Anti-reflux effects of a novel esophagogastric asymmetric anastomosis technique after laparoscopic proximal gastrectomy.

BACKGROUND: Reflux esophagitis is a common postoperative complication of proximal gastrectomy. There is an urgent need for a safer method of performing esophageal-gastric anastomosis that reduces the risk of reflux after proximal gastrectomy. We hypothesize that a novel technique termed esophagogastric asymmetric anastomosis (EGAA) can prevent postoperative reflux in a safe and feasible manner. AIM: To observe a novel method of EGAA to prevent postoperative reflux. METHODS: Initially, we employed a thermal stress computer to simulate and analyze gastric peristalsis at the site of an esophagogastric asymmetric anastomosis. This was done in order to better understand the anti-reflux function and mechanism. Next, we performed digestive tract reconstruction using the EGAA technique in 13 patients who had undergone laparoscopic proximal gastrectomy. Post-surgery, we monitored the structure and function of the reconstruction through imaging exams and gastroscopy. Finally, the patients were followed up to assess the efficacy of the anti-reflux effects. RESULTS: Our simulation experiments have demonstrated that the clockwise contraction caused by gastric peristalsis and the expansion of the gastric fundus caused by the increase of intragastric pressure could significantly tighten the anastomotic stoma, providing a means to prevent the reverse flow of gastric fluids. Thirteen patients with esophagogastric junction tumors underwent laparoscopic proximal gastrectomy, with a mean operation time of 304.2 ± 44.3 min. After the operation, the upper gastroenterography in supine/low head positions showed that eight patients exhibited no gastroesophageal reflux, three had mild reflux, and two had obvious reflux. The abdominal computed tomography examination showed a valve-like structure at the anastomosis. During follow-up, gastroscopy revealed a closed valve-like form at the anastomosis site without stenosis or signs of reflux esophagitis in 11 patients. Only two patients showed gastroesophageal reflux symptoms and mild reflux esophagitis and were treated with proton pump inhibitor therapy. CONCLUSION: EGAA is a feasible and safe surgical method, with an excellent anti-reflux effect after proximal gastrectomy.

Effects of CDC42 on the proliferation and invasion of gastric cancer cells.

Cell division cycle 42 (CDC42), which is a member of the Rho GTPase family, has been reported to regulate the metastasis of various human cancer cells; however, the role of CDC42 in gastric cancer (GC) remains unclear. The present study aimed to investigate the effects of CDC42 on the proliferation, migration and invasion of GC. Furthermore, the molecular mechanisms underlying the effects of CDC42 on GC were explored. The expression levels of CDC42 in the AGS and SGC7901 human GC cell lines were reduced by RNA interference. Knockdown of CDC42 significantly inhibited the proliferation of AGS and SGC7901 cells, and it was suggested that this inhibitory process may be due to cell cycle arrest at G1/S phase and downregulation of cyclin A, cyclin D1, cyclin E and proliferating cell nuclear antigen. Furthermore, knockdown of CDC42 markedly inhibited the migration and invasion of GC cells, and suppressed the expression of matrix metalloproteinase 9. These results indicated that CDC42 is a key regulator involved in regulating the proliferation, migration and invasion of GC, and it may be considered a potential therapeutic target in GC.

[Association of serum lipid profile with distant metastasis in breast cancer patients].

OBJECTIVE: In order to investigate whether the presence of distant metastases is associated with serum lipid abnormalities. METHODS: The fasting serum lipid profile and various clinicopathological data of 324 breast cancer patients with and without synchronous distant metastases were collected and analyzed. The serum lipid profile, including total cholesterol (TC), triglycerides (TG), low-density (LDL-C) and high-density lipoprotein cholesterol (HDL-C) was determined. The nutritional status, the serum albumin was measured and body mass index (BMI) was calculated. Univariate analysis and multiple logistic regression analysis were carried out to investigate the association of serum lipid profile with distant metastases. RESULTS: Univariate analysis showed that the distant metastasis rate was significantly higher in the breast cancer patients with an higher level of serum TC, TG, LDL-C, and LDL-C/HDL-C ratio (P < 0.05). Multiple logistic regression analysis showed that higher serum levels of TC, LDL-C and LDL-C/HDL-C ratio were independent risk factors for distant metastasis in breast cancer (OR = 2.324, 2.648 and 4.862, respectively). CONCLUSIONS: Hyperlipidemia is significantly associated with the distant metastasis in breast cancer patients. Monitoring of serum lipid profile may be helpful to predict the occurrence of distant metastasis in breast cancer patients.

Serum LDL-C and LDL-C/HDL-C ratio are positively correlated to lymph node stages in males with colorectal cancer.

BACKGROUND/AIMS: Although changes in serum lipid profile have been reported in CRC, the specific association between serum lipid profile and lymph node stages remains uncertain. METHODOLOGY: Fasting serum lipid profile, including TC, TG, HDL-C and LDL-C was retrospectively evaluated in 968 patients undergoing curative resection for primary CRC. To determine the nutritional status, the serum albumin levels were measured and BMI was calculated. Statistical analyses were performed to investigate the association of serum lipid profile with lymph node stages. RESULTS: Serum lipid levels correlated well with rate of lymph node metastasis and high LDL-C and low HDL-C levels tended to present more advanced lymph node stages. The observed elevation of the LDL-C/HDL-C ratio for patients with N2 stage was statistically significant when compared with patients with N1 stage. When separated by gender, multivariate logistic regression analysis showed that both LDL-C levels and LDL-C/HDL-C ratio had independent association with advanced N2 stage in males, but not in females. In addition, LDL-C/HDL-C ratio might be a more effective biomarker for identifying N2 stage than LDL-C levels alone (OR value: 2.85 vs. 1.63). CONCLUSIONS: Elevated serum LDL-C levels and an increased LDC-C/HDL-C ratio might favour development of lymph node metastasis and LDCC/HDL-C ratio might be a more effective biomarker for identifying advanced N2 stage than LDL-C levels alone, especially for male patients with CRC.

[Diffuse myxoid malignant fibrous histiocytoma of the pleura: a case report and review of the literature].

OBJECTIVE: To study the clinicopathologic characteristics of diffuse myxoid malignant fibrous histiocytoma (MFH) of pleura. METHODS: The clinical and pathological features of a patient with diffuse myxoid MFH of pleura from this hospital were analyzed, and the reported literature of 7 patients with MFH of pleura were reviewed. RESULTS: The patient was a 65-year-old male. The primary manifestations were cough, chest pain, breathlessness, and a great quantity of bloody pleural effusion. Chest CT scan showed diffuse masses on the visceral and parietal pleura. Exploratory thoracotomy exposed diffuse translucent gray-white masses on the surface of visceral and parietal pleura, with diameters of 1 - 8 cm. Microscopic findings showed that diffuse spindle-shaped and pleomorphic tumour cells were within the myxoid stroma. Tumor cells were positive for vimentin, CD(68), lysozyme, and negative for CK, EMA, and desmin. The patient died of obstruction of superior vena cava, and circulatory failure at 24th postoperative day. Different from cases with single or multiple MFH of pleura reported in the literature, this case of diffuse myxoid MFH had an abrupt onset, and progressed aggressively. CONCLUSION: Diffuse myxoid MFH of pleura is a very rare high-grade malignant tumor with very poor prognosis.