Low Pneumoperitoneum Pressure Improves Recovery of Transabdominal Preperitoneal Hernioplasty.

OBJECTIVE: To evaluate the recovery influence of CO2 pneumoperitoneum pressure for transabdominal preperitoneal hernioplasty (TAPP). STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: General Department II, Zhongda Hospital, Southeast University, Nanjing, China, from August 2016 to October 2018. METHODOLOGY: Eighty cases were enrolled prospectively and divided into three groups in chronological order. A 14 mmHg CO2 pressure was used for negative control group while the pressure was controlled at 12 mmHg for observation group and 10 mmHg for intervention group. General information included the patients' age, gender, type of hernia, hernia defect size, dissection of inguinal area, type of patch, time of operation, and frequency of swelling of perineum. Postoperative recovery was compared among the three groups at 24 hours and 1 month after surgery, including pain scores, foreign body sensation, local complications, urinary retention, swelling of the perineum, sex life and mobility. RESULTS: Seventy-eight patients were included in the final analysis. There were no differences among the three groups in patients' age, gender, type of hernia, hernia defect size, dissection of inguinal area and type of patch. However, the time of operation of intervention group increased (p=0.015) and incidence of swelling of perineum decreased than other two groups (p<0.05). After 24 hours, there were no significant differences in pain, foreign body sensation, local complications and urinary retention. Perineal swelling remission rate of intervention group was better than other two groups (p<0.05). After one month, three groups had no differences in the all terms of pain, foreign body sensation, sexual life and perineal swelling residual rate. CONCLUSION: Low pneumoperitoneum pressure can relieve swelling of perineum perioperatively and improve recovery of TAPP.

miR-181b as a potential molecular target for anticancer therapy of gastric neoplasms.

OBJECTIVE: MicroRNAs (miRNAs) play important roles in carcinogenesis. The aim of the present study was to explore the effects of miR-181b on gastric cancer. METHODS: The expression level of miR-181b was quantified by qRT-PCR. MTT, flow cytometry and matrigel invasion assays were used to test proliferation, apoptosis and invasion of miR-181b stable transfected gastric cancer cells. RESULTS: miR-181b was aberrantly overexpressed in gastric cancer cells and primary gastric cancer tissues. Further experiments demonstrated inducible expression of miR-181b by Helicobacter pylori treatment. Cell proliferation, migration and invasion in the gastric cancer cells were significantly increased after miR-181b transfection and apoptotic cells were also increased. Furthermore, overexpression of miR-181b downregulated the protein level of tissue inhibitor of metalloproteinase 3 (TIMP3). CONCLUSION: The upregulation of miR-181b may play an important role in the progress of gastric cancer and miR-181b maybe a potential molecular target for anticancer therapeutics of gastric cancer.

[Maintenance effect of polyglycosides of Tripterygium wilfordii on remission in postoperative Crohn disease].

OBJECTIVE: To observe the maintenance effect of polyglycosides of Tripterygium wilfordii (GTW) on remission in postoperative Crohn disease (CD). METHODS: From 2005 to 2007, 45 adult cases of postoperative Crohn disease were randomly divided into two groups, GTW group and mesalazine group, which received GTW and mesalazine treatment respectively. CD activity index (CDAI) and clinical markers were collected at 0, 3, 6, 12 months or at the onset of symptoms. Ileocolonoscopy was performed at the end of the trial (1 year after operation) or at the onset of symptoms, and recurrence score were recorded. RESULTS: No clinical recurrence was ascertained in both groups at 3 months. Four patients (18.2%) in GTW group relapsed and 5 (21.7%) in mesalazine group relapsed at 6 months (P=0.530). Seven patients (31.8%) in GTW group and 9 (39.1%) in mesalazine group relapsed at one year (P=0.421). Ten patients (45.5%) in GTW group had endoscopic recurrence compared with 14 (60.9%) in mesalazine group at one year(P=0.231). There were no significant differences between two groups. CONCLUSION: GTW is similar to mesalazine in maintenance of remission of postoperative Crohn disease.

Phase II trial of low-dose gemcitabine in prolonged infusion and cisplatin for advanced non-small cell lung cancer.

PURPOSE: To evaluate the efficacy and safety of the combination of gemcitabine at a low dose of 250 mg/m(2) in 6h prolonged infusion with cisplatin in chemonaive patients with advanced non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: Fifty-eight chemonaive patients with stage IIIB or IV NSCLC were included, 39 males and 19 females, with a median age 61 years (range 28-73). Thirty-four (58.6%) patients had adenocarcinoma, 18 (31.0%) squamous cell, and 6 (10.4%) others. Seventeen (29.3%) had stage IIIB and 41 (70.7%) stage IV. Treatment consisted of 250 mg/m(2) gemcitabine in a 6h infusion on days 1 and 8, and cisplatin at 75 mg/m(2) on day 2 of a 3-week cycle. A total of 219 chemotherapy cycles were administered, with a median of 4 cycles per patient (range 1-6). RESULTS: Of the 58 patients enrolled, all were evaluated for toxicity and 56 assessed for response. The overall response rate was 39.3% (95% confidence interval, 26.5-52.1%) with complete and partial responses of 3.6 and 35.7%, respectively. The median time to disease progression was 5.5 months (95% CI, 4.3-6.7 months), and median overall survival time was 10.5 months (95% CI, 8.5-12.5 months). One-year survival rate was 41.4%. Hematologic toxicity was fairly mild, and grades 3-4 hematologic toxicities consisted of neutropenia in 18.9% of patients, thrombocytopenia in 10.3%, and anemia in 6.9%. No patients required platelet transfusions, no bleeding episodes were recorded, and three patients received packed red blood cells (RBC) transfusions. The main nonhematologic toxicities included grade 3 nausea/vomiting in 27.6% of patients, grade 1-2 alopecia in 63.8%, and grade 1-2 skin rash in 17.3 %. CONCLUSIONS: Low-dose gemcitabine in 6h prolonged infusion plus cisplatin is effective in NSCLC treatment. Toxicity, especially myelosuppression, is remarkably mild.

A phase II trial of modified FOLFOX as first-line chemotherapy in advanced colorectal cancer.

The objective was to evaluate the efficacy and toxicity of leucovorin plus 5-fluorouracil combined with oxaliplatin (modified FOLFOX regimen) every 2 weeks on previously untreated advanced colorectal cancer patients in the Chinese population. Fifty-one inpatients were enrolled to receive 85 mg/m oxaliplatin intravenously over a 2- h period on day 1, together with 400 mg/m2 leucovorin over 2- h, followed by a 46-h infusion of 5-fluorouracil at 2600 mg/m2 every 2 weeks. Treatment was given until progression or unmanageable toxicity ensued. In all, 51 patients received three or more oxaliplatin doses and a median of nine treatment cycles (range 3-16 cycles). Of the 51 eligible patients, two complete responses and 22 partial responses were observed for an overall response rate of 47.0% (95% confidence interval 35-64%). Median progression-free survival was 7.7 months (95% confidence interval 6.8-8.6) and median overall survival was 15.0 months (95% confidence interval 13.1-16.9). Toxicities were mild: five patients (9.8%) reported grade 3-4 neutropenia, 33 patients (64.8%) experienced grade 1-3 neurotoxicity and only six patients (11.8%) experienced grade 3 neurotoxicity. The leucovorin plus 5-fluorouracil combined with oxaliplatin (modified FOLFOX) regimen is active and well tolerated in patients with previously untreated advanced colorectal cancer in the Chinese population.

Triptolide suppresses IL-1beta-induced chemokine and stromelysin-1 gene expression in human colonic subepithelial myofibroblasts.

AIM: To examine the inhibitive effects of triptolide on the expression of IL-8, monocyte chemotactic protein (MCP)-1, and matrix metalloproteinases (MMP)-3 in subepithelial myofibroblasts (SEMF) stimulated with IL-1beta. METHODS: SEMF cultures were established from normal colons in patients who underwent gut resection for colorectal carcinoma. Chemokine and MMP-3 expressions were determined by ELISA and RT-PCR. The cytosolic amount of phosphorylation of I kappa B-alpha(p-I kappa B-alpha) was determined by Western blotting. The DNA binding capacity of NF-kappa B was evaluated by electrophoretic mobility shift assays. RESULTS: IL-1beta stimulated protein and mRNA expression of IL-8, MCP-1, and MMP-3 in SEMF. Triptolide inhibited these effects of IL-1beta in a dose-dependent manner. Mechanistic studies revealed that triptolide markedly decreased IL-1beta -induced NF-kappa B DNA binding capacity and cytosolic amount of p-I kappa B-alpha. These results showed that triptolide inhibited IL-1beta -induced chemokine and MMP-3 expression in SEMF through the NF-kappa B pathway. CONCLUSION: Triptolide inhibited IL-1beta -induced chemokine and MMP-3 expression in SEMF by preventing the phosphorylation of I kappa B-alpha.

[Diagnosis and management of Crohn disease complicated with gastrointestinal fistulae].

OBJECTIVE: To investigate the diagnosis and treatment of patients with Crohn disease (CD) complicated with gastrointestinal fistulae. METHODS: Clinical data of sixty-two cases with CD complicated with gastrointestinal fistula e from 1978 to 2004 were analyzed. RESULTS: These were 68 external fistulae in 6 2 patients including recurrent fistulae in 6 cases, internal fistulae in 8 cases . Twenty- seven fistulae were located in the terminal ileum and 21 fistulae wer e located in ileocolic anastomosis site. The main surgery included 14 ileocecal resections with primary anastomosis and 26 resections of original ileocolic anastomosis with fistula and re-anastomosis. The incidence of recurrence was lower (15.4% ) in patients with postoperative medication including sulfasalazine and immunomodulator than that (34.8% ) in patients without postoperative immunomodulator,but the recurrence time was longer [(40+/- 17) months] in patients with postoperative medication than that [(8+/- 3)months] in the patients without postoperative specific medication. CONCLUSIONS: Most CD fistulae are external fistulae,most of the external fistulae are treated by resection of the fistula and anastomosis. Specific medication including sulfasalazine,mesalamine and immunomodulators should be used to prevent postoperative complications and CD recurrence.

[Effect of fructose-1,6-diphosphate and dexamethasone on ischemia/reperfusion injury after hemorrhagic shock in rabbits].

OBJECTIVE: To investigate the mechanism of myocardial ischemia/reperfusion injury and the protective effect of fructose-1, 6-diphosphagic (FDP) and dexamethasone (DXM) in hemorrhagic shock in rabbits. METHODS: Using a hemorrhagic shock model of Wiggers, 48 rabbits were randomly divided into 6 groups. Group I control group; GroupII with drugs given before ischemia phase (divided into 3 groups: FDP I, DXM I and FDP I+ DXM I); Group III with drugs given in reperfusion phase (divided into 2 groups: FDPII and DXMII). The levels of creatine kinase (CK) and troponin I (cTnI) in plasma were measured, and myocyte apoptosis index was assessed. RESULTS: Baseline levels of CK and cTnI were similar in three groups; CK and cTnI and apoptosis index were lower or with a lower tendency in groupII and in groupIII (P<0.05 or P<0.01); CK and cTnI showed a lower tendency in rise in FDP I and DXM I than in FDPII and even slower in FDP group than in DXM group; CK and cTnI levels rose slower in FDP I+DXM I than in FDP I and DXM I. CONCLUSION: FDP given during ischemia and DXM could effectively protect the myocardium from reperfusion injury following hemorrhagic shock.