MiR-185-5p measurement assists in reflecting Th1/Th2 cell imbalance, inflammatory cytokine production, and exacerbation risk for childhood asthma.

BACKGROUND: MicroRNA (miR)-185-5p participates in the pathology of asthma by regulating immune imbalance, inflammation, periostin synthesis, and smooth muscle contraction. This study intended to explore the dysregulation of miR-185p and its correlation with T-helper (Th)1, Th2 cells, and inflammatory cytokines in childhood asthma. METHODS: In 150 childhood asthma patients and 30 healthy controls (HCs), miR-185-5p from peripheral blood mononuclear cells was detected using reverse transcription-quantitative polymerase chain reaction, Th cells from peripheral blood samples were detected using flow cytometry, inflammatory cytokines from serum samples were detected using enzyme-linked immunosorbent assay. RESULTS: MiR-185-5p was increased in childhood asthma patients versus HCs [median (interquartile range (IQR)): 2.315 (1.770-3.855) versus 1.005 (0.655-1.520)] (P < 0.001). Meanwhile, miR-185-5p was negatively associated with Th1 cells (P = 0.035) but positively correlated with Th2 cells (P = 0.006) and IL-4 (P = 0.003) in childhood asthma patients; however, miR-185-5p was not linked to Th1 cells, Th2 cells, IFN-γ, or IL-4 in HCs (all P > 0.05). In addition, miR-185-5p was positively related to TNF-α (P < 0.001), IL-1ß (P = 0.015), and IL-6 (P = 0.008) in childhood asthma patients, miR-185-5p was only linked to TNF-α (P = 0.040) but not IL-1ß or IL-6 (both P > 0.05) in HCs. Moreover, miR-185-5p was increased in exacerbated childhood asthma patients versus remissive patients [median (IQR): 3.170 (2.070-4.905) versus 1.900 (1.525-2.615)] (P < 0.001). Besides, miR-185-5p was highest in patients with severe exacerbation followed by patients with moderate exacerbation, and lowest in patients with mild exacerbation (P = 0.010). CONCLUSION: MiR-185-5p is associated with imbalanced Th1/Th2 cells, increased inflammatory cytokines along with elevated exacerbation risk, and severity in childhood asthma patients.

[Nested case-control study on paediatric early warning score and ventilator-associated complications in children with acute respiratory distress syndrome].

OBJECTIVE: To explore the relationship between paediatric early warning score (PEWS) and the occurrence of mechanical ventilation complications in children with acute respiratory distress syndrome (ARDS).
 Methods: A total of 110 children with ARDS diagnosed in First Affiliated Hospital of Hebei North University, who underwent mechanical ventilation, were selected. The baseline data, blood gas analysis index, laboratory test index, ventilator parameters, pediatric critical illness score (PCIS) and PEWS in the children were recorded. With reference to ventilatory treatment results, the children with ventilator-associated complications were included in the trial group (n=20), while the patients with good cohort status were included in the control group (n=40) according to the nested case-control study. Independent sample t-test and multivariate logistic regression analysis were used to analyze the factors affecting the occurrence of complications after ventilatory treatment.
 Results: There were statistically significant differences in multiple organ dysfunction syndrome (MODS), partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2), partial pressure of carbon dioxide (PaCO2), serum creatinine (SCr), albumin (ALB), blood urea nitrogen (BUN), mechanical ventilation time, mean article pressure (MAP), tidal volume (VT), positive end-expiratory pressure (PEEP), PCIS, PEWS between the control group and the experimental group (all P<0.05). Multivariate logistic regression analysis showed that MODS, PaO2/FiO2, PaCO2, VT, PEEP and PEWS had influence on complications after mechanical ventilation in children with ARDS (all P<0.05).
 Conclusion: The MODS, PaO2/FiO2, PaCO2, VT, PEEP, and PEWS exert effects on complications after mechanical ventilation in children with ARDS. PEWS combined with other indicators can assess the risk of complications in children with ARDS after mechanical ventilation.

Antibiofilm effects of punicalagin against Staphylococcus aureus in vitro.

Staphylococcus aureus is a common foodborne pathogen which can form biofilms to help them resist to antimicrobials. It brings great harm to human health. Punicalagin has good antimicrobial activities against S. aureus, but its effect on biofilm formation has not been clearly illustrated. The aim of this study was to explore the antibiofilm effects of punicalagin against S. aureus. Results showed that punicalagin did not significantly interfere with the growth of S. aureus at the concentrations of 1/64 MIC to 1/16 MIC. The biomass and metabolic activity of biofilms were significantly reduced when exposed to sub-inhibitory concentrations of punicalagin. The number of viable cells in the biofilms was also decreased after punicalagin treatment. Scanning electron microscopy and confocal laser scanning microscopy images confirmed that punicalagin damaged the structure of biofilms. The antibiofilm mechanism was partly due to the modification of the cell surface which led to the reduction of cell surface hydrophobicity. These findings suggest that punicalagin has the potential to be developed as an alternative to control S. aureus biofilms.

Antibiofilm Effects of Oleuropein against Staphylococcus aureus: An In Vitro Study.

Staphylococcus aureus has posed a huge threat to human health and the economy. Oleuropein has antibacterial activities against various microorganisms but research on its effect on the S. aureus biofilm is limited. This research aimed to estimate the antibiofilm activities of oleuropein against S. aureus. The results suggest that the minimum inhibitory concentration of oleuropein against S. aureus ATCC 25923 was 3 mg/mL. The biomass of biofilms formed on the microplates and coverslips and the viability of bacteria were significantly reduced after the treatment with oleuropein. The scanning electron microscopy observation results indicated that the stacking thickness and density of the biofilm decreased when S. aureus was exposed to oleuropein. It had a bactericidal effect on biofilm bacteria and removed polysaccharides and proteins from mature biofilms. The effects of oleuropein on the biofilm could be explained by a reduction in bacterial secretion of extracellular polymeric substances and a change in bacterial surface hydrophobicity. Based on the above findings, oleuropein has the potential to be used against food pollution caused by S. aureus biofilms.

Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS 2002 and its relationship with postoperative results.

AIM: To evaluate the nutritional risk of patients with gastric carcinoma using the methodologies of European Nutritional Risk Screening 2002 (NRS 2002) and its relationship with postoperative results. METHODS: We prospectively evaluated the nutritional risk of 314 cases of gastric carcinoma patients in one center from 2004 to 2007 with NRS 2002, in accordance with China's normal body mass index (BMI), and observed its relationship with postoperative complications, mortality and length of hospital stay. RESULTS: Of 337 cases, 314 (93.1%) were suitable for assessment by NRS 2002.The number of patients with a score > or = 3 was 125 before operation, comprising 39.8% of patients with gastric carcinoma. The rate of complications (26.2%) of the preoperative nutritional risk group (NRS 2002 score > or = 3) was higher than those in the preoperative nutritional normal group (NRS 2002 score < 3) (P < 0.05). Assessed by multivariate logistics regression analysis, the odds ratio of developing complications was 2.366 (P < 0.05) and 2.277 (P < 0.05) by NRS 2002 score and clinicopathological stage, respectively. The correlation between length of hospital stay and nutritional risk was also assessed by Pearson correlation analysis. The Pearson coefficient was 0.177 (P = 0.002). CONCLUSION: Preoperative nutrition score (NRS 2002) > or = 3 predicted more postoperative complications and longer length of hospital stay. It indicated that preoperative nutritional support was necessary in patients with a preoperative nutritional score (NRS 2002) > or = 3.

Laparoscopic versus open appendectomy: a prospective randomized comparison.

BACKGROUND: Whether laparoscopy offers a benefit over open surgery in the management of acute appendicitis or not remains a subject of controversy despite the publication of numerous randomized studies. This study aimed to compare laparoscopic appendectomy (LA) with open appendectomy (OA) and to ascertain its therapeutic benefit. METHODS: Adult patients older than 14 years presenting with signs and symptoms suggestive of acute appendicitis were randomized to undergo either LA or OA from January 2006 to December 2007. Comparisons were based on operating time, time until return to a general diet, time until return to normal activity and work, length of hospital stay, billed charges, and postoperative complications. RESULTS: The study enrolled 220 patients: 108 to undergo OA and 112 to undergo LA. The groups were similar in terms of clinicopathologic characteristics. The operating time seemed to be shorter for the OA patients than for the LA patients, but the difference was not significant (LA, 30 +/- 15.2 min vs. OA, 28.7 +/- 16.3 min; p > 0.05). The hospital stay of 4.1 +/- 1.5 days for the LA group and 7.2 +/- 1.7 days for the OA group, and the difference was statistically significant (p < 0.05). Laparoscopic appendectomy remained associated with a shorter time until return to a general diet (LA, 20.2 +/- 12.4 h vs. OA, 36.5 +/- 10 h; p < 0.05), to normal activity (LA, 9.1 +/- 4.2 days vs. OA, 13.7 +/- 5.8 days; p < 0.05), and to work (LA, 21.2 +/- 3.5 days vs. OA, 27.7 +/- 4.9 days; p < 0.05). The billed charges appeared to be higher for LA (LA, 5,720.3 +/- 115.7 yuan vs. OA, 5,310 +/- 575.4 yuan), but this difference failed to be clinically important or statistically significant (p > 0.05). Wound infections were more common after OA (n = 14) than after LA (n = 0) (p < 0.05). Intraabdominal abscesses occurred for two patients in the LA group and nine patients in the OA group (p < 0.05). Postoperative ileus occurred with frequencies of 0% in the LA group and 7.4% in the OA group (p < 0.05). The rate for overall complications was significantly lower in the LA group. CONCLUSION: Laparoscopic appendectomy is a useful tool in the treatment of acute appendicitis. Its advantages lie in its minimal invasiveness, its better cosmetic outcome, its lower rate of complications based on surgical expertise and state-of-the-art equipment. It can be recommended as an adoptable method for the routine patient with appendicitis.

Celecoxib increases retinoid sensitivity in human colon cancer cell lines.

Retinoid resistance has limited the clinical application of retinoids as differentiation-inducing and apoptosis-inducing drugs. This study was designed to investigate whether celecoxib, a selective COX-2 inhibitor, has effects on retinoid sensitivity in human colon cancer cell lines, and to determine the possible mechanism of said effects. Cell viability was measured using the MTT assay. Apoptosis was detected via Annexin-V/PI staining and the flow cytometry assay. PGE(2) production was measured with the ELISA assay. The expression of RARbeta was assayed via western blotting. The results showed that celecoxib enhanced the inhibitory effect of ATRA in both COX-2 high-expressing HT-29 and COX-2 low-expressing SW480 cell lines. Further study showed the ATRA and celecoxib combination induced greater apoptosis, but that the addition of PGE(2) did not affect the enhanced growth-inhibitory and apoptosis-inducing effects of the combination. Moreover, NS398 (another selective COX-2 inhibitor) did not affect the inhibitory effects of ATRA in the two cell lines. Western blotting showed that the expression of RARbeta in HT-29 cell lines was increased by celecoxib, but not by NS398, and that the addition of PGE(2) did not affect the celecoxib-induced expression of the retinoic acid receptor beta. In conclusion, celecoxib increased the expression of RARbeta and the level of cellular ATRA sensitivity through COX-2-independent mechanisms. This finding may provide a potential strategy for combination therapy.

[Celecoxib increased cellular ATRA sensitivity of human colon cancer cell lines through COX-2-independent mechanisms].

Retinoid resistance has limited clinical activity of retinoids as differentiation-inducing and apoptosis-inducing drugs. The present study was designed to investigate whether celecoxib (selective COX-2 inhibitor) has effects on cellular retinoid sensitivity of human colon cancer cell lines and its possible mechanism. Cell viability was measured by MTT assay. Apoptosis was detected by Annexin-V/PI staining and flow cytometry assay. PGE2 production was measured by ELISA assay. Expression of RARbeta was assayed by Western blotting. The results showed that celecoxib enhanced the inhibitory effect of ATRA in both COX-2 high-expressing HT-29 and COX-2 low-expressing SW480 cell lines. Further study showed the ATRA and celecoxib combination induced greater apoptosis, and the addition of PGE2 did not affect the number of apoptotic cells induced by the combination. Moreover, NS398 (another selective COX-2 inhibitor) did not affect the inhibitory effects of ATRA on both cell lines. Western blotting showed that the expression of RARbeta in HT-29 cell lines increased in celecoxib group and combination group. And the addition of PGE2 did not affect the expression of RARbeta induced by celecoxib either. In conclusion, celecoxib increased expression of RARbeta and cellular ATRA sensitivity through COX-2-independent mechanisms, which may provide a potential strategy for combination therapy.

[Urinary function after pelvic autonomic nerve preservation of laparoscopic radical resection for rectal cancer].

OBJECTIVE: To evaluate the protection of urinary function after laparoscopic radical resection with pelvic autonomic nerve preservation (PANP) for rectal cancer. METHODS: Prospectively 139 patients with middle or low rectal cancer receiving surgery during November 2005 to October 2007 were divided into two groups (L-PANP, n = 63; O-PANP, n = 76). The radicalism and safety of L-PANP surgery were analyzed and the effects upon urinary function between the two groups assessed by follow-ups and urodynamic study. RESULTS: Patients receiving subtypes I and II of L-PANP surgery had less decrease in contraction of bladder than those receiving the same subtype of O-PANP surgery at 10 days post-operation (Z = -2.358, P = 0.018; Z = -2.268, P = 0.033). And no difference was observed in patients receiving subtype III PANP surgery (Z = -1.302, P = 0.237). However, no matter which subtype of PANP surgery, patients of L-PANP group had a better contraction of bladder than those of O-PANP group at 1 month post-operation (P < 0.05). The 1-year survival rate was 98.0% (50/51) in L-PANP group and 96.6% (57/59) in O-PANP group. And no statistical difference was found between them (P = 0.898). Meanwhile, the 1-year relapse rate of pelvic cavity was 3.9% (2/52) in L-PANP group and 5.1% (3/59) in O-PANP group. And no statistical difference was found between them (P = 0.867). CONCLUSION: As compared with O-PANP surgery, L-PANP surgery shows a superiority in protection of urinary function.

LncRNA SNHG1 promoted HGC-27 cell growth and migration via the miR-140/ADAM10 axis.

Documents have reported that long non-coding RNAs (lncRNAs) are involved in tumor progression. Previous study revealed that lncRNA SNHG1 was often elevated in cancer and was linked with poor prognosis in cancer patients. However, its modulatory mechanism has not been fully clarified in gastric cancer (GC). Here, we reported that SNHG1 expression was significantly increased in GC cell lines and tissues. Knockdown of SNHG1 impeded cell growth via disturbing cell cycle distribution and protecting cells from apoptosis. Nevertheless, SNHG1 down-regulation decreased cell invasive ability and reversed epithelial-mesenchymal transition (EMT) phenotype. Mechanismly, it was found that SNHG1 functioned as a competing endogenous RNA to repress miR-140 expression and thereby elevated its down-stream target ADAM10. In summary, SNHG1 promoted GC cell proliferation and invasion via modulating the miR-140/ADAM10 axis. These findings uncovered that lncRNA SNHG1 could be a candidate target for new therapies in GC patients.

BetaIg-h3 is involved in the HAb18G/CD147-mediated metastasis process in human hepatoma cells.

HAb18G/CD147, a new hepatoma-associated antigen cloned and screened from human hepatocellular carcinoma cDNA library, is closely correlated with metastasis process in human hepatoma cells. In the present study we aimed to identify the pivotal molecules of the HAb18G/CD147 signal transduction pathway. The investigation showed that betaig-h3, a secretory extracellular matrix (ECM) protein, was upregulated in HAb18G/CD147-expressing human hepatoma T7721 cells and was downregulated by depressing HAb18G/CD147 expression. The expression of betaig-h3, upregulated in human hepatoma cells, was positively relative to the expression of HAb18G/CD147 in different human hepatoma cell lines. By overexpressing betaig-h3 in human SMMC-7721 hepatoma cells, we discovered that betaig-h3 promoted cell adhesion, invasion, and matrix metalloproteinase (MMP) secretion potential. HAb18G/CD147-induced invasion and metastasis potential of human hepatoma cells can be attenuated by antibodies specific for betaig-h3, and no significant differences on inhibitory effects were observed among T7721 cells incubated with antibodies for betaig-h3 or HAb18G/CD147 or both types together. Taken together, our study suggests that betaig-h3, regulated by the expression of HAb18G/CD147, is involved in the HAb18G/CD147 signal transduction pathway and mediates the HAb18G/CD147-induced invasion and metastasis process of human hepatoma cells.

Comprehensive swallowing exercises to treat complicated dysphagia caused by esophageal replacement with colon: A case report.

INTRODUCTION: Surgical procedures for colonic replacement of the esophagus are most commonly associated with anastomotic stricture which cause dysphagia. In this report, we describe a rare case of a patient who demonstrated dysphagia resulting from an anastomotic stricture following esophageal replacement with the colon. All the treatments to dilate the anastomotic stricture were ineffective. To investigate the new treatment strategy for a case with complicated dysphagia, clinical dysphagia evaluations, functional oral intake scale (FOIS), videofluoroscopic swallowing study as well as high-resolution manometry were used to evaluate the swallowing function of the patient before and after treatments. INTERVENTIONS: Comprehensive swallowing exercises included the protective airway maneuver, tongue pressure resistance feedback exercise, Masako Maneuver swallowing exercise, and the effortful swallowing exercise. OUTCOMES: Comprehensive swallowing exercises showed good effect in the patient. The FOIS score increased from level 1 to level 7. The videofluoroscopy digital analysis showed that the pharynx constriction rate was 23% and 50%, before and after treatment, respectively. The data from the high-resolution manometry displayed that: the value of the velopharyngeal pressure peak was 82.8 mmHg before treatment and 156.9 mmHg after treatment; the velopharyngeal contraction duration time was 310 milliseconds before treatment and 525 milliseconds after treatment; the value of the hypopharynx pressure peak was 53.7 mmHg before treatment and 103.2 mmHg after treatment; and the hypopharynx contraction duration time was 390 milliseconds before treatment and 1030 milliseconds after treatment. The swallowing visualization illustrated that a bolus could normally pass through the anastomotic stoma, and the bolus leakage was no longer present. The patient was able to eat various consistencies of food independently, and we were able to remove the jejunum nutrient catheter before discharging the patient. CONCLUSION: For patients with dysphagia caused by anastomotic stricture following esophageal replacement with colon, the swallowing function can be improved by enhancing the pharyngeal impetus when treatment using esophageal dilation is ineffective.

[Screening of key molecules of HAb18G/CD147 signal transduction pathway in human hepatoma cells].

Objective To screen the differentially expressed key molecules of HAb18G/CD147 signal transduction pathway in human hepatoma cells. Methods The total RNA was extracted from SMMC-7721 and T7721 cells, which were stably transfected and overexpressed HAb18G/CD147, and then detected by signal transduction-related microarray to identify differentially expressed key molecules. Results The microarray data indicated that there were 13 differentially expressed genes between T7721 and SMMC-7721 cells. In T7721 cell line which overexpressed HAb18G/CD147, the down-regulated genes included bone morphogenetic protein-2 (BMP-2), BMP-5, endothelin-1 (ET-1), Wnt1-induced signaling proteins-2/CCN5 (WISP-2), cysteine-rich 61/CCN1 (Cyr61), prostate stem cell antigen (PSCA), and the up-regulated genes included interleukin-10 receptor α (IL-10Rα), IL-6, IL-8, CXCL2, mitochondrial superoxide dismutase 2 (SOD2), B factor and ßig-h3.Conclusion The study identified totally 13 differentially expressed genes which were related to HAb18G/CD147 signal transduction pathway. These genes are involved in the regulation of various hepatoma biological processes, such as immune microenvironment remolding, angiogenesis, cell proliferation, invasion and metastasis.

Correlation between Pathological Characteristics and Young's Modulus Value of Spastic Gastrocnemius in a Spinal Cord Injury Rat Model.

The goal of the present study were (1) to investigate the pathological characteristics of gastrocnemius muscle (GM) and quantitatively assess GM tissue stiffness in rat models with spinal cord injury (SCI) and (2) to explore the correlation between pathological characteristics changes and Young's modulus value of GM. 24 Sprague Dawley male rats were allocated into normal control groups and SCI model subgroups, respectively. GM stiffness was assessed with shear wave sonoelastography technology. All GMs were further analyzed by pathological examinations. GM weights were decreased, the ratio of type I fibers was decreased, and the ratio of type II fibers was increased in the GM in the model group. MyHC-I was decreased, while MyHC-II was increased according to the electrophoretic analysis in model subgroups. The elastic modulus value of GM was increased in the model group. A significant negative correlation was found between Young's modulus value of GM and the ratio of type I fibers of GM in model subgroup. Our studies showed that the stiffness of GM is correlated with pathological characteristics during the initial stages of SCI in rats. We also identified shear wave sonoelastography technology as a useful tool to assess GM stiffness in SCI rat models.

Minimally invasive surgical approach compared with open pancreaticoduodenectomy: a systematic review and meta-analysis on the feasibility and safety.

BACKGROUND: Laparoscopic and robotic pancreaticoduodenectomy have started utilization tentatively; however, the clinical benefits are still controversial. This study aims to evaluate the safety and efficiency of minimally invasive pancreaticoduodenectomy. METHODS: A systematic literature search was performed through PubMed, EMBASE, and Cochrane Library database without restriction to regions, publication types, or languages. Nine studies that compared laparoscopic/robotic with open pancreaticoduodenectomy were included. Fixed or random-effects models was used to measure the pooled estimates. Sensitivity and subgroup analysis were performed to evaluate the study quality. RESULTS: Patients who underwent minimally invasive pancreaticoduodenectomy experienced longer operative time (P=0.007), but the estimated blood loss (P=0.007), length of stay, (P=0.02), and wound infection (P=0.04) decreased. Perioperative complications, such as pancreatic fistula, delayed gastric emptying, hemorrhage, bile leakage, reoperation, and mortality, were of no significant differences. Pathologically, lymph node number was similar (P=0.11); meanwhile, margin R0 ratio was higher in minimally invasive approach group (P=0.03). Subgroup analysis manifested robotic surgery spent comparable surgical time (P=0.16) as laparotomy, with earlier discharge (P=0.04). CONCLUSIONS: This meta-analysis indicates minimally invasive pancreaticoduodenectomy may be associated with shorter hospital stay, less estimated blood loss, and positive margin rate without compromising surgical safety as open surgery. Surgical duration of robotic method could even be equivalent as laparotomy. Minimally invasive approach can be a reasonable alternative to laparotomy pancreaticoduodenectomy with potential advantages. Nevertheless, future large-volume, well-designed RCTs with extensive follow-up are awaited to confirm and update the findings of this analysis.

[Comparison of laparoscopy-assisted distal gastrectomy with open gastrectomy for advanced gastric cancer].

OBJECTIVE: To evaluate the feasibility, safety and short-term outcomes of laparoscopy-assisted distal gastrectomy for advanced gastric cancer. METHODS: From January 2007 to June 2008, 135 patients with advanced gastric cancer in the lower or middle stomach were operated, of whom 66 underwent laparoscopy-assisted distal gastrectomy(LADG) with D2 dissection of lymph nodes and 69 received conventional open D2 distal gastrectomy(ODG). Clinical data were recorded and compared between the two groups. RESULTS: There were no significant differences in age, gender, and TNM staging between LADG and ODG(all P>0.05). All the patients in the LADG group underwent gastrectomy and lymph nodes dissection successfully without conversion to open surgery and no operative deaths occurred. The operative time was significantly longer for the LADG group than for the ODG group[(266.1±55.1) min vs. (223.8±26.8) min)]. The patients in the laparoscopic surgery group had less blood loss[(131.9±88.7) ml vs.(342.3±178.7) ml], earlier recovery of bowel activity[(3.18±1.22) d vs.(4.50±1.59) d], and shorter hospitalization time[(9.20±3.39) d vs. (11.35±4.61) d]. No significant differences were found in the total number of retrieved lymph nodes(25.81±12.53 vs. 27.47±10.28). The morbidity of complications was comparable between two groups(6.1% vs. 15.94%). No mortality and recurrence were observed during a follow-up period of 1-19 months. CONCLUSIONS: LADG with D2 lymph node dissection is a safe and feasible procedure with adequate lymphadenectomy for advanced gastric cancer.

Diagnosis and treatment of abdominal cocoon: a report of 24 cases.

BACKGROUND: Abdominal cocoon (AC) is a rare disease characterized by total or partial encasement of the small bowel by a thick, fibrous membrane. Twenty-four cases are reported in this article. Our aim was to investigate the methods of diagnosis and treatment for AC. METHODS: The clinical manifestations, diagnoses, surgical treatments, and follow-up results of 24 cases of AC in the Department of General Surgery of the Third Affiliated Hospital of Sun Yat-sen University between January 1997 and September 2007 were retrospectively analyzed. RESULTS: Main clinical manifestations were partial or complete intestinal obstruction (87.5%) and abdominal mass (54.2%). Three cases were preoperatively diagnosed by computed axial tomography and 1 case by barium x-ray examination. The other 20 cases were diagnosed by laparotomy. All of the patients underwent surgery. In all cases, we found that part of or the entire small bowel was encapsulated in a dense, white, fibrous, cocoon-like membrane. During surgery, excision of the thick membrane and lysis of adhesions were carefully performed to release the small intestine. Postsurgical recovery in most cases was smooth, and there was no recurrence during a follow-up period of 3 months to 9 years (mean 37 months). CONCLUSION: The clinical manifestation of AC is nonspecific; therefore, preoperative diagnosis is difficult. However, its manifestations on barium x-ray and contrast computed axial tomography scan are characteristic, and aggregate analysis of the clinic and radiologic data can increase preoperative diagnosis. The main treatment of AC is surgery, and the overall prognosis of these patients is satisfactory.

Comparative study on three types of alimentary reconstruction after total gastrectomy.

BACKGROUND: More than 70 alimentary reconstruction procedures after total gastrectomy have been proposed to reduce the postoperative syndromes such as dumping syndrome, reflux esophagitis, and malnutrition. However, the optimal alimentary reconstruction method is still a matter of debate. The aim of the current study was to investigate the rationality of different alimentary tract reconstruction methods after total gastrectomy for gastric malignancy. METHODS: Three types of digestive reconstruction methods were performed after total gastrectomy in 285 cases of gastric malignancy from May 1996 to December 2006, including Orr-type Roux-en-Y reconstruction (Orr-type), P-type Roux-en-Y reconstruction (P-type), and Moynihan-type reconstruction (Moynihan-type) methods. The operative time, early postoperative complications and mortality, food intake, alimentary symptoms, Visick scores, nutritional status at 1 and 3years after surgery, and cumulative survival at 1, 3, and 5years were comparatively analyzed. RESULTS: There were no significant differences among the three methods in early postoperative complications and mortality, postoperative food intake and nutritional status (hemoglobin, total proteins and albumin), and incidence of diarrhea and dumping syndrome at 1 and 3years (p > 0.05). The overall 1-, 3-, and 5-year cumulative survival rate were 75.30%, 39.86%, and 21.48%, respectively, without significant differences among the three groups (p > 0.05). However, the average operative time used in the Orr-type reconstruction method (2.9 +/- 0.1h) was comparatively shorter than that used in the P-type (3.4 +/- 0.2h) and the Moynihan-type (3.2 +/- 0.1h). The incidences of reflux esophagitis after the gastric reconstruction with the Moynihan-type method at 1 and 3years (72% and 65%) were significantly higher than that with the Orr-type (3% and 0%) and P-type (5% and 0%; p < 0.01). Constituent ratio of Visick scores I-II of the Moynihan-type method at 1 and 3years (54% and 73%) were smaller than that of the Orr-type (94% and 96%) and the P-type (93% and 96%) methods (p < 0.01). CONCLUSION: Orr-type Roux-en-Y reconstruction method can avoid reflux esophagitis, and the procedure is simpler than the other two methods. Therefore, Orr-type Roux-en-Y reconstruction can be recommended as an adoptable method of digestive reconstruction after total gastrectomy for gastric cancer.

[Reevaluation resection margin rectal cancer by flow cytometry and pathological examination].

OBJECTIVE: To investigate the appropriate distal resection margin in rectal cancer patients. METHODS: Thirty specimens of rectal carcinoma with total mesorectal excision(TME) were studied by flow cytometry and pathological examination. The differences of DNA ploidy status, DNA index (DI), proliferative index (PI), S-phase fraction (SPF) among rectal cancer, 3 cm and 5 cm below the tumor, normal rectum, distal mesorectum 3 cm and 5 cm below the tumor, and normal colon mesentery were analysed by flow cytometry, and were compared with the data of pathological examination. RESULTS: Pathological examination showed that there was no tumor invasion 3 cm and 5 cm below the tumor,but the metastasis rates of distal mesorectum 3 cm and 5 cm below the tumor were 26.7% and 6.7% respectively. The DI, PI and SPF of rectal cancer by flow cytometric examination were significantly higher than those of distal rectum 3 cm and 5 cm below the tumor, and normal rectum (P<0.05). The DI, PI and SPF of distal rectum 3 cm below the tumor were also significantly higher than those of distal rectum 5 cm below the tumor, and normal rectum (P<0.05), but there were no significant differences between DI, PI and SPF of distal rectum 5 cm below the tumor and those of normal rectum (P>0.05). The rate of DNA aneuploid of tumor was significantly higher than those of normal rectum and distal rectum 5 cm below the tumor,but there was no significant difference between the rate of DNA aneuploid of tumor and that of distal rectum 3 cm below the tumor. The DI and DNA aneuploid of rectal cancer and distal mesorectum 3 cm and 5 cm below the tumor were significantly higher than those of normal mesorectum,but there were no significant differences between DI and DNA aneuploid of rectal cancer and those of distal mesorectum 3 cm and 5 cm below the tumor. The PI and SPF of rectal cancer were significantly higher than those of normal mesorectum and distal mesorectum 3 cm and 5 cm below the tumor. CONCLUSIONS: Rectal cancer is able to invade distal rectum 3 cm below the tumor and distal mesorectum 5 cm below the tumor, and radical resection of rectal cancer should beyond that range.