the principle of minimally invasive.And optimizing high risk factors of complications before operation is a key point for preventing postoperative complications.

Diagnosis and surgical treatment for primary presacral tumors / 中华普通外科杂志

Objective To investigate the clinical characteristics and surgical treatment for primary presacral tumors.Methods The clinical data of 42 patients of primary presacral tumors from January 2013 to May 2015 were analysed retrospectively.Results Of the 42 patients,16 cases were asymptomatic while 26 patients had discomfort at the sacral or abdominal region,or difficulty in urinating or defecation.90％ of the cases were digital rectum examination (DRE) positive.Among the 42 patients 36 cases underwent surgical treatment,1 case underwent radiotherapy,5 cases refused surgical treatment.Among those receiving surgical resection,28 cases had trans-abdominal surgery and 4 cases had trans-sacral surgery,while 3 cases had trans-abdominal & trans-sacral surgery,1 case had trans-abdominal and perineal surgery.Tumors were completely resected in 31 cases,and palliatively resected in 5 cases.3 cases suffered from intra-operative presacral hemorrhage.1 case with delayed hemorrhage required surgical intervention.2 cases from incision infection recovered after wound disinfection and dressing.3 cases had postoperative hip or leg numbness;1 case with high fever was cured by intensive antibiotics treatment.Conclusion The low incidence of presacral tumors makes early detection difficult.A diagnosis can be obtained by a positive DRE combined with CT or MRI results.Resection is a therapy of choice after biopsies.

Self close intubation ileostomy in the prevention of anastomotic leakage of anterior resection after neoadjuvant chemoradiation in patients of low rectal carcinoma / 中华普通外科杂志

Objective To explore the safety and applicability of a temporary protective ileostomy that closes itself in the prevention of anastomotic leakage following anterior resection after chemoradiation for rectal cancer.Methods From Oct 2010 to Oct 2013,54 cases of middle or low rectal carcinoma were admitted.Protective ileostomy was created to prevent anastomotic leakage.Patients were divided into two groups receiving respectively intubation ileostomy (group A,28 cases),and conventional ileostomy (group B,26 cases).Results The mean time for anus to restore defecation was identical in the two groups.The period of protection of the anastomosis,was 21 d (15 ～ 35 d) in group A.The rate of spontaneous closure of the stoma after removal of the tube was 100％.The stoma was reduced after 3 to 6 months in group B and major complication developed in one case in this group.Conclusions Temporary ileostomy prevents anastomotic leakage of anterior resection in patients of rectal carcinoma receiving preoperative neoadjuvant chemoradiotherapy.Intubation ileostomy is effective and safe in prevention of anastomotic leakage saving stoma reduction procedures.

Hand-assisted laparoscopic one-stage operation for colorectal cancer with single hepatic metastasis: a report of 6 cases / 中华普通外科杂志

Objective To evaluate the feasibility and safety of hand-assisted laparoscopic one-stage operation for colorectal cancer with single hepatic metastasis.Methods The clinical data of 6 patients of colorectal cancer with single hepatic metastasis treated with hand-assisted laparoscopic one-stage operation between Aug 2009 and Mar 2010 were analyzed retrospectively.Result Procedures were completed successfully in all cases and there was no conversion to open surgery.The mean operation time was (183 ±45) min,the mean blood loss in operation was (165 ±70) ml,the mean time to intestinal function recovery was (69.4 ± 10.5) h,and the average length of stay was (9.5 ±3.2) d.There was no major intraoperative or postoperative complications.All the patients received chemotherapy and up to 30 months follow-up found good condition in all but one dying of widespread intraabdominal tumor metastasis.Conclusions Handassisted laparoscopic one-stage operation for colorectal cancer with hepatic metastasis is feasible and safe.

Mechanisms of RON-mediated epithelial-mesenchymal transition in MDCK cells through the MAPK pathway

The epithelial-mesenchymal transition (EMT) is involved in neoplastic metastasis, and the RON protein may be involved. In the present study, we determined the role and the mechanisms of action of RON in EMT in Madin-Darby canine kidney (MDCK) cells by Western blot and cell migration analysis. Activation of RON by macrophage stimulating protein (MSP) results in cell migration and initiates changes in the morphology of RON-cDNA-transfected MDCK cells. The absence of E-cadherin, the presence of vimentin and an increase in Snail were observed in RE7 cells, which were derived from MDCK cells transfected with wt-RON, compared with MDCK cells. Stimulation of RE7 cells with MSP resulted in increased migration (about 69 percent of the wounded areas were covered) as well as increased activation of extracellular signal-regulated kinase 1/2 (Erk1/2) and glycogen synthase kinase-3β (GSK-3β; the percent of the activation ratio was 143.6/599.8 percent and 512.4 percent, respectively), which could be inhibited with an individual chemical inhibitor PD98059 (50 μM) specific to MAPK/ERK kinase (the percent inhibition was 98.9 and 81.2 percent, respectively). Thus, the results indicated that RON protein could mediate EMT in MDCK cells via the Erk1/2 pathway. Furthermore, GSK-3β regulates the function of Snail in controlling EMT by this pathway.

A multicentral self controlled clinical study on the effect of Alvenor on acute attack of hemorrhoids / 中国普通外科杂志

Objective To evaluate the efficacy of Alvenor on acute attack of hemorrhoids Methods We have enrolled 1?103 cases with acute attack of hemorrihoids from 29 hospitals in all over the country treated by Alvenor. Dosage was 1?500 mg twice daily for four days followed by 1?000 mg twice daily for 3 days Signs and symptoms of pain, bleeding, prolapse, edema, pruritus were scored at day 0, day 4 and day 7 Global treatment efficacy assessment was conducted by both the doctors and the patients themselves Statistical analysis was conducted Results Pain, bleeding, prolapse, edema, pruritus etc were significantly improved Conclusion Alvenor is effective in the treatment of patients with acute attack of hemorrhoids especially in relief of symptoms such as pain, bleeding, prolapse etc

Molecular mechanism of etodolac-induced apoptosis in SMMC7721 cell line / 中国病理生理杂志

AIM: To investigate the possible role of nuclear transcription factor kappa B (NF-?B), Bcl-2, Bax and caspase-3 in etodolac-induced apoptosis of liver tumor SMMC7721 cell line. METHODS: Cell apoptosis was determined by flow cytometry analysis with PI staining and DNA laddering. Expression of Bcl-2 and Bax protein was measured by Western blotting. Caspase-3 activity was evaluated by active caspase-3 apoptosis kit with flow cytometry. NF-?B activation was detected by ELISA-based TransAM~(TM) NF-?B p65/p50 kit. RESULTS: Etodolac, a selective COX-2 inhibitor, stimulated apoptosis in liver tumor SMMC7721 cell line significantly. Flow cytometry showed that the apoptotic rate was 16.3%?3.1%, 19.9%?3.6%, 22.9%?3.2%, 31.2%?3.3% with different concentrations of etodolac (0.25, 0.50, 1.0 or 2.0 mmol/L), while the apoptotic peak did not appear in the control group (0 mmol/L) (P