Efficacy of oral Bifidobacterium bifidum ATCC 29521 on microflora and antioxidant in mice.

This study aimed to examine whether Bifidobacterium bifidum ATCC 29521, a species of colonic microflora in humans, is involved in the intestinal tract of mice. This study was also conducted to determine the antioxidant activity of this species by evaluating different microbial populations and reactive oxygen species isolated from feces and intestinal contents for 28 days of oral administration. Microbial diversities were assessed through bacterial culture techniques, PCR-DGGE, and real-time PCR. This study showed that the intake of B. bifidum ATCC 29521 significantly (p < 0.05) improved the ecosystem of the intestinal tract of BALB/c mice by increasing the amount of probiotics (Lactobacillus intestinalis and Lactobacillus crispatus) and by reducing unwanted bacterial populations (Enterobacter, Escherichia coli). Antioxidative activities of incubated cell-free extracts were evaluated through various assays, including the scavenging ability of DPPH radical (64.5% and 67.54% (p < 0.05), respectively, at 21 days in nutrients and 28 days in MRS broth), superoxide anion, and hydroxyl radical (85% and 61.5% (p < 0.05), respectively, at intestinal contents in nutrients and 21 days in MRS broth). Total reducing power (231.5 µmol/L (p < 0.05), 14 days in MRS broth) and mRNA level of genes related to oxidative stress were also determined. Results indicated that B. bifidum ATCC 29521 elicits a beneficial effect on murine gut microbiota and antioxidant activities compared with the control samples. This species can be considered as a potential bioresource antioxidant to promote health. Bifidobacterium bifidum ATCC 29521 may also be used as a promising material in microbiological and food applications.

Integration of genomic and proteomic data to identify candidate genes in HT-29 cells after incubation with Bifidobacterium bifidum ATCC 29521.

As the predominant group inhabiting the human gastrointestinal tract, bifidobacteria play a vital role in human nutrition, therapeutics, and health by shaping and maintaining the gut ecosystem, reducing blood cholesterol, and promoting the supply of nutrients. The interaction between bacterial cells and human intestinal epithelial cell lines has been studied for decades in an attempt to understand the mechanisms of action. These studies, however, have been limited by lack of genomic and proteomic database to aid in achieving comprehensive understanding of these mechanisms at molecular levels. Microarray data (GSE: 74119) coupled with isobaric tags for relative and absolute quantitation (iTRAQ) were performed to detect differentially expressed genes and proteins in HT-29 cells after incubation with Bifidobacterium bifidum. Real-time quantitative PCR, gene ontology, and Kyoto Encyclopedia of Genes and Genomes analyses were further conducted for mRNA validation, functional annotation, and pathway identification, respectively. According to the results of microarray, 1,717 differentially expressed genes, including 1,693 upregulated and 24 downregulated genes, were selected and classified by the gene ontology database. The iTRAQ analysis identified 43 differentially expressed proteins, where 29 proteins were upregulated and 14 proteins were downregulated. Eighty-two candidate genes showing consistent differences with microarray and iTRAQ were further validated in HT-29 and Caco-2 cells by real-time quantitative PCR. Nine of the top genes showing interesting results with high confidence were further investigated in vivo in mice intestine samples. Integration of genomic and proteomic data provides an approach to identify candidate genes that are more likely to function in ubiquitin-mediated proteolysis, positive regulation of apoptosis, membrane proteins, and transferase catalysis. These findings might contribute to our understanding of molecular mechanisms regulating the interaction between probiotics and intestinal epithelial cell lines.

Oral administration of Bifidobacterim bifidum for modulating microflora, acid and bile resistance, and physiological indices in mice.

Bifidobacteria are generally acknowledged as major gut microflora used as probiotics, which promote human health. In this study, the effects of the administration of Bifidobacterim bifidum on modulating gastrointestinal (GI) tract microflora, acid and bile resistance, and physiological indices in BALB/c mice were investigated. Results showed that B. bifidum can significantly improve the ecosystem of the GI tract by increasing the amount of probiotics and reducing the populations of pathogenic bacteria, as measured by plate count and real-time PCR. After exposure to simulated GI tract conditions, the growth of gut microflora in the B. bifidum group was higher than that in the control group when incubated for 12 h in MRS or nutrient broth adjusted to pH 2.0 or 3.0 or in the presence of a concentration of bile salt (0.45% m/v). The blood biochemical index was examined, and the physiological effect of the cell-free extract of gut microflora was evaluated by measuring the activity of various enzymes, including α-glucosidases, esterase, and lactate dehydrogenase. This study suggested that a B. bifidum strain can stabilize blood sugar, lower cholesterol levels in serum, and improve metabolic activity. Moreover, B. bifidum was a promising enhancer of microbial diversity in mouse intestine and played a vital role in human physiological processes, which can benefit the health of a host.

[Risk factors of early recurrence in patients with gastric cancer after curative resection].

OBJECTIVE: To analyze the clinical and pathologic influencing factors of early recurrence in patents with gastric cancer after radical gastrectomy. METHODS: Clinicopathological data of 141 patients with recurrence after curative gastrectomy for gastric cancer from January 2001 to December 2004 were analyzed retrospectively. Risk factors correlated with tumor early recurrence and survival difference between early recurrence group (< 1 year, 82 cases) and control group (1 year after, 59 cases) were assessed. RESULTS: The 1- and 3-year survival rates of in early recurrence group and control group were 36.6%, 2.4% and 100%, 45.8%, respectively (P < 0.05). The median survival time after recurrence in the two groups was 3, 5 months, respectively (P < 0.05). Univariate analysis showed that the age, tumor Borrmann type, tumor site, invasive depth, lymph node metastasis, pTNM stage, metastatic lymph node ratio, surgical procedure and intraperitoneal hyperthermic perfusion chemotherapy (IHPC) were significant factors associated with early recurrence after curative gastrectomy for gastric cancer (P < 0.05). Lymph node metastasis, metastatic lymph node ratio and IHPC were independent factors associate with early recurrence after curative gastrectomy on multivariate analysis (P < 0.05). CONCLUSIONS: The patients with early recurrence after the radical gastrectomy have a poorer survival compared with cases recur later. Lymph node metastasis, metastatic lymph node ratio and IHPC are independent factors associate with early recurrence after curative gastrectomy for gastric cancer.

[Recovery of Phosphorus in the Form of Struvite from the Anaerobic Fermentation Supernatant of Excess Sludge].

To recover nitrogen and phosphorus from the supernatant of anaerobic fermentation of excess sludge in the form of struvite (MAP, MgNH4PO4·6H2O), the optimum conditions of nitrogen and phosphorus dissolution and the effects of different reaction conditions on nitrogen and phosphorus recovery were studied. The results showed that the concentration of ammonia nitrogen and orthophosphate that dissolved in the fermentation liquid peaked on the fifth day of the experiment at pH 10.5 and 35℃. When a phosphorus source was and was not added, the optimum conditions for recovering phosphorus were pH=9.5, N:P=0.8, and Mg:P=1.8 and pH=9.5, Mg:P=1.6, and speed=200 r·min-1, respectively. In addition, reducing the N:P molar ratio had a significant effect on the morphology and purity of the struvite. Scanning electron microscopy (SEM), energy dispersive spectrometry (EDS), X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FTIR) were used to analyze the surface appearance and phase composition of the recovered products. The main component of the precipitate was MAP. Recovery of nitrogen and phosphorus in excess sludge in the form of struvite is an effective means for realizing sludge resource utilization.

Multiphoton-mediated corneal flap generation using the 80 MHz nanojoule femtosecond near-infrared laser.

PURPOSE: To evaluate whether corneal flaps can be generated by the 80 MHz near-infrared, intense nanojoule femtosecond laser based on multiphoton absorption. METHODS: A solid-state Ti:Sapphire femtosecond laser system was integrated in an inverted JenLab Femt-O-Cut laser scanning microscope. A diffraction-limited 40x objective was used to induce multiphoton ionization and plasma production. New Zealand albino rabbits and porcine eyes were used. Surgical outcomes were determined using frame and line scans with nanojoule pulses at a wavelength of 800 nm. RESULTS: Surgical performance was assessed by optical imaging, histology, and electron microscopy. No significant corneal turbidity was observed. Optical imaging and histological examinations detected virtually no perturbation in the surrounding tissue. Corneal flaps and stromal lenticules were generated. Wound repair of the unlifted flaps was observed up to 90 days postoperatively. CONCLUSIONS: Surgical results and follow-up studies confirm that this femtosecond laser at nanojoule pulse energy is able to generate corneal flaps precisely, without causing visible collateral damage to the surrounding tissue or overlying epithelium.

[Comparison of the prognostic value of UICC and JGCA lymph node staging criteria for gastric cancer].

OBJECTIVE: To compare the correlation of prognosis with UICC or JGCA lymph node staging criteria for gastric cancer and evaluate the value of application of those two TNM staging systems in prognosis prediction. METHODS: From January 1996 to December 2005, 395 gastric cancer patients who underwent D2 or D2 plus radical gastrectomy with > or = 15 lymph nodes removed were enrolled into this study. The data were analyzed by both UICC and JGCA lymph node staging criteria, respectively. Kaplan-Meier method was applied to analyze the survival rates, and Log-rank test was performed to assess the statistical significance among groups. RESULTS: Compared with the survival curve based on JGCA lymph node staging criteria, UICC lymph node staging system showed a much more significant difference among N subgroups, and similar result was also found in the patients with T3 disease. The N subgroups stratified by UICC criteria were re-staged with JGCA, while the N subgroups by JGCA criteria with UICC. Though the difference among subgroups were not statistically significant in either group, it was greater based on UICC criteria than that based on JGCA. No significant difference was found in the 5-year survival rates of stage I , II, III and IV based on either UICC or JGCA TNM staging criteria. CONCLUSION: Our results show that UICC staging system is more predictive and relevant to prognosis than JGCA staging system for gastric cancer, and D2 or D2 plus radical gastrectomy with at least or more than 15 lymph nodes removed is required when UICC-TNM gastric cancer staging criteria is applied.

Long intergenic noncoding RNA 01296 aggravates gastric cancer cells progress through miR-122/MMP-9.

Long non-coding RNAs (lncRNAs) play important roles on tumor development and progression in gastric cancer (GC). However, the biological function and regulatory mechanisms of LINC01296 in GC still remain unknown. The objective of this study is to investigate the clinical significance and pathological roles of LINC01296 in GC. Results showed that LINC01296 was up-regulated in GC tissue and correlated with poor prognosis. In vitro, LINC01296 knockdown was up-regulated in GC cells and LINC01296 knockdown suppressed GC cells proliferation, migration and invasion, and promoted apoptosis. In vivo xenograft assays, results showed LINC01296 knockdown significantly inhibited GC tumor growth. Bioinformatics analysis revealed that LINC01296 sponged miR-122, which was proved to target MMP-9. Western blot and RT-PCR showed that LINC01296 was positively correlated with MMP-9 expression, while miR-122 was negatively correlated to it. Overall, results indicate that LINC01296 acts as oncogenic lncRNA in GC carcinogenesis, suggesting the LINC01296/miR-122/MMP-9 regulatory pathway in GC tumorigenesis.

Change in expression of apoptosis genes after hyperthermia, chemotherapy and radiotherapy in human colon cancer transplanted into nude mice.

AIM: To investigate the change in expression of p53, Bcl-2, and Bax genes in human colon cancer cells transplanted into nude mice after hyperthermia, chemotherapy, radiotherapy, thermochemotherapy, thermoradiotherapy and thermochemoradiotherapy. METHODS: Human colon cancer cell line (HT29) was transplanted into the hind limbs of nude mice. Under laboratory simulated conditions of hyperthermia (43 centigrade, 60 min), the actual radiation doses and doses of mitomycin C (MMC) were calculated in reference to the clinical radiotherapy for human rectal cancer and chemotherapy prescription for colon cancer. The mice were divided into 6 groups according to the treatment approaches: hyperthermia, chemotherapy, radiotherapy, thermochemotherapy, thermoradiotherapy, and thermochemoradiotherapy. The mice were sacrificed at different time points and the tumor tissue was taken for further procedures. The morphologic changes in membrane, cytoplasm and nuclei of tumor cells of p53, Bcl-2, and Bax after treatment, were observed by immunohistochemistry staining. RESULTS: All of the six treatment modalities down-regulated the expression of p53, Bcl-2 and up-regulated the expression of Bax at different levels. The combined therapy of hyperthermia, with chemotherapy, and/or irradiation showed a greater effect on down-regulating the expression of p53 (0.208 +/- 0.009 vs 0.155 +/- 0.0115, P < 0.01) and Bcl-2 (0.086 +/- 0.010 vs 0.026 +/- 0.0170, P < 0.01) and up-regulating Bax expression (0.091 +/- 0.0013 vs 0.207 +/- 0.027, P < 0.01) compared with any single therapy. CONCLUSION: Hyperthermia enhances the effect of radio- and chemotherapy on tumors by changing the expression of apoptosis genes, such as p53, Bcl-2 and Bax.

[Management of nonfunctioning islet cell tumors of the pancreas].

OBJECTIVE: To analyze the clinical and pathological features in order to investigate appropriate way of diagnosis and treatment for non-functional islet cell tumors of the pancreas (NFICT). METHODS: The data and experience of surgically treated 43 patients with pathologically confirmed NFICT over the last 30 years were retrospectively reviewed. The survival rate was estimated using Kaplan-Meier method and the potential risk factors affecting survival were compared with Log rank test. RESULTS: There were 7 males and 36 females in this series with a mean age of 31.6 years ranged from 8 to 67 years. Twenty-eight patients were diagnosed as having non-functional islet cell carcinomas of the pancreas (NFICC) and 15 patients benign islet cell tumors. The most common symptoms in NFICT were abdominal pain 55.8%, nausea and/or vomiting (32.6%), fatigue (25.6%) and abdominal mass (23.3%). Preoperatively, all of those were found to have a mass in their pancrease by ultrasonic and computed tomography examination, with 21 in the head, 10 in the body and 6 in the tail of the pancreas. Multicemtric tumor were found in one patient. Thirty-nine of these 43 patients (90.7%) underwent surgical resection, with a curative resection in 30 (69.8%) and palliative in 9 (20.9%). The resectability and curative resection rate in 28 patients with nonfunctioning islet cell carcinomas of the pancreas was 78.6% and 60.7%, respectively. None of the 15 patients with benign nonfunctioning islet cell tumor of the pancreas died of this disease. While the overall cumulative 5- and 10-year survival rate in 28 patients with non-functional islet cell carcinomas of the pancreas was only 58.1% and 29.0%, respectively. Curative resection, female, younger than 30 years old and mass diameter < 10 cm were found to be positive prognostic factors. But multivariate Cox regression analysis indicated that radical resection was the only independent prognostic factor (P = 0.007). CONCLUSION: Nonfunctioning islet cell tumor of the pancreas is frequently found in young female. Surgical resection, especially curative resection can achieve satisfactory long-term survival.

[Analysis of the risk factors of upper urinary tract dilatation due to spinal cord injury].

OBJECTIVE: To evaluate the urodynamic risk factors of upper urinary tract dilatation (UUTD) secondary to spinal cord injury (SCI). METHODS: Ninety-six SCI patients of Tangshan earthquake were divided into 2 groups by ultrasonography: 16 SCI patients (group A) with UUTD and 80 SCI patients (group B) without UUTD received urodynamic test. Responses were evaluated using single and multiple analysis after examination. RESULTS: The incidence of male was significantly higher than that of female. Residual urine volume, maximum cystometric capacity, detrusor leak point pressure and the incidence of bladder low compliance in group A were significantly higher than those in group B. There were no significant differences in age, the incidence of detrusor hyperreflexia, relative safe bladder capacity, the incidence of detrusor-sphincter dyssynergia, maximum flow rate and maximum urethral closure pressure between 2 groups. Bladder low compliance was cardinal risk factors according to Logistic regression analysis. CONCLUSION: An early urodynamic examination and treatment for SCI patients are important to prevent from bladder low compliance and upper urinary tract damage.

Prognostic factors of young patients with colon cancer after surgery.

AIM: To investigate the prognostic factors of 96 young patients with colon cancer within a cancer center by univariate and multivariate analysis. METHODS: A total of 723 patients with colon cancer were treated surgically during a period of 10 years. Ninety six of them were 40 years old or younger.R0, R1 and R2 operations were performed in 69 (71.9%), 4(4.1%) and 23 patients(24%), respectively. Left hemicolectomy was performed in 43 patients, right hemicolectomy in 37 patients, transverse colon resection in 9 patients and low anterior resection in 7 patients. Cox multivariate regression analysis was performed to identify predictors of survival. RESULTS: The operation mortality was 0%, 54 patients died within 111 mo after operation due to occurrence or metastases of the tumor. Liver,lung and bone metastases occurred in 3, 1 and 5 patients, respectively. The mean survival time for all patients was 77.9 +/- 5.01 mo and the overall 3-,5- and 10- year survival rates were 66.68%, 58.14% and 46.54%, respectively. In the univariate survival analysis,patient age,type of operation, radical resection, blood transfusion, histological type, diameter of tumor,depth of tumor invasion, lymphatic invasion, distant metastases, liver metastases and TNM stage were found to be predictors of survival in young patients with colon cancer. In the Cox-regression analysis,blood transfusion and lymphatic invasion were determined as independent prognostic factors of survival. CONCLUSIONS: Age, type of operation, radical resection, blood transfusion, histological type, diameter of tumor,depth of tumor invasion, lymphatic invasion, distant metastasis and TNM stage are the predictors of survival in young patients with colon cancer after surgery.

Corneal multiphoton microscopy and intratissue optical nanosurgery by nanojoule femtosecond near-infrared pulsed lasers.

Multiphoton microscopy including multiphoton autofluorescence imaging (MAI) and second-harmonic generation (SHG) is being used as a novel diagnostic tool to perform tissue nonlinear optical tomography with submicron resolution. The three-dimensional corneal ultrastructure of whole depth has been viewed without any staining or mechanical slicing. Compared with photodisruptive surgical effects occurring at TW/cm2 light intensity, multiphoton imaging can be induced at MW-GW/ cm2 photon intensity. The intratissue surgical effect including nanojoule (nJ) femtosecond laser ablation and flap generation was induced through multiphoton nonlinear absorption at a wavelength of 800 nm and ascertained by the histological outcomes. More interesting, the multiphoton microscopy based on nonlinear absorption of femtosecond laser pulses at the wavelength of 715-930 nm emitted from solid-state Ti:sapphire system is acting as a precise non-invasive monitoring tool to determine the interest of region, to visualize and verify the outcomes in in vivo intrastromal laser nanosurgery. Overall, these data suggest that multiphoton microscopy is a highly sensitive and promising technique for studying the morphometric and biomechanical properties of biological tissues and that the nJ ultrashort Lasers can be used as a ultra-precise nanoscalpel for performing intratissue surgery.

[Study on the anticancer activities of the Clematis manshrica saponins in vivo].

OBJECTIVE: To study the anticancer activity of the Clematis manshrica saponins in vivo. METHOD: Anticancer activities were tested in mice with experimental tumor (S180, HepA and P388) in vivo. RESULT: The Clematis manshrica saponins showed a significant anticancer activities on Sarcoma-180, HepA and P388 implanted in mice. In S180 sarcoma, the average tumor inhibition rates were 42.78%, 52.06% and 58.25% (P < 0.05-0.01) respectively; The mean inhibition rates were 37.44%, 52.05% and 59.36% (P < 0.05-0.001) in Hep A tumor separately; while in P388 tumor, the mean inhibition rates were 34.50%, 46.78% and 54.39% (P < 0.05-0.01), respectively. CONCLUSION: The results indicate that Clematis manshrica has obvious antitumor effects against various transplanted tumor in mice.

[Malignant fibrous histiocytoma of the retroperitoneum: an analysis of 31 cases].

OBJECTIVE: To investigate the diagnosis and treatment of malignant fibrous histiocytoma of the retroperitoneum (MFHR). METHODS: The clinicopathological features, treatment and prognosis of 31 patients with MFHR were retrospectively analyzed. RESULTS: The mean age of the patients was 52.7 +/- 14.1 years. Male:Female = 22:9. The primary symptoms were abdominal mass and pain. The average diameter of tumor was 15 cm. The histopathologic types of the tumor were inflammatory, storiform-pleomorphic, myxoid and giant cell in 16, 10, 4 and 1 cases. The overall survival rate of 1-, 3- and 5-year was 61.3% +/- 9.8%, 31.6% +/- 11.3% and 21.1% +/- 11.4% with a median survival time of 17.0 +/- 6.3 months. Complete resection of the tumor was the major prognostic factor. Postoperative radiotherapy of 20 - 45 Gy was able to prolong the median survival from 12.1 +/- 11.6 months of surgery alone to 26.4 +/- 22.0 months of surgery plus postoperative radiotherapy though without statistical significance (P = 0.051). Postoperative CHOP chemotherapy was not shown to be beneficial. CONCLUSION: Chemotherapy remains the important method of cure. The survival in patients with MFHR might be improved by complete resection combined with chemotherapy or/and radiotherapy.

[Emission characteristics of PM2.5 from blast furnace iron making].

Electrical low pressure impactor (ELPI) was used to online analyze the PM2.5 particle size and mass concentration distribution in the trapping field and ore tank of blast furnace iron-making plant. Results showed that the grain number concentration of PM2.5 in trapping field after dust removal was in the range of 10(5)-10(6)cm-3 , and the particle size was mainly below 0. 1 µm. While the grain number concentration of the PM2.5 in ore tank after dust removal was in the range of 10(4)-10(5) cm-3, the particle size was mainly below 1.0 µm, and the mass concentration distribution showed a single peak. The micro-morphology of PM2.5 monomer was mainly divided into two categories, spherical particles and irregular aggregates. Chemical composition analysis indicated that the concentrations of water soluble SO(2-)(4) , K+ , Ca2+ were higher than other ions in PM2.5, with the percentage of 10. 32% -28.55% , 10. 36% -12. 15% , 3.97% -15. 4% , respectively. The major elements was Fe, Si, Al, with 16. 8% -31. 62% , 2. 24% -8.76% , 1.24% -5. 89% of total mass, respectively; organic carbon and elementary carbon were 2. 7% -4. 6% and 0. 8% -1. 3% , respectively. The emission factors of PM2.5 in trapping field and in ore tank after dust removal were ranged from 0.045 to 0.085 kg t(-1) and 0.042 to 0.071 kg t-1, respectively.

Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years.

AIM: To elucidate the prognostic value of age for gastric cancer and identify the optimal treatment for elderly gastric cancer patients. METHODS: We enrolled 920 patients with gastric cancer who underwent gastrectomy between January 2003 and December 2007 in our center. Patients were categorized into three groups: younger group (age < 50 years), middle-aged group (50-69 years), and elderly group (≥ 70 years). Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed. The log-rank test was used to assess statistical differences between curves. Independent prognostic factors were identified by the Cox proportional hazards regression model. Stratified analysis was used to investigate the impact of age on survival at each stage. Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer. We analyzed the potential prognostic factors for patients aged ≥ 70 years. Finally, the impact of extent of lymphadenectomy and postoperative chemotherapy on survival for each age group was evaluated. RESULTS: In the elderly group, there was a male predominance. At the same time, cancers of the upper third of the stomach, differentiated type, and less-invasive surgery were more common than in the younger or middle-aged groups. Elderly patients were more likely to have advanced tumor-node-metastasis (TNM) stage and larger tumors, but less likely to have distant metastasis. Although 5-year overall survival (OS) rate specific to gastric cancer was not significantly different among the three groups, elderly patients demonstrated a significantly lower 5-year OS rate than the younger and middle-aged patients (elderly vs middle-aged vs younger patients = 22.0% vs 36.6% vs 38.0%, respectively). In the TNM-stratified analysis, the differences in OS were only observed in patients with II and III tumors. In multivariate analysis, only surgical margin status, pT4, lymph node metastasis, M1 and sex were independent prognostic factors for elderly patients. The 5-year OS rate did not differ between elderly patients undergoing D1 and D2 lymph node resection, and these patients benefited little from chemotherapy. CONCLUSION: Age ≥ 70 years was an independent prognostic factor for gastric cancer after gastrectomy. D1 resection is appropriate and postoperative chemotherapy is possibly unnecessary for elderly patients with gastric cancer.

Impact of intraoperative blood loss on survival after curative resection for gastric cancer.

AIM: To elucidate the potential impact of intraoperative blood loss (IBL) on long-term survival of gastric cancer patients after curative surgery. METHODS: A total of 845 stage I-III gastric cancer patients who underwent curative gastrectomy between January 2003 and December 2007 in our center were enrolled in this study. Patients were divided into 3 groups according to the amount of IBL: group 1 (< 200 mL), group 2 (200-400 mL) and group 3 (> 400 mL). Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed. The Log-rank test was used to assess statistical differences between the groups. Independent prognostic factors were identified by the Cox proportional hazards regression model. Stratified analysis was used to investigate the impact of IBL on survival in each stage. Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer. Finally, we explored the possible factors associated with IBL and identified the independent risk factors for IBL ≥ 200 mL. RESULTS: Overall survival was significantly influenced by the amount of IBL. The 5-year overall survival rates were 51.2%, 39.4% and 23.4% for IBL less than 200 mL, 200 to 400 mL and more than 400 mL, respectively (< 200 mL vs 200-400 mL, P < 0.001; 200-400 mL vs > 400 mL, P = 0.003). Age, tumor size, Borrmann type, extranodal metastasis, tumour-node-metastasis (TNM) stage, chemotherapy, extent of lymphadenectomy, IBL and postoperative complications were found to be independent prognostic factors in multivariable analysis. Following stratified analysis, patients staged TNM I-II and those with IBL less than 200 mL tended to have better survival than those with IBL not less than 200 mL, while patients staged TNM III, whose IBL was less than 400 mL had better survival. Tumor location, tumor size, TNM stage, type of gastrectomy, combined organ resection, extent of lymphadenectomy and year of surgery were found to be factors associated with the amount of IBL, while tumor location, type of gastrectomy, combined organ resection and year of surgery were independently associated with IBL ≥ 200 mL. CONCLUSION: IBL is an independent prognostic factor for gastric cancer after curative resection. Reducing IBL can improve the long-term outcome of gastric cancer patients following curative gastrectomy.

[Interim report of prospective clinical study of two different digestive tract reconstruction after total gastrectomy].

OBJECTIVE: To compare post-operative long-term complications and quality of life of two digestive reconstruction procedures after total gastrectomy. METHODS: A total of 109 gastric cancer patients in Tianjin Medical University Cancer Hospital from March 2012 to February 2013 were prospectively enrolled and randomly divided into functional jejunal interposition (FJI) group (52 cases) and Roux-en-Y (R-Y) group (57 cases). The post-operative complications, nutritional status, and the quality of life were compared between two groups. RESULTS: One, 3 and 6 months after operation, the incidence of R-S syndrome in FJI group was lower as compared to R-Y group[13% (6/45) vs. 37% (18/49), 3% (1/30) vs. 42% (14/33), 5% (1/21) vs. 48% (11/23), all P<0.01], while 3 months after operation, the incidence of reflux and heartburn in FJI group was higher[53% (16/30) vs. 21% (7/33), P<0.01; 37% (11/30) vs. 12% (4/33), P<0.05]. There were no significant differences in quality of life questionnaire QLQ-C30 between R-Y and FJI groups. QLQ-STO22 stomach module revealed in FJI group, the eating score was better, but reflux score was worse as compared to R-Y group 3 months after operation (all P<0.01). CONCLUSIONS: Functional jejunal interposition keeps intestinal continuity preserving and food duodenal passing, which is a reasonable digestive reconstruction procedure.

[Comparative study on four different reconstruction procedures after total gastrectomy].

OBJECTIVE: To investigate the optimal reconstruction technique after total gastrectomy. METHODS: A total of 159 patients with gastric cancer undergoing total gastrectomy in Tianjin Cancer Hospital between January 2005 and December 2007 were divided into 4 groups according to the reconstruction technique: group A(functional jejunal interposition with a pouch, n=46), group B(modified Braun type II(, n=38), group C (P pouch with Roux-en-Y esophagojejunostomy, n=25), group D(Roux-en-Y esophagojejunostomy, n=50). Quality of life(QOL), nutritional status 1 year after surgery, and perioperative complications were analyzed. RESULTS: There were no significant differences in perioperative complications(P>0.05). One year after operation, QOL(Visick index) was better in group A than that in group B, C and D(P<0.05), and group D was inferior to group A, B and C(P<0.05). The increase in food intake, weight gain, hemoglobin and total protein were better in group A than those in group B, C and D(P<0.05) and group D was inferior to group A, B and C(P<0.05). The prognostic nutrition index ratio of the four groups were 1.21±0.15, 1.14±0.97, 1.15±0.16, and 1.10±0.16, respectively. Group A was better than that in group B, C and D (P<0.05) and group D was inferior to group A, B and C(P<0.05). The incidences of dumping syndrome, reflux esophagitis, Roux-en-Y stasis syndrome in group A were 4.3%(2/46), 2.2%(1/46) and 2.2%(1/46), respectively, which were significantly lower than those in other groups (P<0.05). CONCLUSIONS: Functional jejunal interposition with a pouch is associated with improved nutritional condition and quality of life, and less perioperative complications. It is a reasonable reconstruction method after total gastrectomy.