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PURPOSE: Although laparoscopic pancreaticoduodenectomy (LPD) is increasingly performed in high-volume centers, pancreaticojejunostomy (PJ) is still the most challenging procedure. Pancreatic anastomotic leakage remains a major complication after PD. Thus, various technical modifications regarding PJ, such as the Blumgart technique, have been attempted to simplify the procedure and minimize anastomotic leakage. Three-dimensional (3D) laparoscopic systems have been shown to be particularly helpful in performing difficult and precise tasks. We present a modified Blumgart anastomosis in 3D-LPD and investigate its clinical outcomes. METHODS: A retrospective analysis of 100 patients who underwent 3D-LPD with modified Blumgart PJ from September 2018 to January 2020 was conducted. Data on the preoperative characteristics, operative outcomes, and postoperative characteristics of the patients were collected and analyzed. RESULTS: The mean operative time and duration of PJ were 348.2 and 25.1 min, respectively. The mean estimated blood loss was 112 mL. The overall rate of postoperative complications over ClavienâDindo classification III was 18%. The incidence of clinically relevant postoperative pancreatic fistula was 11%. The median postoperative hospital stay was 14.2 days. Only one patient required reoperation (1%), and no patient died in the hospital or 90 days after the operation. High BMI, small main pancreatic duct diameter, and soft pancreatic consistency had a significant influence on the occurrence of CR-POPF. CONCLUSIONS: The surgical outcome of 3D-LPD with modified Blumgart PJ seems to be comparable to other studies in terms of operation time, blood loss, hospital stay, and complication incidence. We consider the modified Blumgart technique in 3D-LPD to be novel, reliable, safe, and favorable for PJ in the PD procedure.
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Laparoscopy , Pancreaticojejunostomy , Humans , Pancreaticojejunostomy/adverse effects , Pancreaticoduodenectomy/adverse effects , Pancreaticoduodenectomy/methods , Anastomotic Leak/etiology , Retrospective Studies , Anastomosis, Surgical/methods , Pancreatic Fistula/etiology , Pancreatic Fistula/prevention & control , Pancreatic Fistula/epidemiology , Postoperative Complications/etiology , Laparoscopy/adverse effects , Laparoscopy/methodsABSTRACT
Due to its high mortality and severe economic burden, cancer has become one of the most difficult medical problems to solve today. As a key node in metabolism and the main producer of energy, acetyl-coenzyme A (acetyl-CoA) plays an important role in the invasion and migration of cancer. In this review, we discuss metabolic pathways involving acetyl-CoA, the targeted therapy of cancer through acetyl-CoA metabolic pathways and the roles of epigenetic modifications in cancer. In particular, we emphasize that the metabolic pathway of acetyl-CoA exerts a great impact in cancer; this process is very different from normal cells due to the "Warburg effect". The concentration of acetyl-CoA is increased in the mitochondria of cancer cells to provide ATP for survival, hindering the growth of normal cells. Therefore, it may be possible to explore new feasible and more effective treatments through the acetyl-CoA metabolic pathway. In addition, a growing number of studies have shown that abnormal epigenetic modifications have been shown to play contributing roles in cancer formation and development. In most cancers, acetyl-CoA mediated acetylation promotes the growth of cancer cells. Thus, acetylation biomarkers can also be detected and serve as potential cancer prediction and prognostic markers.
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BACKGROUND: Methyl-CpG binding domain protein 1 (MBD1), which couples DNA methylation to transcriptional repression, has been implicated in transcriptional regulation, heterochromatin formation, genomic stability, cell cycle progression and development. It has also been proven that MBD1 is involved in tumor development and progression. However, whether MBD1 is involved in tumorigenesis, especially in gallbladder cancer, is totally unknown. METHODS: Human GBC-SD and SGC996 cells were used to perform experiments. Invasion, wound healing and colony formation assays were performed to evaluate cell viability. A CCK-8 assay was performed to assess gallbladder cancer cell viability after gemcitabine treatment. Western blot analysis was used to evaluate changes in protein expression. Human gallbladder cancer tissues and adjacent nontumor tissues were subjected to immunohistochemical staining to detect protein expression. RESULTS: We found that MBD1 expression was significantly upregulated in gallbladder cancer tissues compared with that in surrounding normal tissues according to immunohistochemical analysis of 84 surgically resected gallbladder cancer specimens. These data also indicated that higher MBD1 expression was correlated with lymph node metastasis and poor survival in gallbladder cancer patients. Overexpression and deletion in vitro validated MBD1 as a potent oncogene promoting malignant behaviors in gallbladder cancer cells, including invasion, proliferation and migration, as well as epithelial-mesenchymal transition. Studies have demonstrated that epithelial-mesenchymal transition is common in gallbladder cancer, and it is well known that drug resistance and epithelial-mesenchymal transition are very closely correlated. Herein, our data show that targeting MBD1 restored gallbladder cancer cell sensitivity to gemcitabine chemotherapy. CONCLUSIONS: Taken together, the results of our study revealed a novel function of MBD1 in gallbladder cancer tumor development and progression through participation in the gallbladder cancer epithelial-mesenchymal transition program, which is involved in resistance to gemcitabine chemotherapy. Thus, MBD1 may be a potential therapeutic target for gallbladder cancer.
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BACKGROUND: Cigarette smoking is the most well-established risk factor for colorectal cancer (CRC). However, the mechanisms of smoking-associated colorectal carcinogenesis are poorly understood. METHODS: The effects of prediagnosis tobacco use on clinical characteristics, overall survival (OS), and recurrence-free survival (RFS) were analyzed in 396 patients with CRC. Associations between smoking status and OS and RFS were evaluated using Cox's proportional hazards regression. Furthermore, the effects of nicotine on the CRC cell lines SW620 and HT-29 were evaluated using in vitro assays. RESULTS: "Ever smoking" was associated with elevated serum carcinoembryonic antigen, American Joint Committee on Cancer T category, metastasis, and poorer OS and RFS in patients with CRC (OS: hazard ratio [HR] = 1.74, 95% confidence interval [CI], 1.07-2.81, p = 0.025; RFS: HR = 1.66, 95% CI: 1.18-2.34, p = 0.004). MicroRNA (miR)-200c was downregulated in CRC and tumor-adjacent tissues from ever smokers compared with the corresponding tissues from never smokers with CRC. Nicotine inhibited miR-200c expression in a dose- and time-dependent manner in SW620 and HT-29 CRC cell lines. Nicotine induced cell proliferation, migration, and invasion and promoted the epithelial-mesenchymal transition in SW620 and HT-29 cells, and these effects were attenuated by overexpression of miR-200c. CONCLUSION: Our findings support the adverse effects of prediagnosis cigarette smoking on prognosis and clinical behavior in CRC. We demonstrate a novel oncogenic mechanism by which nicotine promotes growth and metastasis in CRC by downregulating miR-200c.
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Cell Movement/drug effects , Cigarette Smoking/adverse effects , Colorectal Neoplasms/etiology , Epithelial-Mesenchymal Transition/drug effects , MicroRNAs/metabolism , Nicotine/toxicity , Caco-2 Cells , Cell Proliferation/drug effects , Colorectal Neoplasms/genetics , Colorectal Neoplasms/metabolism , Colorectal Neoplasms/pathology , Dose-Response Relationship, Drug , Down-Regulation , Female , Gene Expression Regulation, Neoplastic , HT29 Cells , Humans , Male , MicroRNAs/genetics , Middle Aged , Neoplasm Invasiveness , Retrospective Studies , Risk Assessment , Risk Factors , Signal Transduction , Time FactorsABSTRACT
PURPOSE: Our aim was to detect the potential role of interleukin 11 (IL-11) in the development of chemo-resistance in gastric cancer and to reveal the mechanism involved in the process. MATERIALS AND METHODS: Here, we used flow cytometry to examine the percentage of cancer-associated-fibroblasts in tumor samples from chemo-resistant and -sensitive gastric cancer patients. Using MTT assay, we detected the cell viability under different conditions. Using quantitative real-time polymerase chain reaction and Western blotting, we determined the target expressions in mRNA and protein levels. We also performed immunohistochemistry and immunofluorescence to detect the target proteins under different conditions. Animal models were constructed to verify the potential role of IL-11 in chemo-resistant develop in vivo. RESULTS: Herein, we observed enriched cancer associated fibroblasts in drug resistant tumor tissues from gastric patients. Those fibroblasts facilitate the chemotherapeutic drugs resistance development through the secretion of IL-11, which activates the IL-11/IL-11R/gp130/JAK/STAT3 anti-apoptosis signaling pathway in gastric cancer cells. We found that the combination of chemotherapeutic drugs and JAK inhibitor overcomes the resistance and increases the survival of mice with gastric cancer xenografts. CONCLUSION: Ourresults demonstrated that IL-11 contributed to the obtain ofresistance to chemotherapy drugs through gp130/JAK/STAT3/Bcl2 pathway, and targeting the IL-11 signaling pathway induced by fibroblasts might be a promising strategy to overcome the multi-drugs resistant cancer in clinic.
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Animals , Humans , Mice , Blotting, Western , Cell Survival , Drug Resistance , Drug Therapy , Fibroblasts , Flow Cytometry , Fluorescent Antibody Technique , Heterografts , Immunohistochemistry , Interleukin-11 , Models, Animal , Real-Time Polymerase Chain Reaction , RNA, Messenger , Stomach NeoplasmsABSTRACT
Objective@#To evaluate the safety and feasibility of laparoscopic radical antegrade modular pancreatosplenectomy(Lap-RAMPS) for left-sided pancreatic adenocarcinoma.@*Methods@#Clinical data of total 12 patients underwent Lap-RAMPS for left-sided pancreatic adenocarcinoma at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People′s Hospital from March 2016 to August 2017 were reviewed retrospectively.There were 7 male patients and 5 female patients, with median age of 60.5 years old(47-68 years old). Abdominal enhanced CT, pancreatic MRI, PET-CT were performed on all patients to evaluate the lesion and exclude metastasis.Follow-up were done with out-patient clinic or telephone consultancy until October 2017.@*Results@#All patients underwent pure Lap-RAMPS.The medium operative time was 250 minutes(180-445 minutes), and the blood loss was 150 ml(50-500 ml). The medium first flatus time and diet resumption time were 3.0 days(1-5 days) and 3.5 days(1-7 days) respectively.The medium postoperative hospital stay was 9 days(4-18 days). Morbidity occurred in 8 patients with gastric empty delay(n=1), bleeding(n=1), fluid collection(n=3). There was no mortality.The medium overall number of retrived lymph nodes was 15.6 and the positive rate was 41.7%. The R0 rate was 100%.The medium follow-up was 10 months.One patient was diagnosed as liver metastasis after 8 months and accepted chemotherapy.One patient died after 14 months for tumor recurrence and metastasis.Others survived without tumor recurrence or metasitasis.@*Conclusion@#Lap-RAMPS is safe and feasible with accepted oncological outcomes for selected left side pancreatic adenocarcinoma under skilled hands.
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Objective To investigate the treatment efficacy,feasibility and safety of laparoscopic resection for gastric gastrointestinal stromal tumors (GISTs) larger than 5 cm.Methods The clinical data of 31 patients who underwent laparoscopic resection of large gastric GISTs between Jan 2010 and Jun 2017 at Sir Run Run Shaw Hospital and People's Hospital of Zhejiang Province were retrospectively analyzed.Results All operations were successful.Two patients were converted to open surgery.The mean tumor size was (7.2 ±0.5) cm.The mean operation time was (127 ± 12) min,intraoperative blood loss was (83 ±25) ml.The first flatus time was (2.2 ±0.8) days,the first diet resumption time was (2.4 ± 1.2) days,and the median postoperative hospital stay was (5.5 ± 1.5) days.The median follow-up time was 25 months.One patient developing liver metastasis 41 months after primary resection received oral mesylate imatinib therapy for 24 months and was still alive at the last follow-up.One patient died of lung cancer 33 months after primary operation without recurrence of gastric GIST.Conclusions Laparoscopic surgery for gastric GIST larger than 5 cm on laparoscopicaly accessible location is feasible and safe.
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Objective@#To summary the experience of 233 cases of laparoscopic pancreaticoduodenectomy (LPD) performed by a single surgical team.@*Methods@#Data of patients undergoing LPD from September 2012 to October 2016 were reviewed. There were 145 males and 88 females with the mean age of(60.3±13.0)years old, ranging from 19 to 92 years old, and the mean body mass index of (22.8±3.5)kg/m2, ranging from 16.3 to 36.8 kg/m2. There were 195 patients with clinical manifestation and 54 patients who had the history of abdominal surgery.@*Results@#LPD were performed on 233 patients by same surgical team consecutively. The mean operative time was(368.0±57.4)minutes. Mean blood loss was(203.8±138.6)ml. The postoperative morbidity rate was 33.5%, with 6.9% of grade B or C pancreatic fistula and 9.9% of bleeding. The reoperation rate was 5.6%. The mortality during 30 days after operation was 0.9%. Mean postoperative hospital stay was (18.1±11.2)days. Mean tumor size was (3.9±2.4)cm, and the mean number of lymph nodes harvested was 21.3±11.9.One hundred and sixty-three patients were diagnosed as malignant tumor, including pancreatic adenocarcinoma(n=84), cholangiocarcinoma(n=17), ampullary adenocarcinoma(n=55), duodenal adenocarcinoma(n=5), gastric cancer(n=1)and duel cancer (n=1) located in distal stomach and duodenum.@*Conclusion@#The key point to make laparoscopic pancreaticduodenectomy a routine safe procedure is to operate the procedure under skilled hands in selected patients via suitable surgical approaches.
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Objective To investigate the effects of DRP1 gene silencing on the chemosensitivity of human gastric cancer MKN-45 cells to oxaliplatin.Methods A lentiviral vector containing short hairpin RNA (shRNA) targeting DRP1 was constructed and cotransfected to MKN-45 cells.Levels of DRP1mRNA was detected by quantitative RT-PCR,With a final concentration of 0.5,1.0,2.0,4.0,8.0,16.0 and 32.0 μg/ml of oxaliplatin processing Lv-shRNA-DRPI group (experimental group),negative control group (NC group),and blank control group (CON group) respectively.Cellular proliferation was determined by MTT assay and calculate half maximal inhibitory concentration (IC5o).Celluar apoptosis was analyzed by flowcytometry.Using Western blot to detect LC3-Ⅱ and p62 expression.Results DRP1mRNA levels in experimental group (0.087 ± 0.025) was significantly inhibited as compared with NC group (1.040 ± 0.020) and CON group (1.027 ± 0.021) (P < 0.001).Cellular survival rate decreased in a oxaliplatin dose-dependent manner (all P < 0.001).IC50 value in experimental group (14.1 ± 0.4) μg/ml dropped compared with NC group (20.0 ± 1.1) μg/ml and CON group (20.0 ± 1.8) pg/ml (both P < 0.01).Celluar apoptosis rates in experimental group (9.4% ± 1.1%) elevated in contrast with NC group (6.4% ± 0.8%) and CON group (6.5% ± 1.0%) (both P < 0.05),expression of LC3 in experimental group(0.36 ± 0.03) dropped compared with NC group (0.62 ± 0.04) and CON group (0.59 ± 0.07) (both P < 0.05),expression of P62 in experimental group (0.58 ±-0.04) increased in contrast with NC group (0.39±0.04) and CON group (0.36 ±0.04) (both P<0.05).Conclusions DRP1-mediated overactive mitophagy plays a vital role in increasing the sensitivity of gastric cancer cell MKN-45 to oxaliplatin.
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Objective To investigate the effects of DRP1 gene silencing on the chemosensitivity of human gastric cancer MKN-45 cells to oxaliplatin.Methods A lentiviral vector containing short hairpin RNA (shRNA) targeting DRP1 was constructed and cotransfected to MKN-45 cells.Levels of DRP1mRNA was detected by quantitative RT-PCR,With a final concentration of 0.5,1.0,2.0,4.0,8.0,16.0 and 32.0 μg/ml of oxaliplatin processing Lv-shRNA-DRPI group (experimental group),negative control group (NC group),and blank control group (CON group) respectively.Cellular proliferation was determined by MTT assay and calculate half maximal inhibitory concentration (IC5o).Celluar apoptosis was analyzed by flowcytometry.Using Western blot to detect LC3-Ⅱ and p62 expression.Results DRP1mRNA levels in experimental group (0.087 ± 0.025) was significantly inhibited as compared with NC group (1.040 ± 0.020) and CON group (1.027 ± 0.021) (P < 0.001).Cellular survival rate decreased in a oxaliplatin dose-dependent manner (all P < 0.001).IC50 value in experimental group (14.1 ± 0.4) μg/ml dropped compared with NC group (20.0 ± 1.1) μg/ml and CON group (20.0 ± 1.8) pg/ml (both P < 0.01).Celluar apoptosis rates in experimental group (9.4% ± 1.1%) elevated in contrast with NC group (6.4% ± 0.8%) and CON group (6.5% ± 1.0%) (both P < 0.05),expression of LC3 in experimental group(0.36 ± 0.03) dropped compared with NC group (0.62 ± 0.04) and CON group (0.59 ± 0.07) (both P < 0.05),expression of P62 in experimental group (0.58 ±-0.04) increased in contrast with NC group (0.39±0.04) and CON group (0.36 ±0.04) (both P<0.05).Conclusions DRP1-mediated overactive mitophagy plays a vital role in increasing the sensitivity of gastric cancer cell MKN-45 to oxaliplatin.
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<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of laparoscopic gastrectomy for gastric stump cancer.</p><p><b>METHODS</b>Clinical and follow-up data of 7 patients who underwent laparoscopic gastrectomy for gastric stump cancer in our department from January 2008 to July 2015 were analyzed retrospectively.</p><p><b>RESULTS</b>There were 5 male and 2 female patients, with a mean age of (62.1±10.7) years. Initial gastrectomy was performed for gastric cancer in 3 patients and peptic ulceration in 4. The initial surgery was B-II( gastrojejunostomy in 6 patients and Roux-en-Y gastrojejunostomy in 1. Duration between primary gastrectomy and occurrence of gastric stump cancer was ranged from 6-30 years for peptic ulceration, and from 11-15 years for gastric cancer. During the operation, adhesiolysis and exploration to locate the tumor were performed. Following total remnant gastrectomy and lymphadenectomy, intracorporeal anastomosis was accomplished by Roux-en-Y reconstruction. The methods of intracorporeal esophagojejunostomy were end-to-side approach using a circular stapler in 1 patient, side-to-side approach using an endoscopic linear staple in 2 patients, and hand-sewn technique in 4 patients. The operation time was (247.1±17.5) minutes and the intraoperative blood loss was (100.0±30.8) ml without transfusion. The number of retrieved lymph node was 19.1±4.8. The first flatus time, diet resumption time, postoperative hospital stay were (3.3±1.5) days, (3.7±0.8) days, (9.4±2.6) days, respectively. One patient experienced gastrointestinal bleeding that was managed conservatively and ultimately cured. Seven patients were followed up till January 2016. After follow-up from 6 to 38 months, 1 patient died of peritoneal metastasis 17 months after surgery, and 1 patient died of Alzheimer's disease 19 months after surgery. The other 5 patients were still alive without metastasis or recurrence.</p><p><b>CONCLUSION</b>Laparoscopic gastrectomy for gastric stump cancer is feasible and safe.</p>
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Aged , Female , Humans , Male , Middle Aged , Anastomosis, Roux-en-Y , Blood Loss, Surgical , Gastrectomy , Gastric Bypass , Gastric Stump , Pathology , General Surgery , Laparoscopy , Length of Stay , Lymph Node Excision , Neoplasm Recurrence, Local , Operative Time , Retrospective Studies , Stomach Neoplasms , General Surgery , Surgical StaplingABSTRACT
<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of laparoscopic pancreaticoduodenectomy(LPD).</p><p><b>METHODS</b>Data of 66 patients from Sir Run Run Shaw Hospital undergoing LPD from September 2012 to September 2014 were reviewed. There were 44 male and 22 female with the mean age of (58.7±10.3) years and mean body mass index of (23.5±3.9)kg/m(2). Forty-five patients presented the symptoms and four of all had the history of abdominal surgery, including 2 cases of laparoscopic pancreatic surgery.</p><p><b>RESULTS</b>Of 66 patients underwent laparoscopic procedure, 1 patient underwent LPD combined with right hepatic resection, 1 patient underwent laparoscopic distal gastrectomy with LPD, and 1 patient underwent LPD after laparoscopic distal pancreatectomy. The mean operative time was (367±49) minutes. The mean blood loss was(193±126)ml. The rate of overall postoperative complications was 36.4%(24/66), with 4.5%(3/66) of B or C pancreatic fistula and 7.6% (5/66) of bleeding. The mean postoperative hospital stay was (18.9±12.1) days. Mean tumor size was (3.8±2.3) cm, and the mean number of lymph nodes harvested was (20.3±10.9). Forty-severn patients were diagnosed as pancreatic adenocarcinoma(n=18), cholangiocarcinoma(n=7), ampullary adenocarcinoma(n=21), and gastric cancer(n=1), respectively.</p><p><b>CONCLUSION</b>LPD is feasible and safe under the skilled hand.</p>
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Aged , Female , Humans , Male , Middle Aged , Adenocarcinoma , General Surgery , Anastomosis, Surgical , Laparoscopy , Length of Stay , Operative Time , Pancreatectomy , Pancreatic Fistula , Pathology , Pancreatic Neoplasms , General Surgery , Pancreaticoduodenectomy , Postoperative ComplicationsABSTRACT
Objective To evaluate the short-and long-term outcomes of laparoscopy-assisted gastrectomy (LAG) for gastric cancer.Methods After studying the patients' demographic data,extent of gastrectomy and lymphadenectomy,as well as differentiation and tumor TNM stage,85 patients who underwent LAG were individually matched to 85 patients who underwent open surgery (OG) between October 2004 and March 2008.The operative time,intraoperative blood loss,postoperative recovery,complications,pathological findings,and follow-up data were compared between the two groups.Results The mean operative time was significantly longer in the LAG group than in the OG group (277 ± 62) min vs.(211 ±46) min,t =7.882,P <0.05,whereas intraoperative blood loss was significantly lower (161 ±90) ml vs.(267 ± 141) ml,t =-5.854,P <0.05.In addition,there was a significant reduction in the time to first flatus and postoperative hospital stay (3.7 ± 1.3) days vs.(4.2 ± 1.1) days and (10 ± 3) days vs.(12 ± 6) days,respectively t =-2.318,-2.325,P < 0.05.There was no significant difference between the LAG group and OG group with regard to the number of harvested lymph nodes and overall postoperative complications.The 5-year disease-free survival rates and overall survival rates were 76%,78%,respectively,in LAG group and 75%,73%,respectively in OG group (all P > 0.05).Conclusions LAG is suitable and minimally invasive for treating gastric cancer.Compared to OG,the LAG will not increase the risk of recurrence and mortality after surgery.
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Objective To investigate the expressions of Sema4D and HER-2 in breast cancers and their relationship with microlymphtic vessel density (MLVD).Methods MLVD and expressions of Sema4D and HER-2 were detected in 110 cases of breast cancer tissues by immunohistochemistry.The relationship of Sema4D and HER-2 expressions with clinicopathologic parameters was analyzed.Results The positive expression rate of Sema4D and HER-2 was 71.82% (79/110) and 33.64% (37/110),respectively,with a statistically significant differences compared to those in the control group ( P <0.01 ).The positive expression rates of Sema4D and MLVD in cases with lymphatic metastasis were higher than that without lymphatic metastasis ( P < 0.01 ).The expressions of Sema4D and HER-2 were closely correlated with the histological grade,TNM stage,lymph node metastasis,and expression of ER of breast cancers ( P <0.05),but were not related to tumor size and expression of PR (P > 0.05 ).On univariate analysis,the disease-free survival rate of patients with Sema4D positive expression was better than those with its negative expression ( P < 0.05).Sema4D expression was positively correlated with the HER-2 expression ( r =0.535,P < 0.01 ).Conclusions Sema4D may play important roles in the carcinogenesis and development of a breast cancer.
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Objective To evaluate the safety and efficacy of laparoscopy-assisted total gastrectomy (LATG) for gastric cancer by systematic review and meta-analysis.Methods The literature database before February,2012 was extensively searched to retrieve the comparative studies of LATG and open total gastrectomy(OTG) with a relevance of study goal.The inclusion and exclusion criteria were formulated.Aftera quality evaluation,the data was extracted.The Cochrane collaboration RevMan 5.1 version software was used for meta-analysis.Results There are ten studies meeting the inclusion criteria for meta-analysis.The total sample size of these studies was 942 cases.Compared to OTG,LATG experienced longer operation time [weighted mean difference(WMD) =41.12 min,95% confidence interval(CI):20.62-61.63,P <0.01)],less blood loss(WMD =-198.36 ml,95% CI:-300.94--95.78,P < 0.01),earlier time to flatus(WMD =-0.80 days,95% CI:-1.17--0.42,P<0.01),shorter hospital stay(WMD =-4.02days,95% CI:-6.03--2.01,P < 0.01) and decrease in overall complications [relative risk (RR) =0.55,95% CI:0.40-0.76,P < 0.01)].The number of dissected lymph nodes,proximal or distal resection margin and mortality were similar between the two groups.Conclusions Laparoscopy-assisted total gastrectomy is a safe and feasible procedure with less blood loss,less overall complications and quick recovery.
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National advanced training course of traditional Chinese orthopedic and traumatology in anatomy experiment is a short-term courses designed for grassroots doctors.Special training content and methods are designed for the multi-level cadets in the short-term courses.How to use teaching staff advantage to optimize course setting and improve the teaching effects will be discussed in this article.
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Objective:To investigate the immunomodulatory effect of Astragalus Saponin on macrophages and explore the mechanisms of its immunomodulation.Methods:By adding different concentrations of AS into cultured mice peritoneal macrophages,the influence of AS on synthesis of nitro oxide(NO)was observed by NO Kit(enzymic method).MTT assay was used to determine the cytotoxicity of macrophages induced by AS.The morphological changes of the macrophages were identified by Transmission Electron Microscope.LSCM and specificity fluorescent probe Fluo-3/AM were applied to observe the change of Ca2+ in the macrophages induced by AS.Results:AS could significantly increase NO synthesis,enhance the capacity of mice peritoneal macrophages for cytotoxicity to carcinoma cells.The surface projections of the macrophages were exhibited multiplicating,thickening and extenting via Transmission Electron Microscope.Augmented intracellular Ca2+ in the macrophage was observed by LSCM.Conclusion:AS can enhance the immune functions of macrophages,the increase of intracellular Ca2+ be one of the mechanisms of its immunomodulatory effects.