Performance of a Nomogram Based on the Integration of Inflammation Markers with Tumor Staging in Prognosis Prediction of Stage III Colorectal Cancer.

INTRODUCTION: The aim of the present study was to evaluate a nomogram model for predicting the 5-year overall survival (OS) in lymph node-metastatic colorectal cancer (CRC) patients by combining inflammation markers with some traditional prognostic factors. METHODS: A total of 399 patients with stage III (pTXN1-3M0) CRC operated from January 2007 to December 2012 were enrolled in this retrospective study. All patients underwent D2 lymphadenectomy in the hospital. A prognostic nomogram based on the integration of traditional prognostic factors and NLR (neutrophil-to-lymphocyte ratio) and PLR (platelet-to-lymphocyte ratio) was established and compared with the nomogram based on the traditional prognostic factors alone. ROC curves were further applied to verify the predictive accuracy of the established model. RESULTS: Both NLR (P=0.00) and PLR (P=0.01) predicted the 5-year OS. In multivariate analysis, age, T3 category, T4 category, N2 category, N3 category, Pgp (P-glycoprotein), NLR and PLR are proven to be independent (all P≤0.05). The established nomogram showed better predictive power than that of traditional profile (c-index: 0.66 versus 0.63) in both training and validation cohorts. External assessment by ROC curve analysis demonstrated that the established model had a good prediction accuracy of 5-year OS in stage III CRC patients, with area under curve values of 0.657 and 0.629 in training and validating sets, respectively. CONCLUSION: A nomogram based on the integration of traditional prognostic factors and inflammatory markers (NLR and PLR) could provide more precise long-term prognosis information for lymph node-metastatic CRC patients than the model based on traditional profile alone. This model might be useful for clinical application in personalized evaluation.

SIRT1 facilitates amyloid beta peptide degradation by upregulating lysosome number in primary astrocytes.

Previous studies have shown that sirtuin 1 (SIRT1) reduces the production of neuronal amyloid beta (Aß) and inhibits the inflammatory response of glial cells, thereby generating a neuroprotective effect against Aß neurotoxicity in animal models of Alzheimer's disease. However, the protective effect of SIRT1 on astrocytes is still under investigation. This study established a time point model for the clearance of Aß in primary astrocytes. Results showed that 12 hours of culture was sufficient for endocytosis of oligomeric Aß, and 36 hours sufficient for effective degradation. Immunofluorescence demonstrated that Aß degradation in primary astrocytes relies on lysosome function. Enzymatic agonists or SIRT1 inhibitors were used to stimulate cells over a concentration gradient. Aß was co-cultured for 36 hours in medium. Western blot assay results under different conditions revealed that SIRT1 relies on its deacetylase activity to promote intracellular Aß degradation. The experiment further screened SIRT1 using quantitative proteomics to investigate downstream, differentially expressed proteins in the Aß degradation pathway and selected the ones related to enzyme activity of SIRT1. Most of the differentially expressed proteins detected are close to the primary astrocyte lysosomal pathway. Immunofluorescence staining demonstrated that SIRT1 relies on its deacetylase activity to upregulate lysosome number in primary astrocytes. Taken together, these findings confirm that SIRT1 relies on its deacetylase activity to upregulate lysosome number, thereby facilitating oligomeric Aß degradation in primary astrocytes.

Laparoscopy-assisted posterior low anterior resection of rectal cancer.

BACKGROUND: Laparoscopy-assisted low anterior resection (LAR) of colorectal cancer, using a posterior surgical approach, is a difficult and controversial procedure to perform. We report successful operations on 13 patients with clear surgical margins and no serious complications. METHODS: Thirteen patients [10 males and three females, age range: 48 to 69 years (median: 61 years)] with low adenocarcinoma confirmed by preoperative colonoscopic biopsy (four stage T1; nine stage T2) were resected. The distance from inferior edge of tumor to dentate line was 2 ~ 5 cm (average: 3.4 cm). Intraperitoneal laparoscopy was performed to isolate rectosigmoid and mesocolon moving toward distal end of the tumor. Perineal operation was performed in the prone clasp-knife position. RESULTS: The circumferential resection margin (CRM) was negative in all cases. No serious postoperative complications occurred. There were four cases of perineal wound infection, two cases with superficial perineal wound dehiscence, and two cases with persistent postoperative sacral pain. All 13 patients passed the Wexner continence test and had satisfactory anal function during a mean 18-month postoperative follow-up period. CONCLUSION: Laparoscopic posterior LAR of colorectal cancer is a safe and reliable treatment for patients with low colorectal cancer, increasing the chance of anal functional recovery. TRIAL REGISTRATION: Chinese Clinical Trial Register ChiCTR-ONC-14005145. Registered 19 August 2014.

[Protection of the proximal colon segment during laparoscopic proctosigmoidectomy].

To evaluate the protection of proximal colon segment by analyzing blood supply disorder of proximal colon segment during laparoscopic proctosigmoidectomy(11 cases) in the Chaoyang Hospital of Capital Medical University. It is concluded that the disorder of blood supply of proximal colon segment during laparoscopic proctosigmoid surgery has two reasons. One is the anatomic factor of mesenteric vessels; the other is the inappropriate operative procedure. It is recommended that left colonic artery should be retained, and inferior mesenteric artery should be handled at a low level, thus, the risk of proximal intestine blood supply disorder caused by vascular anatomy variation can be reduced.

[Laparoscopy assisted total mesorectal excision for rectal cancer].

OBJECTIVE: To evaluate the feasibility of laparoscopy assisted total mesorectal excision (TME) for rectal cancer. METHOD: From March 2000 to November 2003,67 patients with rectal cancer received laparoscopy assisted TME,in whom 45 cases received anterior resection (AR),and 22 cases received abdominal perineal resection (APR). RESULTS: The operation was performed according to the rules of TME. The operative bleeding volume ranged from 10 to 50 ml. The operative time ranged from 2.5 to 5 hours without operative related death. Gastrointestinal decompression time ranged from 8 to 24 hours after operation. The time of intaking fluid food ranged from 24 to 48 hours after operation; the time of taking general activity ranged from 1 to 3 days after operation,and the defecating time ranged from 1 to 5 days after operation. The time of the hospital stay ranged from 7 to 10 days. All patients were followed up from 3 to 43 months except 3 patients. Two patients had local recurrence, including 1 patient died of local recurrence; 2 patients had liver metastases including 1 patient died of tumor metastasis but another was still alive. No metastasis and recurrence was found in 19 patients within follow - up time of one year. CONCLUSION: The laparoscopy assisted TME is a feasible approach for rectal cancer if surgeons have experience in open operation of laparoscopy assisted TME and good managing skills.