Laparoscopic Low Anterior Resection of the Rectum with Transanal Prolapsing Specimen Extraction: Early Experience with 23 Patients.

OBJECTIVE: For laparoscopic low anterior resection of the rectum, a small additional incision is needed to extract the specimen. We describe an adjustment technique, which inserted the anvil and extracted the specimen through transanal pathway. METHODS: Between July 2010 and July 2012, 23 patients underwent laparoscopic rectal surgery with transanal anvil insertion and transanal prolapsing specimen extraction. All perioperative data and short-term outcomes were recorded in a database. RESULTS: The mean patient age was 61.3 years (range 47-68 years). Of the 23 patients, 17 underwent resection for rectal carcinoma and 6 had tubulovillous adenomas. No intraoperative complications occurred. The mean operative time was 137 minutes (range 118-170 minutes). The distal margins, circumferential resection margins, and lymph node dissections were oncologically adequate for all malignancies. One patient experienced anastomotic leakage (4.3%), treated conservatively. One male patient with benign prostatic hyperplasia suffered from postoperative urinary retention. The average postoperative hospital stay was 11.3 days (range 7-21 days). No patients experienced anal dysfunction. At a median follow-up of 26 months, there were no tumor recurrences. CONCLUSION: The technique of transanal prolapsing specimen extraction for laparoscopic low anterior resection of the rectum is feasible and safe for selected patients.

Giant peritoneal loose body in the pelvic cavity confirmed by laparoscopic exploration: a case report and review of the literature.

A 51-year-old previously healthy male underwent a routine medical examination. Computed tomography and ultrasonography showed an oval-shaped mass that was about 50 × 40 mm in size in the left iliac fossa. Prior to surgery, the lesion was suspected to be a teratoma with core calcification or stromal tumor derived from the rectosigmoid colon. During the procedure, a yellow-white, egg-shaped mass was discovered that was completely free from the pelvic cavity in front of the rectum. The giant, peritoneal loose body was taken out through the enlarged port site. Histological examination showed that the mass consisted of well-circumscribed, unencapsulated, paucicellular tissue, with an obviously hyalinized fibrosclerotic center. A giant peritoneal body is extremely rare. We report such a case and review previously published literature.

[Research on Spectrum Radiation Characteristics of a New Type Infrared/ Ultraviolet Dual Color Decoy].

The advantage of traditional MTV infrared decoys which are mainly consist of magnesium, Teflon and VITON is that it emits high radiant energy, so it is an effective countermeasure to traditional seekers which seek the target by heat source. The spectral radiant intensity which generated from high temperature combustion of MTV infrared decoys in near infrared region and ultraviolet band is very high, and that in Mid-IR region is relative lower, however the radiant intensity of real jet fighter in ultraviolet band is low and the infrared radiant intensity ratio of Mid-IR to near IR band is greater than 1. Thus, the traditional MTV infrared decoys are hardly able to counter the seekers equipped with dual color combined guidance system. Based on the spectral matching principle, we designed and prepared a new infrared/ultraviolet dual color decoy which is mainly consist of oxidant (wt% 45-75), fuel (wt% 10-25), energetic binder (wt% 25-50) and additives. We conducted theoretical calculations on combustion products of the reagent combinations using CEA (Chemic equilibrium & Application) software and initially determined the content of each component of the decoy formulation on the basis of the calculations results, then investigated the infrared radiation characteristics of decoys employing SR5000 spectrum radiometer and remote sensing interferometer spectrometer Tensor37 and analyzed the possible reasons for test results difference of the two systems separately from the test principle and calculation method, the testing environment, stability of testing results and other aspects. We studied the ultraviolet radiation characteristics of decoys using S2000 fiber optical spectrometer and the test results were consistent with the fighter ultraviolet radiant intensity which gained from theoretical calculation. We researched on the temperature characteristics of decoys by Imager IR 8325 mid-infrared thermal imager and it turned out that the dual color decoy is similar to the real fighter target in temperature characteristics. The results indicates that the infrared radiant intensity ratio of Mid-IR to near IR band is from 1 to 3 (1< I(3-5 microm) : I(1-3 microm) <3). The infrared radiant intensity in 3-5 pLm band is tunable from 0.9 to 2.5 kW x sr(-1) while the ultraviolet radiant intensity in 0.3-0.5 microm is about (20 +/- 5)W x sr(-1). The flame temperature is between 850-1100 degrees C. It is proved that the dual color decoy as-designed has excellent characteristics.

Prussian blue nanoparticles as nanocargoes for delivering DNA drugs to cancer cells.

We studied the use of Prussian blue nanoparticles (PBNPs) as novel nanocarriers for sending DNA drugs into cancer cells. 11-mercaptoundecanoic acid (MUA) was used to functionalize the surfaces of PBNPs (nanocubes with an average dimension of 75 nm) for subsequent covalent grafting of a 33-mer DNA drug with a FAM reporter at the 3' end. The PBNPs synthesis and DNA drug conjugation were characterized by transmission electron microscopy (TEM) and Fourier-transform infrared absorption (FTIR), respectively. The drug was a decoy oligodeoxynucleotide (dODN) that inhibits the signal transducer and activator of transcription 3 (STAT3). The DNA-PBNPs drug (dODN@MUA-PBNPs) was delivered into human prostate carcinoma 22rv1 cells by endocytosis in vitro as confirmed by confocal fluorescence microscopy. MTT cell viability assays were carried out to assess the effect of the DNA-PBNPs drug. The results showed that the dODN molecules were successfully conjugated to the MUA modified PBNPs via amide and/or disulfide bond formation and could thus be successfully delivered into the cancer cells. The control experiments showed that the unconjugated dODN molecules were not able to enter the cancer cells no matter whether non-functionalized PBNPs were present or not. It was also found that the DNA-PBNPs drugs were internalized and then distributed homogeneously throughout the cell, including cytoplasmic and nucleic regions, after endocytosis. The cancer cell-killing ability increased with the amount of dODN conjugated on PBNPs and the dosage of DNA-PBNPs drug internalized.

Hospital outcomes for patients with stage III and IV lung cancer admitted to the intensive care unit for sepsis-related acute respiratory failure.

BACKGROUND: In recent years, intensive care for cancer patients has improved and treatment of critically ill cancer patients has become increasingly aggressive over time. However, not all cancer patients would benefit from aggressive care, especially those with late-stage cancer. OBJECTIVE: We aimed to investigate the outcome of late-stage lung cancer patients with sepsis-related respiratory failure and identify predictors of mortality. METHODS: From 2007 to 2008, consecutive stage III and IV lung cancer patients admitted to an intensive care unit (ICU) of a teritiary medical center in Taiwan for sepsis-related respiratory failure were retrospectively enrolled. Data at baseline and upon ICU admission were collected. In-hospital survival was analyzed. Variables of the survivors to hospital discharge and patients who died were compared by uni- and multivariate analyses. RESULTS: Seventy patients were enrolled. During a mean follow-up period of 30.10 days, 29 (41.4%) patients survived to hospital discharge and 41(58.6%) died. Compared with the survivors, the patients who died had poor performance status, lower serum albumin level, higher percentage of disseminated intravascular coagulation, and more severe organ dysfunction as disclosed by higher Sequential Organ Failure Assessment (SOFA) scores. Multivariate analyses revealed that SOFA score (p=0.026) was the only independent predictor of mortality; 44.8 % (13/29) of survivors were weaned from ventilator during hospitalization. CONCLUSION: Among late-stage lung cancer patients with sepsis-related respiratory failure, those with lower SOFA scores seemed to have better survival rate and may benefit from intensive care in the ICU. Early palliative care should be considered for all patients with advanced lung cancer, and hospice care is suggested for those with sepsis-respiratory failure and high SOFA scores.

Matrix metalloprotease-9 induces transforming growth factor-ß(1) production in airway epithelium via activation of epidermal growth factor receptors.

AIMS: Matrix metalloprotease (MMP)-9 is present in abundance in various chronic airway disorders and is involved in lung remodeling. MMP may cleave membrane-bound precursor proteins and release epidermal growth factor-like ligands that subsequently bind to epidermal growth factor receptor (EGFR). We hypothesized that MMP-9 may stimulate the airway epithelium to produce fibrogenic mediators through activation of membrane-bound receptors. MAIN METHODS: Human airway epithelial cells were grown on air-liquid interface culture inserts. MMP-9 was employed to stimulate the cells. Conditioned medium following MMP-9 stimulation was co-incubated with human lung fibroblasts. KEY FINDINGS: MMP-9 stimulated human airway epithelial cells to produce transforming growth factor (TGF)-ß(1) at both the mRNA and protein level. Using a microarray, increased phosphorylation of EGFR tyrosine kinase (TK) was identified and further confirmed by immunoprecipitation and Western blot analysis. A significant increase in EGF and TGF-α release was observed after MMP-9 had been added for 30min. Protease inhibitor, EGFR monoclonal antibody and EGFR-TK inhibitor blocked this action and subsequent TGF-ß(1) production. Neutralizing antibodies against EGF and TGF-α substantially inhibited TGF-ß(1) production following MMP-9 stimulation. MMP-9-induced TGF-ß(1) production occurred through MAP kinase p44/42 phosphorylation. Selective p44/42 kinase inhibitor UO126 successfully inhibited TGF-ß(1) production. Conditioned medium from epithelial cells treated with MMP-9 significantly induced Smad3 phosphorylation and subsequent fibroblast proliferation after 24h culture. SIGNIFICANCE: These data indicate that MMP-9 induces TGF-ß(1) production in the airway epithelium through the cleavage of EGF and EGF-like ligands and activating EGFR, suggesting potential targets of therapeutic intervention in airway fibrotic disorders.

Plasma soluble vascular endothelial growth factor receptor-1 levels predict outcomes of pneumonia-related septic shock patients: a prospective observational study.

INTRODUCTION: Despite recent advances in the management of septic shock, mortality rates are still unacceptably high. Early identification of the high-mortality risk group for early intervention remains an issue under exploration. Vascular endothelial growth factor (VEGF), soluble vascular endothelial growth factor receptor-1 (sVEGFR1) and urokinase plasminogen activator (uPA) have diverse effects in the pathogenesis of sepsis, which involve pro-inflammation, anti-inflammation, endothelial cell repair, and vascular permeability change. Their roles in predicting mortality and organ dysfunction remain to be clarified. METHODS: Pneumonia-related septic shock patients from medical intensive care units were enrolled for this prospective observational study. We also included 20 patients with pneumonia without organ dysfunction for comparison. Plasma levels of VEGF and sVEGFR1 and uPA activity within 24 hours of shock onset were measured. We compared plasma levels of these biomarkers with APACHE II scores between subgroups of patients, and evaluated their predictive value for 28-day mortality and organ dysfunction. RESULTS: A total of 101 patients, including 81 with pneumonia-related septic shock and 20 with pneumonia without organ dysfunction, were enrolled. Non-survivors of septic shock had significantly higher plasma sVEGFR1 levels (659.3 ± 1022.8 vs. 221.1 ± 268.9 pg/mL, respectively, P < 0.001) and uPA activity (47.2 ± 40.6 vs. 27.6 ± 17.2 units, respectively, P = 0.001) when compared with those of the survivors. Kaplan-Meier survival analysis demonstrated significantly higher mortality in patients with higher levels of sVEGFR1 (P < 0.001) and uPA activity (P = 0.031). In Cox regression analysis, plasma sVEGFR1 level was independently associated with, and best predicted, the 28-day mortality of septic shock (HR: 1.55, 95% CI: 1.05-2.30). Plasma sVEGFR1 level and uPA activity had good correlation with renal dysfunction, metabolic acidosis, and hematologic dysfunction; their levels significantly increased when the number of organ dysfunctions increased. In multivariate analysis, plasma sVEGFR1 level (HR: 2.82, 95% CI: 1.17-6.81) and uPA activity (HR: 2.75, 95% CI: 1.06-7.13) were independent predictors of the presence of concomitant multi-organ dysfunction. The predictive value of VEGF for mortality and organ dysfunction was limited in pneumonia-related septic shock patients. CONCLUSIONS: High plasma sVEGFR1 level in the early stage of pneumonia-related septic shock independently predicted 28-day mortality and multi-organ dysfunction.

[Expression and significance of RECK, metalloproteinase-9 and vascular endothelial growth factor-C in colorectal cancer].

OBJECTIVE: To investigate the expression of reversion-inducing cysteine-rich protein with Kazal motifs (RECK), matrix metalloproteinase-9 (MMP-9), and vascular endothelial growth factor-C (VEGF-C) in colorectal cancer. METHODS: S-P immunohistochemistry was used to detect the expression of RECK, MMP-9 and VEGF-C in colorectal cancer specimen. Colorectal mucosal tissue at least 10 cm away from the tumor was used as control. RESULTS: The positive expression of RECK in colorectal cancer was significantly lower than that in the controls(53.3% vs. 100%, P<0.05). Both MMP-9 and VEGF-C were over expressed compared with the controls(86.7% vs. 23.3% and 71.7% vs. 13.3% respectively, P<0.01). The expression of RECK was negatively correlated with that of MMP-9 and VEGF-C, and the expression of MMP-9 was positively correlated with that of VEGF-C. There were significant associations between the expression of these proteins and lymph node metastasis, distant metastasis, and TNM staging (all P<0.05). CONCLUSIONS: RECK expression is low in colorectal cancer, while MMP-9 and VEGF-C expressions are high. Combined testing of these 3 markers is important in the evaluation of tumor metastasis and invasion, and is helpful in the prediction of the prognosis.

[Expression and activity of fatty acid amide hydrolase in the colon in children with slow transit constipation].

OBJECTIVE: To investigate the expression and activity of fatty acid amide hydrolase (FAAH) in the colon and its role in children with slow transit constipation (STC). METHODS: Patients were divided into constipation group (n=21) and control group (n=15). The constipation group was consistent with the diagnostic criteria for STC. Western blotting, immunohistochemistry and real-time PCR were used to examine the FAAH expression in surgical specimen of colon. The location and distribution of FAAH and cannabinoid receptor type 1 (CB1) were detected by immunofluorescence double staining. The biological activity of colon FAAH was detected by high-performance liquid chromatography. RESULTS: Western blotting revealed that FAAH protein expression in the ascending colon, descending colon and sigmoid colon were significantly decreased in the myenteric neurons and absorption cells in the constipation group as compared with the control group (8.68+/-3.4 vs 10.47+/-3.7, 8.21+/-1.2 vs 9.95+/-6.4, 8.01+/-7.2 vs 9.79+/-3.4, all P<0.05). The same results were found by immunohistochemistry and real-time PCR. The FAAH hydrolysis activity in the ascending colon, descending colon or sigmoid colon decreased significantly in the constipation group, as compared with the control group [(0.51+/-0.23) nmol x min(-1) x mg(-1) vs (0.84+/-0.24) nmol x min(-1) x mg(-1), (0.39+/-0.25) nmol x min(-1) x mg(-1) vs (0.55+/-0.44) nmol x min(-1) x mg(-1), (0.35+/-0.37) nmol x min(-1) x mg(-1) vs (0.58+/-0.48) nmol x min(-1) x mg(-1), all P<0.05]. CONCLUSION: FAAH expression and hydrolysis activity in the colon decrease in children with STC. FAAH may play a role in the pathogenesis of slow transit constipation in Children.

Ileum perforation due to delayed operation in obturator hernia: a case report and review of literatures.

A 83-year-old woman was admitted to our hospital because of intermittent abdominal colicky pain and vomiting for 26 h. The pain localized over the periumbilical area with radiation along the medial side of the thigh. Computed tomography scan with three-dimensional reconstruction revealed a loop of small bowel protruding into the left obturator canal. Incarcerated obturator hernia was diagnosed and emergency laparotomy was arranged immediately. Unfortunately, her family refused surgery because of her worsening condition. On the third evening after admission, the patient developed peritonitis and sepsis. Perforation of small bowel due to the incarceration was noted during laparotomy. Bowel resection and an end-ileostomy were performed. She recovered well despite of the complication of multiple organ dysfunction syndrome. Literature is reviewed, and the pathogenesis, clinical manifestation, imaging features and treatment are discussed.

Clinicopathological characteristics of advanced colorectal cancer 30 mm or smaller in diameter.

OBJECTIVE: To investigate the clinicopathological characteristics of advanced colorectal cancer which was 30 mm or smaller in diameter. METHODS: Retrospective analysis documented 80 patients with small advanced colorectal cancer from May 1985 to May 2002. According to the diameter of tumors, all patients were divided into three groups: Group A (10 mm or less), Group B (11-20 mm), Group C (21-30 mm). Considering the number of patients in Group A was smaller, we combined Group A with Group B as Group D. Then various clinicopathological characteristics were compared between Group C and Group D. RESULTS: The most common site of small advanced colorectal cancer was sigmoid colon and rectum that accounted for 36.2% and 35.0% of all cases. The average diameter of total tumors was 23.3 mm. Type 2 was the most common macroscopic type (63.7%) and the moderate differentiation was seen in 77.5% of cases. Thirty-eight (47.5%) cases had lymph node metastasis. Three (3.8%) cases had liver metastasis and three (3.8%) cases had peritoneal metastasis. The frequency of lymph node metastasis was found significantly different between Group C and Group D (54.2% vs. 28.6%, P < 0.05) , as well as between the groups with different depth of invasion (P < 0.05). Curability A resection was performed in 69 (86.2%) cases. CONCLUSIONS: Tumor size and depth of invasion are related to lymph node metastasis in small advanced colorectal cancer. However, the small size of tumor may not always be a reliable parameter for estimating the risk of lymph node metastasis. Small colorectal cancers also do not always mean the early stage. Surgeons should be aware of the features of small advanced colorectal cancers to select ideal management and perform perfect resection.

Submucous colon lipoma: a case report and review of the literature.

Colon lipoma is remarkably rare in clinical practice. We reported a case of ascending colon lipoma in an 83-year-old woman. She was asymptomatic with a lipoma of 35 mm x 30 mm x 24 mm in size which was found by routine colonoscopy. Right hemicolectomy was performed uneventfully. The diagnosis was made by histological examination. Reviewing the literature and combining with our experience, we discussed the clinical features, diagnosis and treatment of this uncommon disease.