The correlation between EGFR mutation status and the risk of brain metastasis in patients with lung adenocarcinoma.

To explore the correlation between epidermal growth factor receptor (EGFR) mutation status and the risk of brain metastasis (BM) in patients with lung adenocarcinoma, the clinical data of 100 patients with pathologically confirmed lung adenocarcinoma and known EGFR mutation status at exon 18, 19, 20, or 21 were analyzed retrospectively. The incidence of BM was similar between patients with wild-type EGFR and those with EGFR mutations (p = 0.48). However, among patients with EGFR mutations, the incidence of BM was significantly higher in patients with mutation at exon 19 than in patients with mutation at other sites (p = 0.007). Besides, among patients with heterochronous BM, 66.7 % had EGFR mutations. Regarding brain-metastasis-free survival (BMFS), patients with EGFR sensitive mutations (mutation at exon 19/21/and dual mutation) had significantly shorter BMFS compared with patients with wild-type EGFR (p = 0.018). For patients treated only with chemotherapy, BM was an unfavorable prognostic factor. Patients with BM had worse overall survival compared with those without BM (p = 0.035). However, in patients with BM and EGFR sensitive mutations, those treated with tyrosine kinase inhibitors (TKIs) had significantly longer overall survival compared with those treated with chemotherapy only (p = 0.0081). In conclusion, among patients with EGFR mutations, those mutated at exon 19 had the highest incidence of BM. Furthermore, patients with EGFR mutations are more likely to develop heterochronous BM. The BMFS was significantly shorter in patients with EGFR sensitive mutations. TKIs improved the survival of patients with lung adenocarcinoma and BM who harbored EGFR sensitive mutations.

[The effects of gastric bypass procedures on blood glucose, gastric inhibitory polypeptide and glucagon-like peptide-1 of normal glucose tolerance dogs].

OBJECTIVE: To observe postoperative glucose tolerance, gastric inhibitory polypeptide (GIP) , and glucogan-like peptide-1 (GLP-1) in normal glucose level dogs after undergoing gastric bypass procedures, and to explore the mechanism of gastric bypass procedures to treat type 2 diabetes. METHODS: The 6 dogs with normal glucose tolerance had undergone gastric bypass procedures, and measure preoperative and postoperative oral and intravenous glucose tolerance (at time points 1, 2, and 4 weeks) through changes in blood glucose, insulin, gastric inhibitory polypeptide (GIP), glucagon-like peptide-1 (GLP-1), and measure preoperative and postoperative week 4 pancreatic tissue morphology. RESULTS: Second weeks after operation, the fasting blood sugar was (3.58 ± 0.33) mmol/L, and significantly lower than preoperative (t = 3.571, P < 0.05). The GLP-1 level before oral glucose tolerance test (OGTT) and 30 minutes after OGTT were (0.90 ± 0.21) and (0.91 ± 0.19) pmol/L respectively, and significantly higher than preoperative (t value were -3.660 and -2.971, P < 0.05). GLP-1 levels began to decrease in the second week after surgery. After 4 weeks, the index recovered to the preoperative level. Four weeks after surgery when compared with preoperative, islet morphology, islet number (6.8 ± 0.8 and 7.1 ± 0.8 respectively) and islet cells (16.7 ± 2.5 and 16.3 ± 3.1 respectively) did not change significantly (P > 0.05). CONCLUSION: Gastric bypass procedures could be briefly affect normal glucose tolerance in dogs' blood glucose, insulin and diabetes-related gastrointestinal hormones.

S100A4 siRNA inhibits human pancreatic cancer cell invasion in vitro.

OBJECTIVE: Pancreatic cancer is one of the most deadly cancers, which is characterized by its high metastatic potential. S100A4 is a major prometastatic protein involved in tumor invasion and metastasis which precise role in pancreatic cancer has not been fully investigated. We knocked down the S100A4 gene in the Bxpc-3 pancreatic cancer cell line via RNA interference to study the changes in cell behavior. METHODS: Real-time polymerase chain reaction and western blotting were used to detect mRNA and protein expression levels of S100A4, matrix metalloproteinase (MMP)-2, E-cadherin and thrombospondin (TSP)-1. Transwell chambers were used to detect the migration and invasion abilities; a cell adhesion assay was used to detect adhesion ability; colony forming efficiency was used to detect cell proliferation; flow cytometry was used to detect apoptosis. RESULTS: S100A4 mRNA expression was reduced to 17% after transfection with S100A4-siRNA, and protein expression had a similar trend. mRNA and protein expression of MMP-2 was reduced and that of E-cadherin and TSP-1 was elevated, indicating that S100A4 affects their expression. S100A4-silenced cells exhibited a marked decrease in migration and invasiveness and increased adhesion, whereas overall proliferation and apoptosis were not overtly altered. CONCLUSION: S100A4 and its downstream factors play important roles in pancreatic cancer invasion, and silencing A100A4 can significantly contain the invasiveness of pancreatic cancer.

Risk factors for post-hepatectomy liver failure in 80 patients.

BACKGROUND: Post-hepatectomy liver failure (PHLF) is a serious complication and a leading cause of death after hepatectomy, an accurate prediction of PHLF is important for improvement of prognosis after hepatectomy. AIM: To retrospectively analyze the risk factors for postoperative liver failure in patients undergoing hepatectomy for liver tumors. METHODS: The clinical data of 80 patients undergoing hepatectomy in our hospital from June 2018 to January 2020 were collected. With laboratory examination as well as pre- and post-operative abdominal three-dimensional reconstructive computed tomography, the demographic data, surgical data, biochemical indicators, coagulation index, routine blood tests, spleen and liver volumes, relative remnant liver volume, and other related indicators were obtained and compared between patients with PHLF and those without PHLF. RESULTS: PHLF occurred in 19 (23.75%) patients. Univariate logistic regression analysis showed that gender, history of hepatitis/cirrhosis, and preoperative bilirubin, albumin, coagulation function, albumin-bilirubin ratio, aspartate amino-transferase-to-platelet ratio index (APRI), Model for End-Stage Liver Disease score, spleen volume (SV), spleen volume/liver volume ratio (SV/LV), and relative remnant liver volume were statistically associated with the occurrence of PHLF (all P < 0.05). Multivariate regression analysis showed that preoperative total bilirubin, platelets (PLT), APRI, and SV/LV were independent risk factors for PHLF (all P < 0.05). The area under the curve and cut-off values were 0.787 and 18.6 mmol/L for total bilirubin, 0.893 and 146 × 1012/L for PLT, 0.907 and 0.416 for APRI, and 0.752 and 20.84% for SV/LV, respectively. CONCLUSION: For patients undergoing liver resection, preoperative total bilirubin, PLT, APRI, and SV/LV are independent risk factors for PHLF. These findings may provide guidance to safely perform liver surgery in such patients.

Is There Necessity for Oversewing the Staple Line During Laparoscopic Sleeve Gastrectomy? An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Laparoscopic sleeve gastrectomy (LSG) has become the current mainstream surgical treatment for obesity. With the development of clinical practice, surgeons realized the associated severity and danger of postoperative bleeding and leakage. Surgeons constantly explore different strategies to reduce the incidence of these complications. By reviewing previous clinical articles on the staple line reinforcement (SLR) in LSG, the conclusions were inconsistent regarding effectiveness. This article aims to discuss effectiveness of oversewing the staple line in LSG. Methods: From the start date of each database to September 27, 2018, a comprehensive search of published articles in English was conducted in PubMed, Embase, Central (Cochrane) databases and Scopus databases. We extracted and analyzed the main results on postoperative bleeding, staple line leakage, hospital stay and operative time of the final included articles. This review was compliant with PRISMA guidelines. Results: Finally, we extracted and analyzed 11 randomized controlled trials (RCTs) which contain 2411 patients (1219 patients as part of the oversewing (OS) group and 1192 patients in the no-oversewing (NOS) group). In the OS group, there were 15 cases (1.23%) of postoperative bleeding, and 8 cases (0.66%) of postoperative leakage. While in the NOS group, 35 patients (2.94%) had postoperative bleeding and 21 patients (1.76%) had postoperative leakage. By comparing and analyzing the OS group and the NOS group, the risk ratio (RR) for postoperative bleeding was 0.48 (95% confidence interval [CI], 0.27-0.83 p = 0.447). In addition, the RR for postoperative leakage was 0.44 (95% CI, 0.21-0.89 p = 0.835). The standardized mean difference (SMD) for hospital stay was -0.10 (95% CI, -0.25 to 0.04 p = 0.061) and 2.26 for operative time (95%CI, 0.82-3.69 p = 0.000). Conclusion: This study suggested that oversewing the staple line during LSG has a significant clinical value: it decreased the incidence of postoperative bleeding, postoperative leakage; moreover, it also significantly prolonged the operative time and but did not change hospital stay. More high-quality and large sample RCTs are expected to get more accurate results.

Short-Term Outcomes of Self-Expandable Metallic Stent versus Decompression Tube for Malignant Colorectal Obstruction: A Meta-Analysis of Clinical Data.

Purpose: To compare the short-term outcomes between self-expandable metallic stent (SEMS) and decompression tubes (DT) for malignant colorectal obstruction. Methods: A comprehensive literature search was performed from inception to 2018/12/6 covering Pubmed, Embase, and Cochrane library. Methodological assessments of eligible studies were performed by using Newcastle-Ottawa Scale (NOS). The Revman software (version 5.3) was used in our statistical analysis. Results: Totally 7 cohort studies were enrolled in our meta-analysis. All the 7 eligible studies proved to be high quality according to the NOS scale. Patients receiving SEMS had higher clinical success rates, higher laparoscopic surgery rates, and higher primary anastomosis rates compared with patients receiving DT. Conclusions: Based on evidence from eastern countries, SEMS placement is an effective procedure that treats malignant colorectal obstruction. Compared with DT placement, patients receiving SEMS may benefit from higher clinical success rates, higher laparoscopic surgery rates, and higher primary anastomosis rates.

Comparison of anastomotic leakage rate and reoperation rate between transanal tube placement and defunctioning stoma after anterior resection: A network meta-analysis of clinical data.

OBJECTIVE: Defunctioning stoma (DS) and transanal tube (TT) placement have all been reported to be effective procedures to prevent anastomotic leakage after anterior resection. However, there are few studies that directly compare the 2 procedures, and those that do are unclear. METHODS: We performed a systematic literature search from the databases of Pubmed, Embase and Cochrane library. We limited the publication date from 2008/01/01 to 2018/07/29. The bias risk of eligible randomized controlled trials and cohort studies were assessed by Cochrane Collaboration's tool and Newcastle-Ottawa Scale, respectively. The direct meta-analysis was performed by RevMan 5.3 software. The network graph, inconsistency test and comparison-adjusted funnel plot were performed by the Stata 14.0 software. The indirect meta-analysis and rank probabilities were performed by GeMTC R package. RESULTS: 6 randomized controlled trials and 26 cohort studies were included in our meta-analysis. All eligible studies were assessed as low risk of bias. The anastomotic leakage rate and reoperation rate was lower in the patients receiving DS or TT placement than patients with non-protection. DS shared similar anastomotic leakage rate with TT. However, the reoperation rate was significantly lower in patients receiving DS than patients receiving TT. CONCLUSION: Both TT and DS were protective factors for anastomotic leakage after anterior resection for rectal cancer. DS reduced severity of anastomotic leakage in a more effective way than TT placement. However, we still suggested the routing use of TT for decreasing the risk of anastomotic leakage in anterior resection because it was cheaper and technically simpler.

Clinical Outcomes of Sleeve Gastrectomy Versus Roux-En-Y Gastric Bypass After Failed Adjustable Gastric Banding.

BACKGROUND: Over recent decades, laparoscopic adjustable gastric banding (LAGB) has been among the most common bariatric surgeries. Nowadays, many patients require revision surgery due to insufficient weight loss and band-related complications. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the two most common revision surgeries for failed LAGB, but the conclusions about their efficacy and safety have been inconsistent. This meta-analysis aimed to review the clinical outcomes of SG and RYGB after failed LAGB. METHODS: In accordance with the PRISMA guidelines, the PubMed, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were systematically searched for articles that had studied the efficacy and safety of SG and RYGB. The most appropriate effects model was chosen based on the heterogeneity of the articles included in this meta-analysis. Statistical analysis was conducted using Stata 14.0. RESULTS: Of 586 articles that were retrieved, 16 articles which examined 2141 SG and 2990 RYGB patients met the inclusion criteria. The patients in RYGB groups showed increased percent excess weight loss (%EWL) at 12 and 24 months after revision surgery but no statistically significant change was found about %EWL after 3, 6, or 36 months. In addition, RYGB was associated with a higher rate of complications, interventions, and readmission in addition to being of more operative time. CONCLUSIONS: This review suggested that RYGB was more effective at demonstrating weight loss after 12 and 24 months, but comparisons of the long-term efficacy of RYGB with that of SG remain inconclusive. In addition, RYGB was accompanied by a greater number of post-operative complications, interventions, and readmissions. Thus, surgeons should consider the overall status of the patients and their comorbidities as crucial factors when selecting a form of revision surgery. Additional high-quality randomized controlled studies are required to further compare the efficacy and safety of these treatments with longer follow-up times.

Differential composition of gut microbiota among healthy volunteers, morbidly obese patients and post-bariatric surgery patients.

The modulation of the gut microbiota was recently deemed one of the mechanisms responsible for the excellent outcomes of bariatric surgery. However, to date, only few studies have assessed this, and they have high heterogeneity. In the present study, next-generation 16S ribosomal DNA amplicon sequencing was used to characterize the gut microbiota of healthy volunteers, as well as patients prior to and after sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Significant differences in α diversity, ß diversity and species were identified between the different groups/time-points. The results demonstrated excellent outcomes of SG and RYGB. The ß diversity was lower in healthy volunteers compared with that in morbidly obese patients with or without type 2 diabetes mellitus. At 3 months after SG, the α diversity was increased and the ß diversity was decreased. The abundance of certain species changed significantly after SG and RYGB. It was also revealed that the abundance of certain microbes was significantly correlated with the body mass index, fasting blood glucose and glycosylated haemoglobin. It may be concluded that bariatric surgery may cause obvious alterations in the gut microbiota and compared with healthy volunteers and obese patients without bariatric surgery, the microbiota composition of post-bariatric surgery has unique characteristics. However, studies with a larger cohort and longer follow-up may be required to confirm these results.

[Comparative study of mesh-plug and polypropylene hernia system tension-free hernioplasty for inguinal hernia].

OBJECTIVE: To compare the effects of mesh-plug and polypropylene hernia system (PHS) tension-free hernioplasty so as to explore the strategy of treatment for different patients. METHODS: Eighty patients with inguinal hernia were assigned into 3 equal groups according to the randomization schedule: PHS group and mesh-plug group. The operating time and the outcomes were recorded. RESULTS: The operating times of the mesh-plug group was 73.8 minutes significantly longer than that of the PHS group (56.5 minutes, P < 0.05). There was no significant difference in the recovery progress between these 2 groups. The numbers of patients who had sense of foreign body and numbness in the mesh-plug group were significantly greater than those in the PHS group (both P < 0.05). CONCLUSIONS: Mesh-plug tension-free hernioplasty is indicated for most inguinal hernia patients owing to the simple operation. More rational in design and more effective in reduction of recurrence, PHS is suitable for thin patients or patients with week or large transversalis fascia defection. And PHS is able to reduce the postoperative discomfort.

Outcomes of Mini vs Roux-en-Y gastric bypass: A meta-analysis and systematic review.

BACKGROUND: Mini gastric bypass has been proved to be capable of achieving excellent metabolic results by numerous published studies. Compared to Roux-en-Y gastric bypass, mini gastric bypass is a technically simpler and reversible procedure. However, comparative outcomes of the effectiveness between Mini gastric bypass and Roux-en-Y gastric bypass remain unclear. METHODS: A systematic literature search was performed in Pubmed, Embase, Cochrane library from inception to February 9, 2018. For assessment of method quality, NOS (Newcastle-Ottawa Scale) and Cochrane Collaboration's tool for assessing risk of bias were used for cohort study and randomized controlled trials, respectively. The meta-analysis was performed by RevMan 5.3 software. RESULTS: 10 cohort studies and 1 randomized controlled trial was included in our meta-analysis. The method quality of the 10 cohort studies was proved as high quality according to the Newcastle-Ottawa Scale. The randomized controlled trial was proved to have a low risk of bias according to Cochrane Collaboration's assessment. Patients receiving mini-gastric bypass had multiple advantageous indexes as compared with patients receiving Roux-en-Y gastric bypass. Examples include: a higher 1-year EWL% (P < 0.05), higher 2-year EWL% (P < 0.05), higher type 2 diabetes mellitus remission rate, as well as a shorter operation time (P < 0.05). No significant statistical difference was observed in hypertension remission rate, mortality, leakage rate, GERD rate, or hospital stay between mini gastric bypass and Roux-en-Y gastric bypass. CONCLUSION: Mini gastric bypass seems to be a simpler procedure with a better weight reduction effect. This seems to also be the case regarding remission rates of type 2 diabetes mellitus when using Mini gastric bypass in comparison to Roux-en-Y gastric bypass. A small sample size and biased data may have influenced the stability of our results. In light of this, surgeons should treat our results in a conservative way. Larger sample size and multi-center randomized control trials are needed to compare the effectiveness and safety between mini-gastric bypass and Roux-en-Y gastric bypass.

Outcomes of transanal tube placement in anterior resection: A meta-analysis and systematic review.

BACKGROUND: In recent years, transanal tube placement was reported to be an effective procedure preventing anastomotic leakage after anterior resection of rectal cancer. However, this procedure is still controversial owing to inconsistent results found in previous studies. METHODS: A comprehensive literature search was performed using Pubmed, Embase, Cochrane library from the databases inception up until June 21, 2018. The methodological quality of randomized controlled trials and cohort studies were evaluated by Cochrane Collaboration's tool for assessing risk of bias and Newcastle-Ottawa Scale, respectively. Statistical analysis was performed using the RevMan 5.3 software. RESULTS: 1 randomized controlled trial and 9 cohort studies were included in our meta-analysis. The randomized controlled trial was proven to be low risk according to the Cochrane Collaboration's tool for assessing risk of bias. All of the cohort studies proved a high quality according to the Newcastle-Ottawa Scale. Patients in transanal tube group had more disadvantageous preoperative demographic characteristics than patients in non-transanal tube group. The anastomotic leak rate was lower in the transanal tube group. Patients in the transanal tube group tended to have lower reoperation rates and shorter hospital stays compared with patients in the non-transanal tube group. CONCLUSION: Despite various unfavorable preoperative characteristics, anastomotic leakage after anterior resection was lower in patients who received transanal tube placement compared with the control group. Transanal tube placement may be an alternative procedure of defunctioning stoma. A large sample size, multicenter RCT was needed to prove our results.

Comparison of safety and effectiveness between laparoscopic mini-gastric bypass and laparoscopic sleeve gastrectomy: A meta-analysis and systematic review.

BACKGROUND: The laparoscopic mini-gastric bypass is a newly emerged surgical procedure in recent years. Owe to safe and simple process and effective outcomes, laparoscopic mini-gastric bypass has quickly become one of the most popular procedures in some countries. The safety and effectiveness of laparoscopic mini-gastric bypass versus laparoscopic sleeve gastrectomy remain unclear. METHODS: A systematic literature search was performed in PubMed, Embase, Cochrane library from inception to May 20, 2017. The methodological quality of Randomized Controlled Trials and non-Randomized Controlled Trials were, respectively, assessed by Cochrane Collaboration's tool for assessing risk of bias and Newcastle-Ottawa scale. The meta-analysis was performed by RevMan 5.3 software. RESULTS: Patients receiving mini-gastric bypass had a lot of advantageous indexes than patients receiving sleeve gastrectomy, such as higher 1-year EWL% (excess weight loss), higher 5-year EWL%, higher T2DM remission rate, higher hypertension remission rate, higher obstructive sleep apnea (OSA) remission rate, lower osteoarthritis remission rate, lower leakage rate, lower overall late complications rate, higher ulcer rate, lower gastroesophageal reflux disease (GERD) rate, shorter hospital stay and lower revision rate. No significant statistical difference was observed on overall early complications rate, bleed rate, vomiting rate, anemia rate, and operation time between mini-gastric bypass and sleeve gastrectomy. CONCLUSION: Mini-gastric bypass is a simpler, safer, and more effective bariatric procedure than laparoscopic sleeve gastrectomy. Due to the biased data, small sample size and short follow-up time, our results may be unreliable. Large sample and multicenter RCT is needed to compare the effectiveness and safety between mini-gastric bypass and sleeve gastrectomy. Future study should also focus on bile reflux, remnant gastric cancer, and long term effectiveness of mini-gastric bypass.

Effect of Roux-en-Y gastric bypass surgery on intestinal Akkermansia muciniphila.

AIM: To investigated changes in intestinal Akkermansia muciniphila (A. muciniphila) and explored the mechanism underlying the therapeutic effects of Roux-en-Y gastric bypass (RYGB) surgery on type 2 diabetes in diabetic Goto-Kakizaki (GK) rats. METHODS: Male diabetic GK rats (n = 12) aged 8 wk were randomly assigned to the surgery group (GK-RYGB) or sham surgery group (GK-Sham) (n = 6 per group), and another 6 male Wistar rats aged 8 wk served as controls (WS-Sham). In the surgery group, RYGB surgery was conducted, and a sham operation was performed in both sham groups. Fasting blood glucose (FBG) levels before and after surgery, fasting levels of serum insulin and serum glucagon-like peptide-1 (GLP-1) and levels 30 min after intragastric injection of glucose, and the amount of A. muciniphila in the stool were determined. Insulin and GLP-1 were measured by enzyme-linked immunosorbent assay, and A. muciniphila were detected by fluorescence-based quantitative polymerase chain reaction. RESULTS: The FBG was improved, and serum GLP-1 and insulin increased significantly (P < 0.05) in the GK-RYGB group after surgery compared to levels before surgery and to levels in the GK-Sham group. Before surgery, the amounts of A. muciniphila in the GK-RYGB and GK-Sham groups were significantly lower than in the WS-Sham group (P < 0.05). After surgery, the amount of A. muciniphila in the GK-RYGB group increased markedly compared to that before surgery and to that in the GK-Sham and WS-Sham groups (P < 0.05). In addition, the A. muciniphila amount was positively related to GLP-1 (r = 0.86, P < 0.05). CONCLUSION: Our results demonstrated RYGB surgery may increase GLP-1 secretion, elevate serum insulin after intragastric injection of glucose, and improve insulin resistance in diabetic GK rats, thereby contributing to a significant reduction in blood glucose. The increased amount of A. muciniphila after RYGB surgery may be related to elevated GLP-1 secretion.

Cyclooxygenase-2 promotes angiogenesis by increasing vascular endothelial growth factor and predicts prognosis in gallbladder carcinoma.

AIM: To investigate the relationships between the expression of cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF) and the degree of vascularization, clinicopathologic feature, survival time of patients with gallbladder carcinomas. METHODS: Sixty-four gallbladder carcinoma specimens were evaluated for COX-2, VEGF expression by immunohistochemical methods. Microvessel counts (MVC) were determined using CD(34). The relationships between COX-2, VEGF expression, CD(34)-stained MVC, clinicopathologic features and survival time were analyzed. The correlations between COX-2 and VEGF expression, CD(34)-stained MVC were also investigated. RESULTS: COX-2, VEGF immunoreactivity were observed in 71.9% (46/64) and 54.7% (35/64) specimens, respectively. The average MVC in 64 cases of gallbladder carcinoma was 57+/-14 per high power vision field. The status of MVC was closely correlated with Nevin staging, tumor differentiation and lymph node metastasis (P<0.01, 0.002, and 0.003, 0.000, respectively). Increased VEGF expression was significantly correlated with tumor differentiation (poorly and moderately>well differentiated, P<0.05, P = 0.016). Clinical stages had no relation with the expression of VEGF (P>0.05, P = 0.612). There was a positive correlation between COX-2 expression and clinical stages. The positive rate of COX-2 was higher in cases of Nevin stages S(4)-S(5) (81.8%) than in those of Nevin stages S(1)-S(3) (50.0%) with a statistical significance (P<0.01, P = 0.009). The expression of COX-2 did not vary with differentiation (P>0.05, P = 0.067). Statistically significant differences were also observed according to lymph node metastasis, COX-2 expression and VEGF expression (P<0.01, 0.000, and 0.001, respectively). There was no relation between VEGF, COX-2 expression, MVC and the age and sex of patients. MVC and VEGF positive rate in the COX-2 positive gallbladder carcinoma tissue was higher than that in the COX-2 negative tissue (P<0.05, 0.000, and 0.032, respectively). Patients with VEGF, COX-2 positive tumors had a significantly shorter survival time than those with negative tumors (P<0.05, 0.004, 0.01, respectively). CONCLUSION: Augmented tumor neovascularization induced by VEGF may be one of the several effects of COX-2 responsible for poor prognosis of human gallbladder carcinoma. COX-2 inhibitor, either in combination therapy with other agents, or for chemoprevention, may be effective via suppression of angiogenesis in this fatal disease.

[Effects of ethanol on the function of cultured hepatocytes].

OBJECTIVE: To develop a novel culture system to investigate the effects of ethanol on the function of cultured hepatocytes. METHODS: Sandwich configuration was used to culture hepatocytes and the effects of ethanol on functions of bile excretion and protein synthesis as well as the morphology of cultured hepatocytes were observed. RESULTS: Bile canaliculi-like structures decreased and anastomatic networks disappeared in ethanol treated hepatocytes. The ability for hepatocytes to internalize, metabolize and excrete compounds into bile was indicated by FDA metabolizing in the hepatocytes. In hepatocytes without ethanol, the bile excretion was showed clearly, but in ethanol-interfered hepatocytes, no bile excretion was observed. After ethanol was given, the level of protein secretion decreased and with the time going, it became lower and lower. CONCLUSION: Hepatocytes can be seriously damaged by ethanol. The study provides a new model to investigate the mechanism of some liver diseases caused by ethanol.

[The protective role of gadolinium chloride in lung injury associated with acute necrotizing pancreatitis].

OBJECTIVE: To discuss the role of gadolinium chloride (GdCl(3)) in lung injury associated with acute necrotizing pancreatitis (ANP). METHODS: Experimental animals were randomized into five groups (n = 18 for each group): normal control group, ANP group, GdCl(3) pretreatment group, ANP GdCl(3) pretreatment group, ANP GdCl(3) treatment group. Rat ANP model was induced by intraductal administration of 3% sodium taurocholate. Alveolar macrophages (AM) were obtained by bronchoalveolar lavage. The blood gas assay, the ratio of wet/dry tissue, protein content of bronchoalveolar lavage fluids (BALF), the myeloperoxidase (MPO) of lung tissue and generation of TNFalpha and NO by AM were evaluated. The apoptosis of AM was checked by agarose gel electrophoresis analysis, transmission electric microscopy observation and cytometry propidium iodide single stained method. The lung tissue was examined by histology. RESULTS: The parameter of GdCl(3) pretreatment group compared with normal control group had no statistical significance (P > 0.05). The indicators of ANP GdCl(3) pretreatment group and ANP GdCl(3) treatment group were elevated compared with the normal control group and had statistical significance (P < 0.05). But compared to the ANP group, they were all decreased and also had the statistical significance (P < 0.05). The 180 - 200 bp ladder pattern unique to apoptosis in agarose gel electrophoresis and the apoptotic typical morphologic feature in AM by transmission electric microscopy and typical subdiploid peak in DNA content figure could be observed in ANP GdCl(3) pretreatment group and ANP GdCl(3) treatment group, while the other three groups could not. CONCLUSIONS: Lung injury associated with ANP could be ameliorated by application of GdCl(3) through inducing apoptosis of AM of ANP.

[The role of nitric oxide in lung injury associated with acute necrotizing pancreatitis].

OBJECTIVE: To discuss the role of nitric oxide (NO) in lung injury associated with acute necrotizing pancreatitis (ANP). METHODS: One hundred and twenty SD rats were randomized into five groups: control group, ANP group, L-arginine (L-arg) pretreatment group, L-NAME pretreatment group, and mixed pretreatment group (n = 24 for each group). Rat ANP model was induced by intraductal administration of 3% sodium taurocholate. Alveolar macrophages (AMs) were obtained by bronchoalveolar lavage. The protein content of bronchoalveolar lavage fluids (BALF), the myeloperoxidase (MPO) of lung tissue and generation of tumor necrosis factor alpha (TNFalpha)and NO by alveolar macrophages were evaluated. The expression of TNFalpha mRNA and iNOS mRNA was also measured. RESULTS: Lung injury was aggravated gradually with progression of the disease. The level of MPO of lung tissue and the protein content of BALF showed a steady increase with time and peaked at the 12(th) hour (10.8 +/- 0.6 U/g for MPO and 2,011.0 +/- 105.5 micro g/ml for protein, respectively). TNFalpha and NO secreted by AMs were elevated gradually and peaked at the 6(th) hour (1,624.2 +/- 149.2 pg/ml and 88.8 +/- 6.5 micro mol/L respectively) but decreased at the 12(th) hour. The expression of TNFalpha mRNA and iNOS mRNA was similar with the change of TNFalpha and NO. The parameters of the groups of L-arg, L-NAME and the mixed pretreatment were similar to those of ANP group. The parameters compared with those of the control group showed a significant difference (P < 0.05). The parameters of groups of L-Arg and L-NAME pretreatment in comparison with those of the ANP group showed significant difference (P < 0.05). CONCLUSIONS: Over production of NO mediated by iNOS aggravates lung injury caused by acute necrotizing pancreatitis. Administration of exogenous NOS substrate would worsen lung injury, whereas administration NOS inhibitor would alleviate lung injury.

[Application of side to side anastomosis between the lesser curvature of stomach and jejunum in laparoscopic Roux-en-Y gastric bypass].

OBJECTIVE: To evaluate the application of side-to-side anastomosis of the lesser curvature of stomach and jejunum in laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: Clinical data of 29 patients with type 2 diabetes mellitus (T2DM) undergoing side to side anastomosis of the lesser curvature of stomach and jejunum in LRYGB from May 2012 to November 2012 in Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University were analyzed retrospectively. RESULTS: All the procedures were successfully completed without conversion to laparotomy. The side-to-side anastomosis of the lesser curvature of stomach and jejunum avoided the laparoscopic suture. No gastrojejunostomy anastomotic bleeding, fistula, obstruction and other complications occurred after operation and no complications of gastrojejunostomy anastomosis were found during a follow up of 1 to 7 months. CONCLUSIONS: Side-to-side anastomosis of the lesser curvature of stomach and jejunum in LRYGB can manipulate the size of anastomosis accurately and avoid the laparoscopic suturing. It is simple and easy to learn.

Knockdown of Ezrin by RNA interference reverses malignant behavior of human pancreatic cancer cells in vitro.

BACKGROUND: Pancreatic cancer is one of the most aggressive tumors with a dismal prognosis. The membrane cytoskeletal crosslinker Ezrin participates in several functions including cell proliferation, adhesion, motility and survival. There is increasing evidence that Ezrin is overexpressed in vast majority of malignant tumors and regulates tumor progression. However, its roles in pancreatic cancer remain elusive. METHODS: Three pairs of specific Ezrin siRNAs were designed and synthetized and screened to determine the most efficient one for construction of a hairpin RNA plasmid targeting Ezrin. After transfection into the Panc-1 pancreatic cancer cell line, real-time quantitative PCR and Western blotting were performed to examine the expression of mRNA and protein. The MTT method was applied to examine the proliferation and the drug sensibility to Gemcitabine. Flow cytometry was used to assess the cycle and apoptosis, while capacity for invasion was determined with transwell chambers. Furthermore, we detected phosphorylated-Erk1/2 protein and phosphorylated-Akt protein by Western blotting. RESULTS: Real-time quantitative PCR and Western blotting revealed that Ezrin expression was notably down-regulated at both mRNA and protein levels by RNA interference (P< 0.01). Proliferation was inhibited and drug resistance to gemcitabine was improved (P< 0.05). Flow cytometry showed that the proportion of cells in the G1/G0 phase increased (P< 0.01), and in G2/M and S phases decreased (P< 0.05), with no apparent differences in apoptosis (P> 0.05). The capacity for invasion was markedly reduced (P< 0.01). In addition, down-regulating Ezrin expression had no effect on phosphorylated-Akt protein (P>0.05), but could decrease the level of phosphorylated-Erk1/2 protein (P< 0.05). CONCLUSIONS: RNA interference of Ezrin could inhibit its expression in the pancreatic cancer cells line Panc-1, leading to a potent suppression of malignant behavior in vitro. Assessment of potential as a target for pancreatic cancer treatment is clearly warranted.