[Lung protective ventilation in elderly patients undergoing spinal operation in the prone position: a randomized controlled trial].

OBJECTIVE: To investigate effect of lung protective ventilation on respiration and circulation in elderly patients receiving spinal operation performed in the prone position. METHODS: Sixty patients undergoing elective spinal surgery were randomized control group [with VT of 10 mL/kg (PBW) and RR of 10-12 /min] and test group [with VT of 6 mL/kg +RMs+PEEP: 5 cmH(2)O (PBW) and RR of 12-18 /min]. Recruitment maneuver was performed once every 30 min. HR, MAP, P(peak), P(Plat), PaO(2)/FiO(2), SpO(2), PaCO(2), WBC, NEUT%, CRP, VAS, pulmonary complications risk score, and clinical pulmonary infection score were recorded before the operation, upon entry in the operation room, at 5 min before and 30 min, 1 h, and 3 h after changing into the prone position, and at 1 day and 3 days after the operation. RESULTS: Pulmonary complications risk score, HR, MAP, WBC, NEUT%, and PaCO(2) were all comparable between the two groups (P>0.05). P(peak) and P(plat) of the test group were lower than those of the control group after entering the operation room and at 5 min before and 30 min, 1 h, and 3 h after changing into the prone position (P<0.05). Compared with those in the control group, the oxygenation index at 1 day after the operation was significantly higher and CRP and postoperative clinical pulmonary infection score at 1 day and 3 days after the operation were significantly lower in the test group (P<0.05). CONCLUSIONS: Lung protective ventilation can reduce the risk of barotrauma, reduce lung inflammation, and improve postoperative oxygenation in elderly patients undergoing spinal surgery in the prone position without affecting intraoperative hemodynamics or causing CO(2) retention.

[Comparison of local immune microenvironment between liver-metastasis colorectal cancer and non-liver-metastasis colorectal cancer].

OBJECTIVE: To investigate the difference of local immune microenvironment in primary tumors between liver-metastasis and non-liver-metastasis cohort in stage III to IIII colorectal cancer patients. METHODS: Tumor samples from 167 patients of colorectal cancer were harvested, who received tumor resection for the first time in The First Affiliated Hospital of Sun Yat-sen University from 2000 to 2005. Patients were divided into two groups according to liver metastasis or not. Expressions of 18 immune markers, including CD3, CD4 and CD8 were examined and quantified by immunohistochemistry staining. RESULTS: No significant differences of gender, age, BMI, tumor differentiation, pathology type and preoperative CEA level were found between the two groups. The expressions of CD8, CD45RO, IL-17, tryptase and FAS were lower in liver-metastasis group as compared to non-liver-metastasis group (all P<0.05). CONCLUSIONS: Decrease of the number of T lymphocyte and mast cell may play an important role in local infiltration of immune microenvironment of stage III to IIII colorectal cancer with liver metastasis.

High expression of CD73 as a poor prognostic biomarker in human colorectal cancer.

BACKGROUND AND OBJECTIVES: To investigate the expression dynamics of CD73 and its prognostic significance in human colorectal cancer (CRC). METHODS: CD73 expression dynamics were detected by Western blotting. Immunohistochemistry was used to examine the expression of CD73 in CRC tissues from two independent cohorts by tissue microarrays. The optimal cutpoint of CD73 expression was assessed by the X-tile program. RESULTS: Western blotting analysis demonstrated that CD73 expression in CRC was significantly higher than in normal colorectal tissues. According to the X-tile program, the cutpoint for high expression of CD73 in CRC was determined when CD73 expression index was more than 5.9. High expression of CD73 was observed in 44.8% and 50.4% of CRC in the training and validation cohorts, respectively. Overexpression of CD73 was significantly correlated with tumor differentiation, nodal status, American Joint Committee on Cancer stage. Patients with high expression of CD73 had a poorer overall survival rate compared with patients with low expression of CD73 in both cohorts. In multivariate Cox regression analysis, overexpression of CD73 was proven to be an independent prognostic biomarker for CRC. CONCLUSIONS: High expression of CD73 can be an independent and useful biomarker for predicting the poor survival of patients with CRC.