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Perforated peptic ulcer is a common acute abdominal disease and requires emergency surgical treatment. Laparoscopic repair PPU was started early but progressed slowly. Compared with the popularization of minimally invasive concept of laparoscopic cholecystectomy, laparoscopic repair is still under the situation of disputation, low overall application rate and extremely unbalanced development in different regions and organizations. With the embodiment of minimally invasive advantages of laparoscopy and the technology progress, as well as the updating of surgeons′ ideas and the emergence of higher quality RCT studies, the proportion of PPU in laparoscopic treatment is gradually increasing. In order to make full use of the minimally invasive value and differential diagnostic value of laparoscopy, the laparoscopy-first approach can be adopted as a routine for appropriate PPU patients. The key to case selection and the physicians experience and proficiency. Laparoscopy should be actively adopted but should not be easily expanded. If necessary, the patients should be converted to open operation. If not the advantages of laparoscopy will be drowned.
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Objective:To further understand the clinical characteristics of scirrhous gastric cancer (SGC)and clear it definitions. Analyzed the clinicopathologic features and prognosis of patients with SGC and Non SGC(NSGC).Methods:The study included 342 gastric cancer patients who had undergone gastrectomy in the Second Hospital University of South China between May 2011 and May 2018. The SGC was diagnosed by endoscopic, CT, tumor stroma ratio and appearance of surgical specimen clinicopathological characteristics were summarized and compared between SGC patients and NSGC using pearson′s χ2 test or student′s t test. Survival curves were estimated with the Kaplan-Meier method. Patients were matched 1∶1 using propensity score matching, and their overall survival rates were compared. Results:A total of 342 patients with gastrectomy were collected, 49 (14.3%) were diagnosed as SGC. Patients with SGC were younger, later pathological stage lymph node metastases tend to occur than those(NSGC). SGC had a higher total gastric resection rate, easier prone to nerve/vascular invasion and omental metastasis ( P<0.01). The median survival of SGC patients and overall survival at 1, 3, and 5 years after surgery were shorter than NSGC patients, which were independent risk factors affecting the prognosis of patients. Conclusions:SGC can be well defined by endoscopy, CT, TSR and tumor appearance. It is a peculiar solid tumor with poor differentiated, advanced stage and poor prognosis. Future research should focus on how to diagnose SGC earlier and intervene in time.
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Transforming growth factor-β(TGF-β), a member of the TGF-β superfamily, plays a role in multiple biological processes, including cell proliferation, differentiation, migration and tissue fibrosis, etc. Normally, TGF-βs widely express in normal tissues and most cell lines, such as macrophages and dendritic cells, But in pathological conditions, Cancer cells and cancer-associated fibroblasts also produce and secrete TGF-β. Scirrhous gastric cancer (SGC) is a special subtype of gastric cancer with rapid development, frequent peritoneal implantation, and accompanied by significant interstitial fibrosis deposition. these biological behavior characteristics all suggest that its occurrence and development are closely related to TGF-β expression, and TGF-β is considered to be associated with poor prognosis of the SGC. The use of antibodies and inhibitors of TGF-β and its signaling pathways can reduce the invasiveness of cancer cells and improve the prognosis of SGC patients. This paper reviews the expression and significance of TGF-β in SGC.
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OBJECTIVE@#To determine the incidence of surgical site infection (SSI) after abdominal surgery and to further evaluate the related risk factors of SSI in China.@*METHODS@#The multicenter cross-sectional study collected clinical data of all adult patients who underwent abdominal surgery from May 1, 2018 to May 31, 2018 in 30 domestic hospitals, including basic information, perioperative parameters, and incisional microbial culture results. The primary outcome was the incidence of SSI within postoperative 30 days. SSI was classified into superficial incision infection, deep incision infection, and organ/gap infection according to the US Centers for Disease Control and Prevention (CDC) criteria. The secondary outcome variables were ICU stay, postoperative hospital stay, total hospital stay, 30-day mortality and treatment costs. Multivariate logistic regression was used to analyze the risk factors of SSI.@*RESULTS@#A total of 1666 patients were enrolled in the study, including 263 cases of East War Zone Hospital of PLA, 140 cases of Affiliated Hospital of Qingdao University, 108 cases of The First Affiliated Hospital of Nanchang University, 87 cases of Central War Zone Hospital of PLA, 77 cases of West China Hospital, 74 cases of Guangdong General Hospital, 71 cases of Chenzhou First People's Hospital, 71 cases of Zigong First People's Hospital, 64 cases of Zhangjiagang First People's Hospital, 56 cases of Nanyang City Central Hospital, 56 cases of Lanzhou General Hospital of Lanzhou Military Command, 56 cases of Shandong Provincial Hospital, 52 cases of Shangqiu First People's Hospital, 52 cases of People's Hospital of Xinjiang Uygur Autonomous Region, 48 cases of The Second Xiangya Hospital of Central South University, 48 cases of Chinese PLA General Hospital, 44 cases of Affiliated Hospital of Xuzhou Medical University, 38 cases of Hunan Province People's Hospital, 36 cases of Dongguan Kanghua Hospital, 30 cases of Shaoxing Central Hospital, 30 cases of Northern Jiangsu People's Hospital, 29 vases of The First Affiliated Hospital of Zhengzhou University, 27 cases of General Hospital of Tianjin Medical University, 22 cases of Zigong Fourth People's Hospital, 21 cases of The Second Hospital of University of South China, 18 cases of Tongji Hospital, 15 cases of Nanchong Central Hospital, 12 cases of The 901th Hospital of PLA, 11 cases of Hunan Cancer Hospital, 10 cases of Lanzhou University Second Hospital. There were 1019 males and 647 females with mean age of (56.5±15.3) years old. SSI occurred in 80 patients (4.8%) after operation, including 39 cases of superficial incision infection, 16 cases of deep incision infection, and 25 cases of organ/interstitial infection. Escherichia coli was the main pathogen of SSI, and the positive rate was 32.5% (26/80). Compared with patients without SSI, those with SSI had significantly higher ICU occupancy rate [38.8%(31/80) vs. 13.9%(220/1586), P<0.001], postoperative hospital stay (median 17 days vs. 7 days, P<0.001) and total hospital stay (median 22 days vs. 13 days, P<0.001), and significantly higher cost of treatment (median 75 000 yuan vs. 44 000 yuan, P<0.001). Multivariate analysis showed that male rise(OR=2.110, 95%CI:1.175-3.791, P=0.012), preoperative blood glucose level rise(OR=1.100, 95%CI: 1.012-1.197, P=0.026), operative time (OR=1.006, 95%CI:1.003-1.009, P<0.001) and surgical incision grade (clean-contaminated incision:OR=10.207, 95%CI:1.369-76.120, P=0.023; contaminated incision: OR=10.617, 95%CI:1.298-86.865, P=0.028; infection incision: OR=20.173, 95%CI:1.768-230.121, P=0.016) were risk factors for SSI; and laparoscopic surgery (OR=0.348, 95%CI:0.192-0.631, P=0.001) and mechanical bowel preparation(OR=0.441,95%CI:0.221-0.879, P=0.020) were protective factors for SSI.@*CONCLUSIONS@#The incidence of postoperative SSI in patients with abdominal surgery in China is 4.8%. SSI can significantly increase the medical burden of patients. Preoperative control of blood glucose and mechanical bowel preparation are important measures to prevent SSI.
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Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Abdome , Cirurgia Geral , China , Estudos Transversais , Cirurgia Geral , Duração da Cirurgia , Complicações Pós-Operatórias , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida CirúrgicaRESUMO
Objective To further explore the relationship of CEA in gastric cancer tissue expression and serum levels,and seek after the prediction effect of serum CEA in the peritoneal metastasis.Methods Retrospective analysis of 38 gastric cancer patients with peritoneal metastasis (group A) and 60 gastric cancer patients without peritoneal mnetastasis (group B),and analyze the first time in two groups of patients with preoperative serum CEA levels.The expression levels of CEA was examined by Immunohistochemistry method in primary tumors、negative margin and peritoneal metastases foci from group A and in primary tumors from group A,and the detection result of the statistical was analyzed.Results The expression of the first preoperative CEA serum levels in group A and group B was 73.68％ and 41.67％ respectively (x2 =9.604,P =0.002),and the two groups of patients with the first preoperative CEA serum levels was (74.00 + 6.00) ng/mL,(46.06 + 9.03) ng/mL,The two groups was statistically significant (t =4.715,P ＜0.01).In group A,the expression of CEA of primary tumors was higher than that of negative margins (x2 =29.587,P =0.000);the difference expression of CEA positive degree in gastric cancer primary tumors and negative margins was statistically significant(Z =-5.348,P =0.000).In peritoneal metastases foci the expression of CEA was 92.11％,that was 64.82％ in primary tumor(x2 =6.728,P =0.009);the difference expression of CEA positive degree in peritoneal metastases foci and primary tumors was statistically significant (Z =-5.397,P =0.017).In primary tumors,the expression of CEA in group A and group B was 68.42％ and 42.67％ respectively (x2 =4.450,P =0.035),the two groups of patients with the difference expression of CEA positive degree was statistically significant,the two groups was statistically significant(Z =-2.227,P =0.026).Conclusion Over expression of CEA might have a critical role in peritoneal metastases of gastric carcinoma.The differences of the expression of CEA in gastric cancer in different tissues may indicate the risk of gastric cancer peritoneal metastasis.
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Gastrin is mainly secreted by the G cells in antrum and the upper part of small intestine.Gastrin receptor distributes in various tissues.Gastrin and its receptor have several functions including regulating cell growth and differentiation,inhibiting apoptosis,promoting cell proliferation,invasion and metastasis.Studies have shown that gastrin and its receptor involve with various cancers occurrence and development.Gastrin and its receptor can be used to diagnosis early gastric cancer,and be used as a potential targets in gastric carcinoma treatment.The relationship of gastrin and its receptor with gastric carcinoma were reviewed in this paper.
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Objective To assay free amino acids (FAA) content of breast cancer tissue and mammary glandular tissue and discuss the therapeutic basis of unbalanced amino acids of breast cancer. Methods The selected samples were conserved and then cut into pieces, grinded, syruped and deproteinized. Then FAA were separated from the samples. The content of 17 kinds of free amino acids in breast cancer tissue and mammary glandular were assayed respectively. Results The concentration of FAA in breast cancer tissue was higher than that in mammary glandular tissue. Conclusions Free amino acids metabolism was greatly different in breast cancer and mammary glandular tissues. This offers a therapeutic basis for the treatment of unbalanced free amino acids in the case of breast cancer.
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Objective To explore the possible role and mechanism of the Kupffer cells (KCs) in liver allo-geneic transplantation at the early stage. Methods In vitro cell contact coculture system was established. Culture supernatants were collected respectively on the 1st, 2nd, 4th, 6th d after cocul-ture and the KCs and PBMCs were harvested on the 6th day after culture. The expression of HLA-G on the membrane of the KCs and PBMCs was detected with immunochemistry. Nitrate reduction test was used to determine the concentration of nitric oxide. IFN-γ, IL-10, TGF-β1 cytokine levels in the supernatants were also measured with ELISA. The proliferation of lymphocytes was evaluated with MTT. Results six days later, no HLA-G molecules were detected on the membrane of the KCs and PBMCs. In the experimental group containing KCs, the levels of NO, IL-10 and TGF-β1 was signifi-cantly increased(P<0. 05), while the levels of IFN-γ was relatively lower(P<0. 05) as compared to the experimental group without KCs. No IL-10 and IFN-γ were detected in the control group, and on-ly few NO and TGF-β1 was found in the control group with KCs. MTT test showed that the value of optical density was lower in the experimental group with KCs than that in any other group(P<0. 05).Conclusion No HLA-G is expressed on the membrane of KCs and PBMCs after contact coculture.KCs may participate in regulating production of NO and Th2/Th3-like cytokines and suppressing the proliferation of lymphocytes, through which KCs probably take part in inducing immunotolerance of liver transplantation in early stage.
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Objective To investigate histopathological change of axillary lymph nodes and ecto-node encroachment of breast cancer following neoadjuvant chemotherapy in locally advanced breast cancer.Methods Second Hospital Affiliated to University of South China had received 86 patients with breast carcinoma from June 2002 to August 2009,these patients suffered lump over 5 cm and homonymy nonfusion lymphadenectasis.All samples were grouped on the basis of wether or not accept neoadjuvant chemotherapy.The first group included 46 patients,who were reluctant to receive neoadjuvant chemotherapy,operated after pricking pathological diagnosis.There were 40 patients with metastatic axillary lymph nodes and 17 patients with axillary ecto-node encroachment in the first group.The second group included 40 patients,who were voluntary to receive neoadjuvant chemotherapy,and operated after pricking pathological diagnosis and received three cycles of neoadjuvant chemotherapy on average.There were 26 patients with metastatic axillary lymph nodes and 6 patients with axillary ecto-node encroachment in the second group.Results The rate of metastatic axillary lymph nodes was 86.9% and the rate of axillary ecto-node encroachment was 36.9% in the first group,while 65% and 15% respectively in the scond group.There were significant deference in the rate of metastatic lymph node and axillary ecto-node encroachmen between two groups.Conclusion Neoadjuvant chemotherapy is effective to treat metastatic lymph node and axillary ecto-node encroachment in breast cancer.
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Objective To study the surgical treatment of left colon cancer complicated with acute abdo-men.Methods From January 2000 to Dcember 2008,the clinic data of 36 patients with left colon cancer complicated by acute abdomen were analyzed retrospectively.All cases have been chosen emergency opera-tion.One-stage colectomy and annstomosis were performed in 28 cases,Hartmann in 5 cases and palliative colostomy in 3 cases.Results Anastomic leakage was found in one case after operation,infection of inci-sion happended in 4 cases,infection of lung happened in 2 cases,the times of defecation rised in one case,one patient died.Conclusion More attention shoud be paid to left colon cancer complicated by acute abdo-men.According to the patients'status,different operative manners were chosen.One-stage operation should be chosen firstly to improve quality of life and avoid staged operation.
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Objective To detect the expressions of COX-2 and VEGF-C in breast cancer and to explore the relationship between their expressions and lymphatic metastasis. Methods Immunohistochemical stai- ning (SABC) was used to detect the expressions of COX-2 and VEGF-C proteins in 60 cases of breast canc- er. Results The positive rate of COX-2 and VEGF-C in breast cancer were 66.7% and 60. 0%, and the expression of COX-2 was positively correlated with VEGF-C (r =0.429, P<0.05). COX-2 and VEGF-C expressions were positively correlated with lymphatic metastasis (P<0.05). The lymphatic metastasis rate in the positive group of COX-2 and VEGF-C were higher than that in the negative group of COX-2 and VEGF-C. Conclusion Over expression of COX-2 and VEGF-C were observed in breast cancer, and closely related to lymphatic metastasis. COX-2 has positive correlation with VEGF-C and was correlated with lym- phatic metastasis of breast cancer. COX-2 may promote the over expression of VEGF-C in tumor cells and cause lymphatic metastasis.
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Objective To evaluate the efficacy of transcatheter arterial chetnoembolization (TACE) in adjuvant with ther - motherapy in the treatment of primary hepatic carcinomas (PHCs) ,and to obsorre the changes of T - lymphocyte subsets and naturalkiller(NK) cells before and after therapy and the clinical significance. Methods Forty patients with advanced PHCs were randomly divided into two groups (the study group and the control group) ,with 20 cases in each. The patients in the study group were treated by TACE in adjuvant with thermotherapy, and the patients in the control group were treated by TACE alone. The changes of T - lymphocyte subsets and NK cells were examined by im - munofluorescence staining in 40 cases of PHC before and after TACE in adjuvant with ther - motherapy and were compared with those of 20 cases who received conventional interventional chemotherapy (control group). Results The short -term remission rate of the study group and control group were 65% and 40% , respectively (P