Development and validation of survival nomograms in colorectal cancer patients with synchronous liver metastases underwent simultaneous surgical treatment of primary and metastatic lesions.

Colorectal cancer patients with synchronous liver metastases (CRSLM) can be treated by simultaneous surgery, that is the primary tumor and liver metastasis are removed at the same time. However, criteria for simultaneous surgery are underwent continuously modified and expanded. An appropriate selection of adequate candidates for simultaneous surgery is vital to get best benefits. A retrospective study including CRSLM patients underwent simultaneous surgical treatment was conducted. CRSLM patients from SEER database were screened as development set, while CRSLM patients in Harbin (China) were enrolled as validation set. Overall survival (OS) and cancer-specific survival (CSS) were applied as end-point. Variables were screen by LASSO-Cox regression, then Cox regression was applied to construct 1-, 3- and 5-year OS, and CSS nomograms. Nomograms were compared to TMN stage for survival prediction and evaluated by concordance indexes (C-indexes), Time-dependent receiver operating characteristic (ROC) curves, Decision Curve Analysis (DCA). 1347 and 112 CRSLM patients were included in the development set and validation set respectively. Nine factors were found associated with OS and CSS, i.e., Age, Primary Site, Differentiation grade, Histology type, T stage, N stage, Tumor size, Chemotherapy, CEA. Compared to the TNM stage, OS nomogram in development set and validation set got C-indexes values of 0.701 vs 0.641, 0.670 vs 0.557 respectively. Meanwhile, compared to the TNM stage, CSS nomogram in development set and validation set got C-indexes values of 0.704 vs 0.649, 0.677 vs 0.569 respectively. AUC values of the OS and CSS nomograms were higher than the TNM stage, DCA showed the OS and CSS nomograms got more clinical net benefit than the TNM stage, in both the development set and validation set. Our nomograms for predicting survival might be helpful to identify the right CRSLM patients who can get most benefit from simultaneous surgery.

Myoelectric activity and motility of the Roux limb after cut or uncut Roux-en-Y gastrojejunostomy.

AIM: To explore the mechanisms of uncut Roux-en-Y gastrojejunostomy, which is used to decrease the occurrence of Roux stasis syndrome. METHODS: The changes of myoelectric activity, mechanic motility and interstitial cells of Cajal (ICC) of the Roux limb after cut or uncut Roux-en-Y gastrojejunostomy were observed. RESULTS: When compared with the cut group, the amplitude (1.15 +/- 0.15 mV vs 0.48 +/- 0.06 mV, P < 0.05) and frequency (14.4 +/- 1.9 cpm vs 9.5 +/- 1.1 cpm, P < 0.01) of slow waves and the incidence (98.2% +/- 10.4% vs 56.6% +/- 6.4%, P < 0.05) and amplitude (0.58 +/- 0.08 mV vs 0.23 +/- 0.06 mV, P < 0.01) of spike potential of the Roux limb in the uncut group were significantly higher. The migrating myoelectric complexes (MMC) phase III duration in the uncut group was significantly prolonged (6.5 +/- 1.1 min vs 4.4 +/- 0.8 min, P < 0.05), while the MMC cycle obviously shortened (42.5 +/- 6.8 vs 55.3 +/- 8.2 min, P < 0.05). Both gastric emptying rate (65.5% +/- 7.9% vs 49.3% +/- 6.8%, P < 0.01) and intestinal impelling ratio (53.4% +/- 7.4% vs 32.2% +/- 5.4%, P < 0.01) in the uncut group were significantly increased. The contractile force index of the isolated jejunal segment in the uncut group was significantly higher (36.8 +/- 5.1 vs 15.3 +/- 2.2, P < 0.01), and the expression of c-kit mRNA was significantly increased in the uncut group (0.82 +/- 0.11 vs 0.35 +/- 0.06, P < 0.01). CONCLUSION: Uncut Roux-en-Y gastrojejunostomy may lessen the effects of operation on myoelectric activity such as slow waves, spike potential, and MMC, decrease the impairment of gastrointestinal motility, and remarkably increase the expression of c-kit mRNA.

[Effect of electroacupuncture on myoelectric activity of Jejunal limb After Roux-en-Y esophagojejunostomy].

OBJECTIVE: To explore the effect of electroacupuncture on myoelectric activity of Jejunal limb after Roux-en-Y esophagojejunostomy. METHODS: Fourteen health young pigs were randomly divided into 2 groups, an experimental group (total gastrectomy and Roux-en-Y esophagojejunostomy was carried out) and a control group (the abdominal cavity was closed after the electrode was placed), 7 pigs in each group. Electroacupunture was given at "Zusanli" (ST 36) in the experimental group. The changes of myoelectrogram of the jejunal limb was investigated. RESULTS: Compared with the control group, the amplitude and the frequency of the slow wave, and the amplitude and incidence rate of the spike potential in the experimental group were changed significantly; the duration of migrating motor complex (MMC) phase III was (2.6 +/- 0.7) minutes in the experimental group, which was significantly shorter than (7.1 +/- 1.1) minutes in the control group. Electroacupuncture did not significantly influence the amplitude and the frequency of the slow wave, but could increased significantly the incidence rate and the amplitude of the spike potential; after electroacupuncture, the duration of MMC phase III was (5.7 +/- 0.9) minutes, which was significantly longer than (2.6 +/- 0.7) minutes before electroacupuncture. CONCLUSION: Electroacupuncture at "Zusanli" (ST 36) can relieve the Roux-en-Y stasis syndrome through influencing myoelectric activity of the jejunum.

[Morphology of portal hypertension at the early stage of liver damage induced by CCl4: an experimental study with dogs].

OBJECTIVE: To explore the morphological basis of portal hypertension happened at the early stage of liver damage. METHODS: Sixteen mongrel dogs were injected intraperitoneally with carbon tetrachloride (CCl(4)) once a week for 4 weeks and then once every 4 days, totally for 7 weeks. Before the experiment and 7 weeks after the beginning of experiment, small pieces of liver tissues were taken through a median upper abdominal incision and underwent HE staining, Masson's staining, and immunohistochemistry with alpha-smooth muscle actin (alpha-SMA) to label the activated astrocyte (hepatic stellate cell, HSC), and transmission electron microscopy. The portal vein pressure was measured by puncture of gastroepiploic vein. The diameter of spleen was measure too. RESULTS: Since the second weeks after the experiment, the dogs showed vomiting, diarrhea, anorexia, weight loss, and varicose vein in the abdominal wall. One dog died of toxic enteritis 3 weeks after the beginning of experiment. 7 weeks after the injection of CCl(4), the average portal vein pressure of the rest 115 dogs was 22.7 cm H(2)O +/- 1.5 cm H(2)O, significantly higher than that before the experiment (12.2 cm H(2)O +/- 1.9 cm H(2)O, 1cm H(2)O = 0.098 kPa, P < 0.05). The long diameter of spleen of the 15 dogs was 24.4 +/- 3.1 cm, significantly greater than that before the experiment (18.7 cm +/- 2.4 cm, P < 0.05). Seven weeks after the injection of CCl(4) the appearance of liver did not change remarkably among the dogs, however, the spleens of the dogs showed swelling and stagnation of blood. No obvious ascites was seen. HE staining showed slight liver damage, such as fatty degeneration of liver cells; Masson's staining and electron microscopy showed typical sinusoid capillarization. alpha-SMA immunohistochemistry stain showed increased number of activated HSCs. Immunohistochemistry showed a number of alpha-SMA positive cells in the hepatic lobules. Portal hypertension was successfully induced in 15 dogs. CONCLUSION: At the early stage of liver damage the possible cause of portal hypertension is the increased resistance of blood stream due to sinusoid capillarization and activation of HSC.