Choice and consideration of digestive tract reconstruction after total gastrectomy and proximal gastrectomy / 中华消化外科杂志

At present, the surgical treatment of upper gastric cancer, including esophago-gastric junction cancer, mainly includes the total gastrectomy and proximal gastrectomy. After total gastrectomy, the reconstruction of digestive tract is completed through the anastomosis of esophagus and jejunum. Patients undergoing total gastrectomy often face the risk of poor eating effect and malnutrition. Compared with total gastrectomy, the proximal gastrectomy can preserve part of the gastric tissue, but due to the loss of the normal physiological structure of the cardia, patients have a higher risk of postoperative reflux. In order to solve the problem of reflux, there are many improved operation methods of digestive tract reconstruction after proximal gastrectomy. At present, the choice of total gastrectomy or proximal gastrectomy and the operation methods of digestive tract reconstruction is still controversial. Because of the lack of sufficient theoretical research support. The authors comb the research progress and consider the concept and method of digestive tract reconstruction after total gastrectomy and proximal gastrectomy, in order to provide theoretical basis for clinical work.

LncRNA C21orF96 promotes the invasion and metastasis of gastric cancer by regulating the expression of miR-875-5p and USF2 genes / 中华普通外科杂志

Objective To verify that lncRNA-C21orF96 regulates the expression of miRNA-875-5p and USF2 genes and promotes the invasion and metastasis of gastric cancer.Methods RT-PCR was used to measure the expression of lncRNA-C21orF96 related miRNA in gastric cancer cells.pcDNA3.1 plasmid was used to over-express lncRNA-C21orF96 in KATO-Ⅲ and siRNA was used to knockdown the expression of lncRNA-C21orF96 in SGC-7901,and RT-PCR was used to measure the expression of miRNA-875-5p and USF2 genes;By overexpressing lncRNA-C21orF96 in MKN45,transwell was used to observe changes of cells invasion and migration.Results LncRNA-C21orF96 showed a significant inverse relationship with miR-875-5p,(SGC-7901:21.19 ±1.09 vs.3.28 ±0.06,P＜0.01;SNU-16:24.76 ±2.09 vs.8.16 ±0.07,P ＜ 0.01).In KATO-Ⅲ over-expressing lncRNA-C21 orF96,miR-875-5p expression decreased significantly while USF2 expression increased (P ＜0.01);In SGC-7901 with lncRNA-C21orF96 knockdown,miR-875-5p expression increased significantly while USF2 expression decreased (P ＜ 0.05).The number of cells passing through the artificial basement membrane in the experimental group was significantly different from that in the control group (migration:216.19 ± 2.30 vs.89.19 ± 4.60,P＜0.001;invasion:146.18 ±5.3 vs.59.18 ± 2.60,P ＜ 0.001).Conclusions The overexpression of lncRNA-C21orF96 significantly reduces the expression of miR-875-5p and promotes the expression of USF2,hence promoting the invasion and metastasis of gastric cancer.

Analysis of gastric gastrointestinal stromal tumors in Shandong Province: a midterm report of multicenter GISSG1201 study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.</p><p><b>RESULTS</b>Among 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>The choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.</p>

A Chinese multi-center study on the significance of monitoring imatinib plasma concentration in patients with gastrointestinal stromal tumor before and after administration / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the factors which may influence the imatinib plasma concentration in Chinese patients with gastrointestinal stromal tumor(GIST), and to illuminate the significance of monitoring imatinib plasma concentration in adjuvant therapy for patients with GIST.</p><p><b>METHODS</b>A cross-sectional study with 60 GIST patients who accepted the imatinib therapy after surgery was conducted. They were respectively administrated in 10 domestic hospitals from December 2014 to April 2016, including The First Affiliated Hospital of Nanjing Medical University(n=28), The Affiliated Hospital of Nantong University(n=9), The Affiliated Hospital of Xuzhou Medical College(n=6), Nanjing Drum Tower Hospital(n=5), The Second Affiliated Hospital of Nanjing Medical University (n=2), Jingling Hospital (n=2), The Second People's Hospital of Lianyungang(n=2), Shandong Provincial Hospital(n=2), Jiangsu Province Tumor Hospital(n=2), and The First Affiliated Hospital of Zhejiang University(n=2). Some specific time points for collecting blood sample before and after taking imatinib were determined, then liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was used for monitoring imatinib plasma concentration in patients with GIST. Linear regression analysis was used for the correlation analysis of imatinib plasma concentration with dosage, clinicopathologic feature and side effect.</p><p><b>RESULTS</b>Patients who could not tolerate 400 mg imatinib per day(n=3) received 300 mg per day. There was no significant difference in imatinib plasma concentration between patients with 300 mg and those with 400 mg imatinib(n=53)(P=0.527). However, the imatinib plasma concentration in patients with 600 mg imatinib per day (n=4) was significantly higher as compared to those with 400 mg(P=0.000). Linear regression analysis indicated a negative correlation between the imatinib plasma concentration in patients with 400mg imatinib per day for 90 days continuously and body surface area(R=0.074, P=0.035), but no significant correlations of with age, creatinine clearance and serum albumin concentration were observed (all P>0.05). The differences in imatinib plasma concentration were not statistically significant between patients of different gender and those taking proton-pump inhibitor (PPI) or not (both P>0.05). Difference in imatinib plasma concentration between patients with different surgery was significant (P=0.026). Compared to patients who underwent wedge resection, enterectomy and other surgeries, the imatinib plasma concentration of patients with subtotal gastrectomy or total gastrectomy decreased significantly (all P<0.05). After 90 days of taking imatinib continuously, linear regression analysis revealed a negative correlation between imatinib plasma concentration in patients with 400 mg imatinib per day and white blood cell count (R=0.103, P=0.013), and a positive correlation with serum alanine aminotransferase (ALT) concentration (R=0.076, P=0.033).</p><p><b>CONCLUSIONS</b>The imatinib plasma concentration in patients with larger body surface area, subtotal gastrectomy or total gastrectomy may be lower. For these patients, dosage of imatinib should be considered to increase in order to achieve effective plasma concentration. Excessive imatinib plasma concentration can result in some side effects, such as decrease of white blood cells and liver damage. Therefore, it is significant for receiving optimal clinical therapeutic efficacy to monitor imatinib plasma concentration, adjust imatinib dosage timely and keep imatinib plasma concentration in effective and safe range.</p>

Influence of atopy on prognosis of juvenile-onset systemic lupus erythematosus / 中华实用儿科临床杂志

Objective To evaluate the influence of atopy on the prognosis of juvenile-onset systemic lupus erythematosus (JSLE).Methods The study was performed on 60 cases with JSLE diagnosed at the Department of Pediatrics,Renji Hospital Affiliated to School of Medicine of Shanghai Jiaotong University from October 2005 to April 2015.These patients were enrolled by mixed cohort study and subdivided into atopic group(26 cases) or non-atopic group(34 cases).The clinical and laboratory data of the disease onset,disease assessment scores,medications during follow-ups and remission/flare of the disease were recorded and analyzed to compare the difference between 2 groups.Results (1) The systemic lupus erythematosus disease activity index (SLEDAI) score [(17.080 ± 5.628) scores vs (12.590 ± 4.856) scores],anti-double-stranded DNA (anti-dsDNA) [(62.590 ± 43.602) IU/mL vs (40.230 ±30.189) IU/mL],erythrocyte sedimentation rate (ESR) [(59.150 ± 40.315) mm/1 h vs (40,350 ± 31.865)mm/1 h] were significantly elevated at onset in the atopic group compared with non-atopic controls (all P ＜ 0.05),while the complement C3[(0.450 ±0.218) g/L vs(0.640 ±0.333) g/L],C4 [(0.047 ±0.024) g/L vs(0.116 ±0.172) g/L] in atopic group was lower than those in the non-atopic group (all P ＜ 0.05).(2)During the follow ups of 1 and 6 months to 1 year,the JSLE patients with atopy always had higher SLEDA1 score compared with the non atopic controls(all P ＜ 0.05).(3)For medications,the daily cumulative glucocorticoid dose received by patients in the atopic group were larger than that of the non-atopic group,and the number of immunosuppressive agents used in the atopic group was more than that in the non-atopic controls (P ＜ 0.05).(4) During the 1-year follow-up,the rate of disease relapse in the atopic group was higher than that in the non-atopic group and the atopic group also needed much more time to reach disease remission (P ＜ 0.05).Conclusion JSLE patients combined with atopy may have an adverse influence on the prognosis of JSLE.

Analysis and verification of gastric cancer metastatic lymphonodus associated long non-coding RNA / 中华普通外科杂志

Objective To analyze and verify the expression profiles of long non-coding RNAs (lncRNAs) in gastric cancer (GC) metastatic lymphonodus.Methods Microarray analysis was performed in 3 GC positive lymphonodus and 1 normal lymph node with Agilent Array platform to measure the expression levels of lncRNAs and mRNAs and to investigate the expression differences of lncRNAs in GC metastatic lymphonodus and normal lymphonodus, and hierarchical clustering used to screen out the differently expressed lncRNAs.15 up-regulated lncRNAs and 15 down-regulated lncRNAs were randomly chosen and RT-PCR was used to verify the expression differences.Results Comparing with normal lymphonodus, 353 lncRNAs and 547 mRNAs are up-regulated, but 464 lncRNAs and 562 mRNAs are down-regulated in GC metastatic lymphanodus as 6 times or more variation was found.The expressions of lncRNA OR3A4, LOC84740, FCGR1C and C21orf 96 were increased in GC metastatic lymphonodus, but lncRNA MSTO2P, LOC344595, TUG1, TYW3 and KRT8P10 decreased.Conclusions LncRNAs are aberrantly expressed in GC metastatic lymphonodus.

Correlation and clinical significance of expressions of HIF-1α and Sema4D in colorectal carcinoma tissues / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the expressions of hypoxia-inducible factor 1 alpha(HIF-1α) and Semaphorin 4D(Sema4D) in colorectal carcinoma and normal colorectal tissues, and to investigate their correlation and clinical significance.</p><p><b>METHODS</b>The expressions of HIF-1α and Sema4D were examined in 86 cases of colorectal carcinoma and 52 normal colorectal tissues by SP immunohistochemical staining. Correlation between these two expressions and association of the expressions with clinicopathological characters and prognosis were analyzed.</p><p><b>RESULTS</b>The positive rates of HIF-1α and Sema4D protein in colorectal carcinoma tissues were significantly higher than those in normal colorectal tissues(58.1% vs. 7.7%, χ(2)=34.624, P<0.01; 60.5% vs. 11.5%, χ(2)=31.839, P<0.01). HIF-1α and Sema4D protein expressions were closely associated with colorectal carcinoma histological types(P=0.003, P=0.010), TNM staging (P=0.003, P=0.017) and lymphatic metastasis (P=0.003, P=0.020), and a significant correlation was observed between the expressions of HIF-1α and Sema4D protein (r=0.567, P<0.01). The 5-year overall survival rate was 37%. Univariate analysis showed that 5-year survival rates of patients with positive and negative HIF-1α protein expression were 24% and 56%(P=0.003), and those with positive and negative Sema4D protein expression were 23% and 59%(P=0.001). Multivariate Cox analysis showed that expression of Sema4D was an independent prognostic factor of colorectal cancer patients(P=0.026), while expression of HIF-1α was not(P=0.501).</p><p><b>CONCLUSION</b>Combined detection of HIF-1α and Sema4D has the potential to predict the development trend of colorectal carcinoma and prognosis of patients.</p>

Hypoxia-inducible factor-1α and semaphorin4D genes involved with tumor-associated macrophage-induced metastatic behavior and clinical significance in colon cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hypoxia promotes tumor angiogenesis and hypoxia-inducible factor-1 alpha (HIF-1α) plays a pivotal role in this process. Recently identified pro-angiogenic factor, semaphorin4D (Sema4D) also promotes angiogenesis and enhances invasive proliferation in some tumors. Furthermore, tumor-associated macrophages (TAMs) can increase the expression of HIF-1α and Sema4D in cancer cells and thus influence tumor growth and progression. The purpose of this study was to evaluate the effect of TAMs on the expression of Sema4D and HIF-1α and the impact of biologic behavior in colon cancer cells.</p><p><b>METHODS</b>Immunohistochemistry was used to analyze HIF-1α and Sema4D expression in 86 curatively resected colon cancer samples and 52 normal colon tissues samples. The relationship between their expression and clinicopathological factors was analyzed. Furthermore, macrophage-tumor cell interactions, such as metastasis, angiogenesis, were also studied using in vitro co-culture systems. Statistical analysis was performed using SPSS 17.0 software (SPSS Inc., USA). Differences between two groups were analyzed with Student's t test.</p><p><b>RESULTS</b>HIF-1α (58%) and Sema4D (60%) were expressed at a significantly higher level in tumors than in normal tissues (P < 0.01, for both). Furthermore, HIF-1α and Sema4D expression was significantly correlated with lymphatic metastasis, specific histological types and TNM stages (P < 0.05), but not with age and tumor size (P > 0.05). Sema4D expression was correlated with that of HIF-1α (r = 0.567, P < 0.01). TAMs markedly induced HIF-1α and Sema4D expression in colon cancer cells and subsequently increased their migration and invasion.</p><p><b>CONCLUSIONS</b>HIF-1α and Sema4D expression are closely related to lymphatic metastasis, specific histological types and TNM stages in colon cancer. Furthermore, TAMs promote migration and invasion of colon cancer cells and endothelial tube formation, possibly through up-regulation of HIF-1α and Sema4D.</p>

Expression of VEZT in gastric cancer tissues and the construction of VEZT over-expression vector / 中华普通外科杂志

Objective To investigate the expression of VEZT and its clinical pathological significance in gastric cancer tissues,and to construct the VEZT over-expression vector.Methods The expression of VEZT was examined in 119 cases of gastric carcinoma and their corresponding normal mucus tissues by SP immunohistochemical staining.The relationships between the VEZT expression levels and its clinicopathological characteristics,prognosis were also investigated.VEZT cDNA was extracted and amplificated from 293 cells by polymerase chain reaction (PCR).Using DNA recombinant technique,the target gene was connected to the pEGFP-N1 vector to construct recombinant plasmid vector after the target gene and pEGFP-N1 were purified.The recombinant plasmid was identificated by 1％ enzyme electrophoresis and DNA sequencing.Results The VEZT-positive expression in gastric carcinoma was 30.3％ and 60.5％ in normal gastric tissues.VEZT expression in high differentiated cancer tissues was higher than that in lower differentiated tissues(x2 =5.002,P ＜ 0.05),expression of VEZT in early gastric cancer was significantly higher than that in patients with advanced gastric cancer (x2 =5.551,P ＜ 0.05),expression of VEZT in patients without lymph node metastasis was significantly higher than that of lymph node metastasis (x2 =5.878,P ＜ 0.05).Patients with positive VEZT expression have better prognosis than the negative patients(x2 =6.908,P ＜ 0.01).The target fragment,consistent with the theoretical value,was verified by gel electrophoresis.DNA sequencing confirmed that the gene sequence had no mutation and the eukaryotic expression plasmid vector pEGFP-N1-hVEZT was successfully constructed.Conclusions VEZT protein was correlated with TNM staging,tumor stage,invasion depth and lymph node metastasis,positive VEZT expression predicting better five year survival.The VEZT over-expression plasmid vector was successfully constructed.

Reversal effects of short hairpin RNA interference and tetrandrine on multidrug resistance of human colorectal cancer cell line LoVo/5-fluorouracil / 中华消化外科杂志

Objective To compare the reversal effects of short hairpin RNA (shRNA) interference and tetrandrine on multidrug resistance (MDR) of human colorectal cancer cell line LoVo/5-fluorouracil(5-FU ).Methods An eukaryotic expression plasmid of shRNA targeting MDR1 was constructed and transfected into human colorectal cancer cell line LoVo/5-FU (transfection group).LoVo/5-FU was also pretreated with tetrandrine (tetrandrine group).Drug sensitivity was detected by methyl thiazolyltetrazolium colorimetric method.Cell cycle,apoptosis of cells and positive expression rate of P-glycoprotein (P-gp) were determined by flow cytometry assay.The expressions of MDR1 mRNA and P-gp were detected by real-time polymerase chain reaction and Western blot,respectively.All data were analyzed by analysis of variance and SNK-q test.Results (1)Drug sensitivity:the 50％ concentration of inhibition(IC50)of the control group,tetrandrine group and transfection group were (7.3 ± 0.3),(4.4 ±0.7) and (2.4 ±0.4) mmol/L,respectively,a significant difference between the 3 groups was found(F =65.27,P ＜ 0.05 ).There was a significant difference in the IC50 between the tetrandrine group and the transfection group (q =6.67,P ＜ 0.05 ).(2) Changes of cell cycle:the proportion of cells in the G1 phase and S phase of the control group,tetrandrine group and transfection group were 38.13％ ± 3.75％,51.36％ ± 2.76％,59.24％±4.31％ and 20.46％±2.23％,14.32％± 1.91％,9.40％± 1.65％,respectively,a significant difference between the 3 groups was found(F =25.23,24.37,P ＜ 0.05 ).There were significant differences in the proportion of cells in the G1 phase and S phase between the tetrandrine group and the transfection group(q =3.67,4.35,P ＜ 0.05 ).(3) Cell apoptosis:the cell apoptotic rates of the control group,tetrandrine group and transfection group were 1.32％ ± 0.47％,3.24％ ± 0.26％,5.88％ ±- 0.44％,respectively,a significant difference between the 3 groups was found(F =99.26,P ＜ 0.05 ).There was a significant difference in the cell apoptotic rate between the tetrandrine group and transfection group(q =11.48,P ＜ 0.05 ).(4)The expression of P-gp:the positive expression rates of P-gp of the control group,tetrandrine group and transfection group were 96.9％ ± 2.3％,61.6％ ± 4.9％,76.6％ ± 3.6％,respectively,a significant difference between the 3 groups was found(F =67.83,P ＜ 0.05 ).There was a significant difference in the positive expression rate of P-gp between the tetrandrine group and transfection group (q =6.97,P ＜ 0.05 ).(5)The mRNA expression of MDR1:the mRNA expressions of MDR1 of the control group,tetrandrine group and transfection group were 1462 ±161,570 ±85,233 ± 81,respectively,a significant difference between the 3 groups was found(F =90.59,P ＜ 0.05 ).There was a significant difference in the mRNA expression of MDR1 between the tetrandrine group and transfection group (q =5.12,P ＜ 0.05 ).Conclusions MDR1 shRNA and tetrandrine could reverse M DR1 gene-mediated m.ultidrug resistance in human colon cancer cell line LoVo/5-FU,but the effect of MDR1 shRNA is better than that of tetrandrine.MDR1 shRNA and tetrandrine might take effect by inhibiting P-gp expression and down-regulating mRNA expression of MDR1.

Expression and biological function of miR-622 in gastric cancer cells / 中华普通外科杂志

Objective To investigate the biological function of miR-622 in human gastric cancer cell lines of SGC-7901 and NCI-N87 cells and its role in gastric carcinogenesis.Methods We analyzed the expression of miR-622 in those human gastric cancer cell lines by quantitative real-time polymerase chain reaction.Tumorigenesis,migration and invasion ability of miR-622 overexpression was assessed in vitro with miR-622 precursor and inhibitor in in SGC-7901 and NCI-N87 cells.Results The expression level of miR-622 in SGC 7901 was 1.29 ± 0.57,and it was 10.96 ± 1.02 in NCI-N87 cells.The soft agar colony formation rate was 76％ in SGC-7901 after transfecting miR-331-3p precursor,the ability of scratch healing was ( 11 ±7) μm,and the ability of transwell invasion was (731 ±3),compared with that in control group,the differences were statistically significant ( P ＜ 0.05 ).Conclusions Over-expression of miR-622 promotes tumorigenesis,migration,and invasion in gastric cancer cells in vitro.

Reversal of multidrug resistance in human colon carcinoma LOVO/5-Fu cells by tetrandrine / 中华普通外科杂志

Objective To explore the reversal effect on MDR1 gene-mediated multidrug resistance in human colon carcinoma LOVO/5-Fu cells by tetrandrine ( Tet) and to clarify its molecular mechanism.Methods LOVO/5-Fu cells were treated for 48 h with Tet.Drug sensitivity was measured by MTT.The cell cycle, apoptosis of cells and expression of P-glycoprotein (P-gp) were determined by flow cytometry assay.Expression of MDR1 mRNA was detected by real-time quantitative PCR (real-time PCR).P-gp expression was detected by Western blot.Results After LOVO/5-Fu cells were treated for 48 h with Tet, the IC50 of 5-Fu decreased to ( 4.15 ± 0.31 ) μg/ml ( P ＜ 0.05 ) ; and the apoptotic rate increased to (3.44% ± 0.28% ) ( P ＜ 0.05) ; the expression of MDR1 mRNA reduced to (570 ± 85) (P ＜ 0.05 ).Conclusions Tetrandrine reverses MDR1 gene-mediated multidrug resistance in human colon carcinoma LOVO/5-Fu cells possibly by inhibiting the expression of MDR1, decreasing the expression of P-gp, thus enhancing the sensitivity of LOVO/5-Fu cells to 5-fluorouracil.

Comparison of the efficacy of XELOX and FOLFOX4 in the treatment of locally advanced unresectable gastric cancer / 中华消化外科杂志

Objective To compare the efficacy of XELOX and FOLFOX4 in the treatment of locally advanced unresectable gastric cancer. Methods The clinical data of 72 patients with gastric cancer who were admitted to the Shandong Provincial Hospital from July 2006 to October 2009 were prospectively analyzed. Of all the patients, 3 lost follow-up, and 69 patients with locally advanced unresectable gastric cancer were randomly divided into XELOX group ( n = 36 ) and FOLFOX4 group ( n = 33 ) according to the random number table.All patients received chemotherapy for six weeks. The efficacy of the two regimens were evaluated by the multidiscipline team six weeks later. The cell cycle of patients with complete or partial remission and received surgical treatment was detected by flow cytometry. All data were analyzed using the Pearson chi-square test, Levene test or t test. Results The curative rates of XELOX and FOLFOX4 were 53% (19/36) and 52% (17/33), respectively,with no significant difference between the two groups ( x2= 0. 01 , P ＞ 0. 05 ). The incidences of nausea and vomiting, phlebitis and hand-foot syndrome were 25% (9/36), 6% (2/36) and 19% (7/36) in the xELOX group, and 55% ( 18/33), 39% (13/33) and 3% (1/33) in the FOLFOX4 group, respectively, with significant difference between the two groups ( x2 = 6.31, 11.59, 4.53, P ＜ 0.05 ). Nineteen patients in the XELOX group and 17 patients in the FOLFOX4 group received surgical resection of the gastric cancer, and no complications such as anastomotic leakage and hemorrhage occurred postoperatively. In the XELOX group, the s-phase fraction (SPF),proliferation index (PI) and G2/M of the gastric cancer cells were 5.89% ± 0.79%, 9.22% ± 1.99% and 5.19% ± 1. 66% after neoadjuvant chemotherapy, which were significantly lower than 6.76% ± 1.21%, 10.44% ±2.12% and 6. 04% ± 0. 57% before neoadjuvant chemotherapy, while the ratio of gastric cancer cells in the G0/G1 phase after neoadjuvant chemotherapy was 90.39% ±4.78%, which was significantly higher than 87.54%±6.34% before neoadjuvant chemotherapy (x2 =3.61, 2.52, 2. 15, 2.91, P ＜0.05). In the FOLFOX4group, the SPF, PI and G2/M of the gastric cancer cells were 6.09% ± 0.96%, 10.65 % ± 2.47% and 4.88% ±0.87% after neoadjuvant chemotherapy, which were significantly lower than 7.15% ± 1.45%, 11.87% ± 2.33%and 5.67% ± 1.03% before neoadjuvant chemotherapy, while the ratio of gastric cancer cells in the G0/G1 phase after neoadjuvant chemotherapy was 91.45% ± 5.22%, which was significantly higher than 88.01% ± 4.23%before neoadjuvant chemotherapy ( x2 = 3.50, 2.06, 3.37, 2.94, P ＜ 0.05 ). There was a significant difference in PI between XELOX group and FOLFOX4 group after neoadjuvant chemotherapy ( x2 = 2.66, P ＜ 0.05 ).Conclusions XELOX and FOLFOX4 are safe and effective in the treatment of locally advanced unresectable gastric cancer, and they can significantly restrain the proliferation of gastric cancer cells. XELOX regimen is more effective than FOLFOX4 regimen.

Application of multi-slice computed tomography in the diagnosis of colorectal neoplasms / 中华消化外科杂志

Colorectal neoplasms always present with thickness of the intestinal wall or a soft tissue mass in the enteric cavity. Multi-slice computed tomography (MSCT) with high spatial resolution and advanced post-processing techniques can demonstrate the above signs of the tumor, and the invasive signs of adjacent structures and lymph node metastasis. Combined with three dimensional reformation images, MSCT shows a higher sensitivity than that of double contrast barium enema and electronic colonoscope. MSCT is promising in the diagnosis and preoperative evaluation of colorectal neoplasms.

Distal spread of low and middle rectal cancer in mesorectum and rectal wall found by large slices stained with CK20 / 中华普通外科杂志

Objective To examine the frequency and mode of distal spread of low and middle rectal cancer in the mesorectum and rectal wall. Methods Thirty-four specimens from low and middle rectal cancer were collected between August 2004 and December 2005 in Cancer Center of Sun Yat-sen University. Twenty-eight specimens of low and middle rectal cancer were collected between October 2006 and October 2007 in Shandong Provincial Hospital of Shandong University. All 62 specimens were studied using large slices stained with CK20. Logistic regression was used to analyze clinicopathologic factors related to distal spread of low and middle rectal cancer in the mesorectum and rectal wall. Results Two types of distal spread of the tumor were observed in rectal wall: submucosa invasion and muscularis propria invasion. Distal spread in rectal wall was observed in 16% (10/62) of the patients. The length of distal spread in rectal wall was found from O. 5 cm to 1.0 cm. Four types of distal spread of the tumor were observed in mesorectum: lymph node invasion, blood and lymphatic vessel invasion, perineural invasion, isolated neoplastic microfoci. Distal spread in mesorectum was observed in 24% (15/62) of the patients. The length of distal spread in mesorectum was found from 0. 5 cm to 4. 0 cm. Three more cases with microcapillary invasion in distal mesorectum was observed by immunohistochemical technique, which was difficult to identify by conventional HE staining. Univariate analysis showed that serum CEA , lymph node invasion, CMI and TNM stage were correlated with distal spread of low and middle rectal cancer in the mesorectum and rectal wall. TNM stage was shown to be independent impact factor by multivariate analysis( Wald = 9. 567, P =0. 002). Conclusion TNM stage is an independent impact factor for distal spread of low and middle rectal cancer in the mesorectum and rectal wall. Resection of 1.5 cm for distal rectal wall is necessary for a curative intention, but it must be emphasized that the clearance for distal mesorectum should be 5 cm at least.

Effects of glutamine enriched parenteral nutrition on mucosal ischemia and reperfusion injury of small bowel in rats / 中国现代普通外科进展

Objective:Small bowel IRI models in rats were established to explore the effect of glutamine enriched parenteral nutrition on mucosal barrier,and to discuss the probable mechanisms.Methods:Thirty Wistar rats were randomly assigned into 3 groups:The control group(N group,n=10) ,conducted fictitious operation and fed with common forage,TPN group(n=10) and TPN+Glu group(n=10) .The morphous of mucous,serum and intestinal mucosal Gln concentration,levels of D-lactate,endotoxin,TNF-?,IL-6,HO-1 positive ratio and HO-1 mRNA were detected.Results:Glutamine obviously improved the structure of intestinal mucosal and decreased the expressions of D-lactate,endotoxin,TNF-?and IL-6.And enhanced the expressions of HO-1 mRNA and HO-1.Conclusion:Glutamine enriched parenteral nutrition can alleviate small intestinal IRI and inflammatory reaction and enhance the HO-1 and HO-1 mRNA expressions.HO-1 and its metabolin's anti-oxygen,anti-apoptosis,anti-inflammator action may be the mechanism of the protective action of Gln on mucosal barrier of small bowel.

A study on distal spread of low and middle rectal cancer in mesorectum and rectal wall / 中华普通外科杂志

Objective To examine the frequency and mode of distal spread of low and middle rectal cancer in the mesorectum and rectal wall to determine the optimal distal clearance in situ. Methods Thirty-four specimens with low and middle rectal cancer were collected in the pathologic study between August 2004 and December 2005 in Cancer Center of Sun Yat-sen University,Twenty-eight specimens with low and middle rectal cancer were enrolled in the pathologic study between October 2006 and October 2007 in Shandong Provincial Hospital of Shandong University.Logistic regression wag used to analyze clinicopathoiogic factors related to distal spread of low and middle rectal cancer in the mesorectum and rectal wall. Results Two types of disial spread of the tumor were identified in rectal wall:submucosa invasion and muscularis propda invasion.Distal spread in rectal wall was observed in 16%(10/62)of the patients.The length of distal spread in rectal wall was found from 0.5 cm to 1.0 cm.Four types of distal spread of the tumor were identified in mesorectum:lymph node invasion,blood and lymphatic vessel invasion,perineural invasion,isolated neoplastic microfoci.Distal spread in mesorectum was observed in 19%(12/62)of the patients.The length of distal spread in mesorectum was found from 0.5 cm to 4.0 cm.Univariate analysis showed that serum CEA,lymph node invasion.circumferential margin involvemenl and Dukes stage were correlated with distal spread of low and middle rectal cancer in the mesorectum and rectal wall.Dukes stage was shown to be independent impact factor by multivariate analysis(Wald=8.386,P=0.004).Conclusion Dukes stage is an independent impaet factor for distal spread of low and middle rectal cancer in the mesorectum and rectal wall.Resection of 1.5 cm for distal rectal wall mandatory for a curative resection,provided that the clearance for distal mesorectum is no less than 5.0 cm.

Comparative Study of Mammography with Ultrasonography for the Diagnosis of Breast disease with Microcalcification / 中国现代普通外科进展

Objective:To explore the diagnostic value of mammography and ultrasonography(US)in diagnosis of breast disease with microcalcifications.Methods:Seventy-eight cases with breast microcalcifications were detected by mammography.The detection rate of breast microcalcification at US was analyzed.And the sensitivity,specificity and the accuracy of US in diagnosis breast disease with microcalcifications was compared with these of mammography.Results:The detection rate of breast microcalcification was 66.7%,And US depicted more malignant(87.5%)than benign microcalcification(33.3%).The sensitivity specificity and accuracy of US was 68.7%、83.3%、 74.3%respectively,and the sensitivity specificity and accuracy of mammography was 72.9%、 73.3%、75.6%respectively,there were no significant difference between the two methods.The sensitivity,specificity and accuracy of the combined the two methods was 89.6%,90.0%,92.3% respectively.Conclusion:US can effectively detect and identify the breast microcalicications.The combination can improve the assessment of breast disease with microcalicications,and has a significant clinical practical value in diagnosis of early breast cancer.

Expression of p27 in Rectal Carcinoma and Modulatory Relation Between Transforming Growth Factor-?1 and p27 / 中国普外基础与临床杂志

Objective To detect p27 expression in rectal carcinoma and serum transforming growth factor ? 1 (TGF ? 1) level in these patients, and to elucidate the modulatory effect of serum TGF ?1 on p27 expression in rectal carcinoma. Methods Expression of p27 was measured in 37 cases of rectal carcinoma, 22 of rectal adenoma and 19 of normal control specimens by immunohistochemical staining using antibodies to p27. Serum level of TGF ?1 was measured in these patients by enzyme linked immunosorbent assay (ELISA) method. Results p27 protein was expressed in normal rectal tissue, rectal adenoma and rectal carcinoma, and the positive rate was 89.47%, 90.91% and 64.87%, respectively. The positive rate of p27 in rectal carcinoma was significantly lower than that of normal rectal tissue and rectal adenoma ( P =0.025). p27 was mainly located in nucleolus of normal rectal tissue and rectal adenoma, and the positive rate of p27 in cytoplasm of rectal carcinoma was higher than that of normal and rectal adenoma. The positives rates of serum TGF ?1 in normal group, rectal adenoma group and rectal carcinoma group were 21.05%, 27.27% and 51.35%( P =0.045),respectively. The expression of p27 related to histological differentiation, lymph node metastasis and infiltration depth. Serum level of TGF ?1 related to lymph node metastasis, infiltrated depth and CEA level. The positive rate of p27 in TGF ?1 negative group and positive group was 88.89% and 42.11%(Mantel Haenszel ? 2=6.755, P =0.009), respectively. Conclusion TGF ?1 may be useful in assessment of malignance and prognosis of rectal carcinoma. TGF ?1 can down regulate p27 expression in rectal carcinoma.

The evaluation of Survivin protein expression for the prognosis of postoperative patients with hepatocellular carcinoma / 中国普通外科杂志

Objective To evaluate the correlation between the expression of Survivin、VEGF and MMP 2 and the prognosis of patients with hepatocellular carcinoma Methods Expressions of Survivin、 VEGF and MMP 2 were detected by immunohistochemical S P method in 67 postoperative HCC cases Twelve candidate factors associated with long term survival were analyzed by Kaplan Meier Log rank estimation A multivariative Survival analysis of these individual variables was undertaken using the cumulative survival rate by the COX proportional hazards model Results A multivariative analysis determined three independent significant factors influencing overall cumulative survival including Survivin, VEGF, liver function (Child grade) The three prognostic factors predicted an increased risk of death from HCC Conclusion Survivin, VEGF, liver function, particularly the Child Pugh classification are the most significant prognostic factors for HCC patients undergoing hepatic resection