Association between systemic lupus erythematosus and inflammatory bowel disease in European and East Asian populations: a two-sample Mendelian randomization study.

Background: Previous studies have shown a coexistence phenomenon between systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD), but the causal relationship between them is still unclear. Therefore, we conducted a two-sample Mendelian randomization (MR) analysis using publicly available summary statistics data to evaluate whether there was a causal relationship between the two diseases. Methods: Summary statistics for SLE and IBD were downloaded from the Open Genome-Wide Association Study and the International Inflammatory Bowel Disease Genetics Consortium. European and East Asian populations were included in this MR work. We adopted a series of methods to select instrumental variables that are closely related to SLE and IBD. To make the conclusion more reliable, we applied a variety of different analysis methods, among which the inverse variance-weighted (IVW) method was the main method. In addition, heterogeneity, pleiotropy, and sensitivity were assessed to make the conclusions more convincing. Results: In the European population, a negative causal relationship was observed between SLE and overall IBD (OR = 0.94; 95% CI = 0.90, 0.98; P < 0.004) and ulcerative colitis (UC) (OR = 0.93; 95% CI = 0.88, 0.98; P = 0.006). After removing outliers with Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO), the results remained consistent with IVW. However, there was no causal relationship between SLE and Crohn's disease. In the East Asian population, no causal relationship was found between SLE and IBD. Conclusion: Our results found that genetic susceptibility to SLE was associated with lower overall IBD risk and UC risk in European populations. In contrast, no association between SLE and IBD was found in East Asian populations. This work might enrich the previous research results, and it may provide some references for research in the future.

Antioxidant and Immunomodulatory Activities of Polysaccharides from Fermented Wheat Products of Grifola frondosa: In Vitro Methods.

Despite the well-known health benefits of Grifola frondosa, there is a lack of understanding regarding the potential antioxidant and immunomodulatory properties of different varieties when fermented with wheat grains. We aimed to explore the potential of G. frondosa-fermented wheat flour as a functional food. Three varieties of G. frondosa (GFA, GFB, and GFC) were fermented with wheat grains for solid-state fermentation. Polysaccharides were extracted and analyzed for total sugar content, monosaccharide composition, Mw profile, antioxidant activity, cytotoxicity, and immunomodulatory properties. Results were evaluated using HPLC, DPPH assay, MTS assay, Griess reagent, and ELISA method. Our study found variations in three different varieties of G. frondosa-fermented wheat polysaccharides. Glucose was the predominant monosaccharide, followed by galactose and mannose. Each variety had a different molecular weight distribution, with GFA-wheat mainly present in fraction II, GFB-wheat in fraction I, and GFC-wheat in fraction III. At a concentration of 1.25 mg/mL, GFA-wheat and GFB-wheat polysaccharides increased DPPH scavenging ability by 76.8% and 58.7%, respectively. The polysaccharides showed no apparent toxic effect and enhanced the production of NO, IL-6, and TNF-α in RAW 246.7 macrophages. GFB-wheat polysaccharides demonstrated remarkable immunomodulatory properties at a concentration of 5 µg/mL. Our study provides a theoretical basis for using G. frondosa in wheat staple agricultural products to improve human health.

Heterologous expression of pediocin/papA in Bacillus subtilis.

Listeria monocytogenes is a food-borne pathogen. Pediocin is a group IIα bacteriocin with anti-listeria activity that is naturally produced by Pediococcus acidilactic and Lactobacillus plantarum. The pedA/papA gene encodes pediocin/plantaricin. In native hosts, the expression and secretion of active PedA/PapA protein rely on the accessory protein PedC/PapC and ABC transporter PedD/PapD on the same operon. The excretion machines were also necessary for pediocin protein expression in heterologous hosts of E. coli, Lactobacillus lactis, and Corynebacterium glutamicum. In this study, two vectors carrying the codon sequence of the mature PapA peptide were constructed, one with and one without a His tag. Both fragments were inserted into the plasmid pHT43 and transformed into Bacillus subtilis WB800N. The strains were induced with IPTG to secrete the fused proteins PA1 and PA2. Supernatants from both recombinant strains can inhibit Listeria monocytogenes ATCC54003 directly. The fused protein possesses inhibition activity as a whole dispense with removal of the leading peptide. This is the first report of active pediocin/PapA expression without the assistance of PedCD/PapCD in heterogeneous hosts. In addition, the PA1 protein can be purified by nickel-nitrilotriacetic acid (Ni-NTA) metal affinity chromatography.

A New Nomogram Based on Early Postoperative NLR for Predicting Infectious Complications After Gastrectomy.

PURPOSE: Our study aimed to construct a visible model to evaluate the risk of infectious complications after gastrectomy. METHODS: The clinical data of 856 patients who underwent gastrectomy were used to retrieve medical records. Univariate and multivariate analyses were performed to correlate early postoperative NLR and operative variables with postoperative complications, and the construction of the nomogram was based on logistic regression. The concordance index and receiver operating characteristic curves were used to evaluate the model performance. RESULTS: The postoperative infectious and noninfectious complication rates after gastrectomy were 18.5% (158/856 cases) and 12.3% (105/856 cases) respectively. Postoperative NLR (within 24 h) independently predicted the development of postoperative infectious complication. Multivariate analysis revealed that age, diabetes, body mass index (BMI), intraoperative blood transfusion and postoperative NLR were independent risk factors. The nomogram model showed a good performance in terms of predicting infectious complications after gastrectomy (concordance index=0.718). CONCLUSION: Age, diabetes, BMI, intraoperative blood transfusion and postoperative NLR were independent risk factors of postoperative infectious complications after gastrectomy, and a novel nomogram based on these results can be used to predict postoperative infection and has the advantages of simple application and easy access.

SIRT4 inhibits the proliferation, migration, and invasion abilities of thyroid cancer cells by inhibiting glutamine metabolism.

BACKGROUND: SIRT4, a protein localized in the mitochondria, is one of the least characteristic members of the sirtuin family. It is known that SIRT4 has deacetylase activity and plays a role in energy metabolism, but little is known about its possible role in carcinogenesis. Recently, several studies have suggested that SIRT4 may function as either a tumor oncogene or a tumor suppressor gene. However, its relationship with thyroid cancer remains unclear. METHODS: We stably overexpressed SIRT4 or silenced its expression in the human thyroid cancer cell line BCPAP by means of lentiviral vectors. We conducted a variety of tests, such as CCK-8, wound healing, migration, and invasion assays, to investigate the role of SIRT4 in the proliferation, migration, and invasion abilities of thyroid cancer cells. We also investigated the effects of SIRT4 overexpression on cell cycle progression and apoptosis of BCPAP cells and studied the role of glutamine metabolism in the effects of SIRT4 on BCPAP cell migration and invasion. Finally, we analyzed SIRT4 expression levels in thyroid cancer specimens by immunohistochemistry and investigated their association with clinicopathological features. RESULTS: Overexpression of SIRT4 inhibited the proliferation, migration, and invasion abilities of BCPAP thyroid cancer cells, blocked the cell cycle in the G0/G1 phase, and induced apoptosis. Mechanistically, SIRT4 inhibited BCPAP migration and invasion by inhibiting glutamine metabolism. Moreover, we found that SIRT4 protein levels in thyroid cancer tissues were markedly lower than in their non-neoplastic tissue counterparts (P<0.001). CONCLUSION: SIRT4 plays a pivotal role in the growth and metastasis of thyroid cancer cells and could be a potential therapeutic target in thyroid cancer.

Surgical Treatment and Chemotherapy of Adult Primary Liver Sarcoma: Experiences from a Single Hospital in China.

BACKGROUND: The aim of this study is to improve the preoperative diagnostic accuracy and treatment results by investigating the clinical features and prognosis of primary liver sarcoma (PLS). METHODS: Clinical data, surgical treatments, adjuvant chemotherapy, and prognosis of 17 PLS patients whose diseases were pathologically confirmed were retrospectively analyzed. RESULTS: The main clinical symptoms included epigastric pain in 9 patients, epigastric distention in 7, and loss of appetite in 4; these symptoms were detected during the postoperative follow-up for gastric carcinoma in 1. The resection rate was 64.7% (12/17), including R0 resection in 10 patients and R1 resection in 2, and laparotomy with biopsy in 5. Five patients accepted an adjuvant selective hepatic artery infusion chemotherapy (mitomycin C 16-20 mg+ 5-fluorouracil 5.0 g+ epirubicin 40-50 mg), and 4 accepted adjuvant systemic chemotherapy (vincristin, cisplatin, cyclophosphamide, and adriamycin). All 5 patients with simple laparotomy died within 1 year, and the overall 1-, 3-, and 5-year survival rates for all patients were 58.8% (10/17), 29.4% (5/17) and 11.7% (2/17), respectively, whereas those were 100.0% (10/10), 50.0% (5/10), and 20.0% (2/10) for R0 resected patients respectively. CONCLUSIONS: The diagnosis of PLS is difficult before operation due to its nonspecific manifestations, and the high survival rate can be achieved by radical resection with adjuvant chemotherapy.

Simple instruments facilitating achievement of transanal total mesorectal excision in male patients.

AIM: To assess the efficacy of a modified approach with transanal total mesorectal excision (taTME) using simple customized instruments in male patients with low rectal cancer. METHODS: A total of 115 male patients with low rectal cancer from December 2006 to August 2015 were retrospectively studied. All patients had a bulky tumor (tumor diameter ≥ 40 mm). Forty-one patients (group A) underwent a classical approach of transabdominal total mesorectal excision (TME) and transanal intersphincteric resection (ISR), and the other 74 patients (group B) underwent a modified approach with transabdominal TME, transanal ISR, and taTME. Some simple instruments including modified retractors and an anal dilator with a papilionaceous fixture were used to perform taTME. The operative time, quality of mesorectal excision, circumferential resection margin, local recurrence, and postoperative survival were evaluated. RESULTS: All 115 patients had successful sphincter preservation. The operative time in group B (240 min, range: 160-330 min) was significantly shorter than that in group A (280 min, range: 200-360 min; P = 0.000). Compared with group A, more complete distal mesorectum and total mesorectum were achieved in group B (100% vs 75.6%, P = 0.000; 90.5% vs 70.7%, P = 0.008, respectively). After 46.1 ± 25.6 mo follow-up, group B had a lower local recurrence rate and higher disease-free survival rate compared with group A, but these differences were not statistically significant (5.4% vs 14.6%, P = 0.093; 79.5% vs 65.1%, P = 0.130). CONCLUSION: Retrograde taTME with simple customized instruments can achieve high-quality TME, and it might be an effective and economical alternative for male patients with bulky tumors.

The hedgehog/Gli-1 signaling pathways is involved in the inhibitory effect of resveratrol on human colorectal cancer HCT116 cells.

OBJECTIVES: The study aimed to investigate the effects of resveratrol on colorectal cancer HCT116 cells, including cell viability, apoptosis, and migration, and the partial mechanisms focused on hedgehog/gli-1 signaling pathways. MATERIALS AND METHODS: We chose the appropriate time and concentration of recombinant human Sonic hedgehog (Shh) stimulation by cell viability. The proportion of cell apoptosis was detected by flow cytometry; HCT116 cell migration was measured by scratch test; the expression of Ptch, Smo, and Gli-1 was measured by Western blot analysis. RESULTS: Shh signaling increased HCT116 cell viability and migration, inhibited cell apoptosis, and upregulated the expression of Ptch, Smo, and Gli-1. Resveratrol obviously inhibited HCT116 cell viability and migration, promoted cell apoptosis, and suppressed the protein of Ptch, Smo, and Gli-1. Furthermore, the effects of resveratrol and Shh on human colorectal cancer HCT116 cells were in a dose- and time-dependent manner. CONCLUSION: The inhibitory effect of resveratrol on HCT116 cells may be mediated by hedgehog/gli-1 signaling pathways.

Potentially predictive microRNAs of gastric cancer with metastasis to lymph node.

AIM: To detect the expression of 60 microRNAs (miRNAs) in gastric cancer tissues and find new predictive biomarkers of gastric cancer with metastasis. METHODS: The expressions of 60 candidate miRNAs in 30 gastric cancer tissues and paired normal tissues were detected by stem-loop real-time reverse transcription-polymerase chain reaction. After primary screening of miRNAs expression, 5 selected miRNAs were further testified in another 22 paired gastric tissues. Based on the expression level of miRNAs and the status of metastasis to lymph node (LN), receiver-operating-characteristic (ROC) curve were used to evaluate their ability in predicting the status of metastasis to LN. RESULTS: Thirty-eight miRNAs expressions in gastric cancer tissues were significantly different from those in paired normal tissues (P < 0.01). Among them, 31 miRNAs were found to be up-expressed in cancer tissues and 1 miRNAs were down-expressed ≥ 1.5 fold vs paired normal gastric tissue. Five microRNAs (miR-125a-3p, miR-133b, miR-143, miR-195 and miR-212) were differently expressed between different metastatic groups in 30 gastric cancer biopsies (P < 0.05). Partial correlation analysis showed that hsa-mir-212 and hsa-mir-195 were correlated with the status of metastasis to LN in spite of age, gender, tumor location, tumor size, depth of invasion and cell differentiation. ROC analysis indicated that miR-212 and miR-195 have better sensitivities (84.6% and 69.2%, respectively) and specificities (both 100%) in distinguishing biopsies with metastasis to LN from biopsies without metastasis to LN. CONCLUSION: miR-212 and miR-195 could be independent biomarkers in predicting the gastric cancer with metastasis to LN.

Modulating autophagy: a strategy for cancer therapy.

Autophagy is a process in which long-lived proteins, damaged cell organelles, and other cellular particles are sequestered and degraded. This process is important for maintaining the cellular microenvironment when the cell is under stress. Many studies have shown that autophagy plays a complex role in human diseases, especially in cancer, where it is known to have paradoxical effects. Namely, autophagy provides the energy for metabolism and tumor growth and leads to cell death that promotes tumor suppression. The link between autophagy and cancer is also evident in that some of the genes that regulate carcinogenesis, oncogenes and tumor suppressor genes, participate in or impact the autophagy process. Therefore, modulating autophagy will be a valuable topic for cancer therapy. Many studies have shown that autophagy can inhibit the tumor growth when autophagy modulators are combined with radiotherapy and/or chemotherapy. These findings suggest that autophagy may be a potent target for cancer therapy.

Single-layer anastomosis without hemostasis in the submucosa layer by electric coagulation or ligation: a novel technique of anastomosis for all gastrointestinal tracts.

Single-layer anastomosis has been used extensively for all gastrointestinal tracts around the world. Until now, most surgeons take for granted that submucous layers need careful hemostasis either by electric coagulation or ligation for the prevention of anastomotic stoma bleeding. We experienced hemostasis in the submucosa layer by adequate strength of anastomosis rather than electric coagulation for gastrointestinal tracts. In the present study the safety and benefit of this novel anastomotic technique was evaluated. From 1994 to 2006, 527 gastrointestinal anastomosis were performed using the improved anastomotic technique, and 281 anastomosis (control group) were completed with the commonly adopted technique. The improved anastomotic technique could decreased the incidence of leaks (p = 0.024), and the procedure time required for anastomosis in comparison to control group (p = 0.0002). The incidence of abscesses (p = 0.51) and bleeding (p = 1.00) of the improved anastomotic technique were no significantly different between the groups. The novel technique, single-layer anastomosis without hemostasis in the submucosa layer by electric coagulation or ligation, is suitable for all gastrointestinal anastomosises and it should be popularized.

[Surgical treatment and prognostic analysis of retroperitoneal paragangliomas: a study of 19 cases].

OBJECTIVE: To investigate the clinical characteristics, surgical treatment and prognostic analysis of retroperitoneal paragangliomas and to enhance the diagnostic and therapeutic levels of retroperitoneal paragangliomas. METHODS: The clinical data of all patients undergoing paraganglioma resection at our department from November 1999 to March 2009 were retrospectively analyzed. The parameters included clinical manifestations, tumor function, surgical findings, operative approach, tumor pathology, imaging study and post-operative survival time. RESULTS: (1) The ratio of male to female was 1.375:1 and the median age 50 years old. The most common presenting symptom was abdominal mass (9/19, 47%). And the preoperative CT misdiagnosis rate was high (89%). (2) The most common tumor location was periaortic and percival (9/19, 47%). The average maximal diameter of tumors was 8.6 cm. 58% (11/19) tumors had integral peplow, 42% (8/19) adhered to adjacent organs and 26% (5/19) required adjacent organ resection. (3) The rate of functional tumor was 63% (12/19). Preoperative and intra-operative hypertension occurred in 67% (8/12) and 33% (4/12) respectively. (4) Immunohistochemical staining was performed in 18 tumors of 16 patients. Among all tumors, 89% (16/18) showed positive immunoreactivity for chromogranin and 67% (12/18) for S-100. PCNA staining showed different proliferative activities (0%-48% positive). Only malignant tumors showed positive immunoreactivity for Ki-67 staining and P53 staining (20% & 34% respectively). (5) The overall 5-year survival was 77%. Survival was significantly worse after metastasis (χ2=6.604, P=0.01). But it was not dependent on tumor diameter (χ2=3.208, P=0.201), the secreting function of tumor (χ2=0.121, P=0.728) and the status of tumor margins (χ2=0.036, P=0.849). CONCLUSION: It is difficult to make an early diagnosis of retroperitoneal paragangliomas. Survival is significantly worse after metastasis. Lifelong follow-up for recurrence is important. And it is absolutely essential to perform immunohistochemical staining for tumors.

The surgical treatment and outcome for primary duodenal adenocarcinoma.

BACKGROUND: To investigate the early diagnosis and outcomes of surgical treatment of primary duodenal adenocarcinoma (PDAC) for curative purpose. METHOD: Thirty-two PDAC patients treated surgically between February 1990 and September 2006 were analyzed retrospectively. RESULTS: All 32 patients underwent laparotomy including 18 (56.3%) pancreaticoduodenectomy (PD), six (18.7%) segmental resection (SR), and eight bypass procedures. And R0 resections were obtained in 22 patients; the other ten procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 78.1% (25/32), 43.8% (14/32), and 18.8% (6/32), respectively; moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (20/20), 70.0% (14/20), and 30.0% (6/20), which were significantly higher than those (41.7% = /12, 0%, and 0%) in patients with palliative operation (P < 0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (5/18) in pancreaticoduodenectomy patients and 16.7% (1/6) in segmental resection patients, and there was no significant difference between the above two procedures (P > 0.05). CONCLUSION: PD is suggested for tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients especially for tumors of the distal duodenum.

Surgically treated primary malignant tumor of small bowel: a clinical analysis.

AIM: To evaluate the clinical presentation, treatment and survival of patients with primary malignant tumor of small bowel (PMTSB). METHODS: Clinicopathologic data about 141 surgically treated PMTSB patients (91 males and 50 females) at the median age of 53.5 years (range 23-79 years) were retrospectively analyzed. RESULTS: The most common initial clinical features of the patients were intermittent abdominal discomfort or vague abdominal pain (67.4%), abdominal mass (31.2%), bowel obstruction (24.1%), hemotochezia (21.3%), jaundice (16.3%), fever (14.2%), coexistence of bowel perforation and peritonitis (5.7%), coexistence of gastrointestinal bleeding and shock (5.0%), and intraabdominal bleeding (1.4%). Ileum was the most common site of tumor (44.7%), followed by jejunum (30.5%) and duodenum (24.8%). PMTSB had a nonspecific clinical presentation. Segmental bowel resection (n = 81) was the most common surgical procedure, followed by right hemi-colectomy (n = 15), pancreaticoduodenectomy (n = 10), and others (n = 19). Twenty-seven adenocarcinoma patients and 13 malignant lymphoma patients received adjuvant chemotherapy with 5-fluorouracil and cyclophosphamide, adriamycin, vincristine and prednisone, respectively. Information about 120 patients was obtained during the follow-up. The median survival time of PMTSB patients was 20.3 mo. The 1-, 3- and 5-year survival rate was 75.0% (90/120), 40.0% (48/120) and 20.8% (25/120), respectively. Adenocarcinoma was found in 73.7% (42/57), 21.1% (12/57) and 15.8% (9/57) of the patients, respectively. Gastrointestinal stromal tumor was observed in 80.0% (20/25), 72.0% (18/25) and 36.0% (9/25) of the patients, respectively. Carcinoid was detected in 100.0% (15/15), 80.0% (12/15) and 46.7% (7/15) of the patients, respectively. Malignant lymphoma was demonstrated in 69.2% (9/13), 30.8% (4/13) and 0% (0/13) of the patients, respectively. CONCLUSION: En bloc resection is the principal therapy for most PMTSB and chemotherapy is the important treatment modality for malignant lymphoma and other malignant tumors of small bowel which cannot be radically removed.

The impact of expressions of CD97 and its ligand CD55 at the invasion front on prognosis of rectal adenocarcinoma.

BACKGROUND: Various evidence show that CD97 plays an important role in tumor differentiation, migration, invasiveness, and metastasis by binding its cellular ligand CD55. CD55 is a complement regulatory protein expressed by cells to protect them from bystander attack by complement, and it has been shown to be an indicator of poor prognostic in several cancers. METHODS: CD97 and CD55 stains were detected in tumor tissues from 71 cases of rectal adenocarcinomas and their corresponding normal colorectal tissues by immunohistochemistry. RESULTS: The expressions of CD97 and CD55 in rectal tumor tissues were significantly higher than those in normal colorectal tissues (P < 0.05, both). The patients with recurrence and/or metastasis had significantly higher expressions of CD97 at tumor cells and CD55 at stroma (67.8% [21/31] and 63.6% [21/33]) at the invasion front than those patients without recurrence and/or metastasis (25.0% [10/40] and 26.3% [10/38]). The expression of CD97 at tumor cell at the invasion front showed modest correlation with that of CD55 in the stroma at the invasion front(r = 0.392, P < 0.01). Univariate analysis revealed that lymph node metastasis (P = 0.001), stages II-IV (P = 0.026), and strong CD97 expression at tumor invasion front (P = 0.002) were shown to have a significant adverse impact on the postoperative survival rate. Moreover, lymph node metastasis (P = 0.037) and strong CD97 expression (P = 0.015) were associated with poor survival in a multivariate analysis. CONCLUSIONS: Elevated expression of CD97 and its ligand CD55 at the invasion front correlate with tumor recurrence and metastasis, and CD95 may be a poor prognostic factor for rectal adenocarcinoma.

Analysis of super-low anterior resection for rectal cancer from a single center.

PURPOSE: The purpose of this study was to evaluate the outcome and genitourinary complications of super-low anterior resection (SLAR) followed by adjuvant radiochemotherapy in the management of patients with low rectal cancer. METHOD: One hundred and six low rectal cancer patients managed with SLAR were analyzed retrospectively. RESULTS: There were seven patients who failed to follow up, and the 5-year survival rate was 65.7% (65/99). There were 35 patients (35.4%) who developed distant metastases, and 12 (12.1%) had local recurrence. The local recurrence rates were 21.1% (4/19), 7.1% (2/28), 5.9% (1/17), and 0% (0/2) in the patients with tumor distance of less than or equal to 2 cm, ranging from 2.1 to 3.0, from 3.1 to 4.0, from 4.1 to 5.0, and more than 5 cm, respectively. This implied local recurrence rate increased against the distance between the lower margin of tumor and resection line. Ninety-eight of 106 rectal patients had complete data of questionnaire: 58 scored 1, 32 scored 2, 7 scored 3, and 1 score 4. This revealed that the fecal function of most patients (91.8%, 90/98) was normal or nearly normal. Twenty-four of 37 males suffered from sexual dysfunction, and among them, eight were impotent (all older than 70 years), and 29 had retrograde ejaculation. Meanwhile, seven of 35 females suffered from sexual problem, 1 had dyspareunia, seven had decreased lubrication, and one had inability to achieve orgasm. CONCLUSIONS: SLAR followed by adjuvant radiochemotherapy can effectively control local-regional disease and can be one choice of avoiding the functional morbidity of abdominoperineal resection.

Single-layer anastomosis without hemostasis in the submucosa layer by electric coagulation or ligation: a novel technique of anastomosis for all gastrointestinal tracts.

BACKGROUND/AIMS: Single-layer anastomosis has been used extensively for all gastrointestinal tract around the world. Up to now, most of surgeons take it for granted that submucous layers need careful hemostasis either by electric coagulation or ligation for prevention of anastomotic stoma bleeding. We experienced hemostasis in the submucosa layer by adequate strength of anastomosis rather than electric coagulation for gastrointestinal tracts. In the present study was evaluated the safety and benefit of this novel anastomotic technique. METHODOLOGY: From 1994 to 2006, 527 gastrointestinal anastomosis were performed using the improved anastomotic technique, and 281 anastomosis (control group) were completed with commonly adopted technique. RESULTS: The improved anastomotic technique could decreased the incidence of leaks (p = 0.024), and procedure time required for anastomosis in comparison to control group (p = 0.0002). The incidence of abscesses (p = 0.51) and bleeding (p = 1.00) of the improved anastomotic technique were no significant between the groups. CONCLUSIONS: The novel technique, single-layer anastomosis without hemostasis in the submucosa layer by electric coagulation or ligation, is suitable for all gastrointestinal anastomosises and it should be popularized.

Analysis of procedure-related complications after pancreatodoudenectomy.

PURPOSE: To analyze the procedure-related complications after pancreaticoduodenctomy (PD) and their risk factors. METHODS: One hundred twenty-six patients underwent pancreatoduodenectomy for diseases at region of pancreatic head were reviewed retrospectively. RESULTS: The overall surgical morbidity was 40.5% (51/126). Ten (7.9%) of 51 patients were identified as having pancreatic leakage, others included delayed gastric emptying (8.7%, 11), abdominal infection and abscess (7.9%, 10), abdominal bleeding (5.6%, 7), wound infection (4.8%, 6), wound dehiscence (2.4%, 3), biliary fistula (1.6%, 2) and operative death (1.6%, 2). Other postoperative complications were lung inflammation (3.9%, 5) and newly developed diabetes mellitus (2.3%, 3). Age (>60 years), coexisting diabetes mellitus, small main pancreatic duct (≤0.5 cm), and surgeon's experience (<10 patients within 5 years) were demonstrated to be independent risk factors by both univariate and multivariate analysis (p < 0.01). CONCLUSIONS: Old patients with coexisting diabetes mellitus and small main pancreatic duct undergo pancreatoduodenectomy by a less experienced surgeon may be at high risk of procedure-related complications.

Radical resection and outcome for malignant tumors of the pancreatic body and tail.

AIM: To analyze the factors influencing radical (R0) resection rate and surgical outcome for malignant tumor of the pancreatic body and tail. METHODS: The clinical and operative data and follow-up results of 214 pancreatic body and tail cancer patients were analyzed retrospectively. RESULTS: One hundred and twenty/214 pancreatic body and tail cancer patients underwent surgical treatment; the overall resection rate was 59.2% (71/120), and the R0 resection rate was 40.8% (49/120). Compared with non-R0 treatment, the patients receiving an R0 resection had smaller size tumor (P<0.01), cystadenocarcinoma (P<0.01), less lymph node metastasis (P<0.01), less peri-pancreatic organ involvement (P<0.01) and earlier stage disease (P<0.01). The overall 1-, 3- and 5-year survival rates for pancreatic body and tail cancer patients were 12.7% (25/197), 7.6% (15/197) and 2.5% (5/197), respectively, and ductal adenocarcinoma patients had worse survival rates [15.0% (9/60), 6.7% (4/60) and 1.7% (1/60), respectively] than cystadenocarcinoma patients [53.8% (21/39), 28.2% (11/39) and 10.3% (4/39)] (P<0.01). Moreover, the 1-, 3- and 5-year overall survival rates in patients with R0 resection were 55.3% (26/47), 31.9% (15/47) and 10.6% (5/47), respectively, significantly better than those in patients with palliative resection [9.5% (2/21), 0 and 0] and in patients with bypass or laparotomy [1.2% (1/81), 0 and 0] (P<0.01). CONCLUSION: Early diagnosis is crucial for increasing the radical resection rate, and radical resection plays an important role in improving survival for pancreatic body and tail cancer patients.

The surgical treatment and outcome for primary duodenal adenocarcinoma.

BACKGROUND: The purpose of this study was to investigate the early diagnosis and outcomes of surgical treatment of primary duodenal adenocarcinoma (PDAC) for curative purpose. METHOD: Thirty-two PDAC patients treated surgically between February 1990 and September 2006 were analyzed retrospectively. RESULTS: All 32 patients underwent laparotomy, including 18 patients (56.3%) pancreaticoduodenectomy (PD), six patients (18.7%) segmental resection (SR), and eight patients bypass procedures. R0 resections were obtained in 22 patients; the other 10 procedures were palliative. The total 1-, 3-, and 5-year survival rates in this study were 86.2% (25/29), 48.3% (14/29), and 20.7% (6/29), respectively, moreover, the 1-, 3-, and 5-year survival rates in patients with R0 resection were 100.0% (19/19), 73.7% (14/19), and 31.6%(6/19), which were significantly higher than those (50.0% = 5/10, 0%, and 0%) in patients with palliative operation (P > 0.05), respectively. Furthermore, the 5-year survival rate was 27.8% (5/18) in pancreaticoduodenectomy patients and 16.7% (1/6) in segmental resection patients, and there was no significant difference between the above two procedures (P > 0.05). CONCLUSION: PD is suggested for tumor located at the first and second portion of the duodenum, and SR may be appropriate for the selected patients, especially for tumors of the distal duodenum.