[Related factors and prognosis analysis of esophagorespiratory fistula after esophageal cancer surgery].

Objective: To explore the factors associated with the development of esophagorespiratory fistula (ERF) after esophageal cancer surgery and its relationship with patient survival. Methods: A total of 241 patients with esophageal cancer after surgery, who received postoperative sputum suction through bronchoscope from West China Hospital of Sichuan University between January and December 2021 were included. The clinical data and airway features under bronchoscope of these patients were collected. Of the 241 patients, 203 were males (84.2%) and 38 were females (15.8%), aged (63.63±8.05) years. The related factors of ERF were analyzed by multivariate logistic regression analysis, and Kaplan-meier was used to analyze the relationship between bronchoscopic specific manifestations, treatment modality and patient survival. Results: Of the 241 postoperative patients with esophageal cancer, 21 (8.7%) developed ERF. There were 39 (16.2%) patients with bronchoscopic specific manifestations, including 16 cases (6.6%) of hyperemia, 13 cases (5.4%) of congestion, and 15 cases (6.2%) of erosion. Bronchoscopic specific manifestations of tracheal mucosa (OR=13.734, 95%CI: 3.535-29.074, P<0.001) and thoracotomy (OR=9.121, 95%CI 1.843-44.237, P=0.007) were independent risk factors for the development of ERF, and preoperative chemotherapy (OR=0.128, 95%CI: 0.052-0.607, P=0.006) was a protective factor in the occurrence of ERF. The median survival time was 224 (95%CI: 95-353)d in the stent-treated group (14 patients) after the onset of ERF, and the median survival time of patients in the supportive care group (7 patients) was 29 (95%CI: 8-50)d, and the survival difference was statistically significant (χ2=5.69, P=0.017). Conclusions: Bronchoscopic specific manifestations are independent risk factors for the development of ERF in postoperative patients with esophageal cancer and are useful in assessing the risk of developing ERF. After the occurrence of postoperative ERF, timely intervention by insertion of tracheal stents to seal the fistula may prolong the survival time of the patients.

[Alveolar echinococcosis metastatic to the brain: a case report].

This paper reports a case with alveolar echinococcosis metastatic to the brain. This case underwent 10-year antiechinococcosis treatment and operations of the liver, right kidney and brain. Following multiple operations and oral administration of albendazole, the case still had recurrence and distant metastasis of hepatic echinococcosis. It is suggested that early prevention, early diagnosis, early regular treatment and surgical radical treatment are critical to the treatment of alveolar echinococcosis.

Decreased expression of SorCS1 in colorectal cancer: An independent predictor of poor prognosis.

Previously, we identified that sortilin related VPS10 domain containing receptor 1 (SorCS1) was hypermethylated in colorectal cancer (CRC) tissues. Here, we aimed to investigate the association between CRC and SorCS1. DNA methylation was determined by methylation-specific polymerase chain reaction (MSP) or quantitative real-time methylation analysis (MethyLight). Colorectal cancer tissue specimens from 239 patients that had undergone surgical treatment were evaluated using immunohistochemistry (IHC) analysis for the expression of SorCS1 and correlated with clinicopathological variables and prognosis. We found that SorCS1 was hypermethylated in CRC cell lines and 67.5% (27/40) CRC tumor tissues. The loss of SorCS1 mRNA (p<0.001) and protein expression (p=0.033) were highly correlated with promoter methylation. In addition, SorCS1 expression was significantly increased in younger patients (p=0.006), low CEA level (p<0.001) and pT1-2 stage (p=0.005). Survival analysis revealed that decreased expression of SorCS1 was an independent factor for predicting the increased risk of recurrence (p=0.024) and poor overall survival (p=0.006). Subgroup analysis for CEA level, pT and pN classifications showed that SorCS1 retained its stratified significance only in patients with low CEA level, pT3-4 tumors and pN1-2 lymph node status. Our findings suggest that SorCS1 is epigenetically inactivated in a substantial fraction of CRC, and its expression may be a promising prognostic factor in CRC patients.

[The status analysis of diagnosis and treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China: a report of 1 003 cases in 16 domestic medical centers].

Objective: To analyze the status of domestic surgical treatment of synchronous peritoneal carcinomatosis from colorectal cancer in China. Methods: Clinicopathological data of patients who underwent surgery from October 2003 to October 2018 in 16 domestic medical centers was retrospectively analyzed. Excel database was created which covered 77 fields of 7 parts: baseline information of patients, laboratory tests, imaging tests, chemoradiotherapy information, intra-operative findings, postoperative pathology and follow-up data. The Wilcoxon rank-sum test was used for comparison of the measurement data between groups. The χ(2) test was used for comparison of the categorical data between groups. The survival curve was calculated by the Kaplan-Meier method. Results: Of the 1 003 patients, there were 575 male and 428 female patients with the age of (58.5±14.1) years (range: 18 to 92 years). In a total of 920 patients, the carcinoma of sigmoid colon was performed in 292 cases (31.8%) with the highest ratio. The proportion of patients with liver metastasis and lung metastasis were 27.9% (219/784) and 8.3% (64/769). Preoperative detection of carcino-embryonic antigen level was the most common method in China (87.74%, 880/1 003), and the positive rate was 64.5% (568/880). The correct rate of preoperative imaging tests was 40.7% (280/688). The ratio of peritoneal carcinomatosis index (PCI) scores between 0 and 10 was the highest (59.6%, 170/285). Two hundred and sixty-two (27.0%) patients were performed by totally laparoscopic operation in 971 patients. The resection of primary tumor was performed in 588 of the 817 patients (72.0%). In a total of 457 cases, 253 (55.4%) patients were performed cytoreduction which group scored completeness of cytoreduction (CCR) 0. The postoperative hyperthermic intraperitoneal chemotherapy was implemented in 70 of the 334 cases (21.0%). Among 1 003 cases, 562 cases (56.03%) had complete follow-up data and the median overall survival was 15 months. The primary tumor resection and the CCR scores were affected by the PCI scores. The patients underwent primary tumor resection (187/205 vs. 26/80, χ(2)=105.085, P=0.000) and the patients were performed cytoreduction which scored CCR 0 or CCR 1 (162/204 vs. 8/78, Z=-10.465, P=0.000) had significant difference between the groups of PCI<20 and ≥20. There was a close correlation between the surgical method and the CCR scores (Z=-3.246,P=0.001).When the maximum degree of tumor reduction was planned, most surgeons would choose laparotomy. The overall survival time was longer in patients with primary tumor resection (P=0.000). The median survival time was 18.6 months in the group of primary tumor resection. Conclusions: It is difficult to diagnose the synchronous peritoneal carcinomatosis from colorectal cancer before the operation. Primary tumor resection has an obvious effect to prolong the survival time. It is necessary to standardize the treatment of peritoneal metastasis.

IGF-1 regulates Ang II and VEGF signaling pathways in retinal neovascularization.

OBJECTIVE: To investigate the effect of insulin-like growth factor (IGF)-1 on regulating the occurrence of retinal neovascularization and the expression mechanism of Angiotensin II (Ang II) and vascular endothelial factor (VEGF). MATERIALS AND METHODS: A total of 40 C57BL/6J healthy mice of either gender were selected, and randomly divided into 4 groups: control group, model group, IGF-1 overexpression carrier intervention group and IGF-1 siRNA intervention group (10 in each group). Mice in control group were fed in the air without any further processing. The mice in other 3 groups were used to build high oxygen-induced retinal neovascularization model. The vitreous cavity of mice in the model group was injected with the equal amount of normal saline, while the mice in the IGF-1 overexpression carrier intervention group were injected with 1 µl IGF-1 liposomes mixture. At the same time, IGF-1 siRNA intervention group mice were continuously injected with 1 µl IGF-1 siRNA liposomes mixture for 3d. Stretched preparation of retina was used to observe the neovascularization form; HE staining tissue section were prepared to observe the amount of vascular endothelial nuclei out of the retina boundary; IGF-1, Ang II and VEGF expression levels of retinal tissue were detected by RT-PCR and Western blot. RESULTS: A large area of non-perfusion and tortuous expansion form of the blood vessel was found in the optic nerve surroundings of retinal serial sections in model group, while neovascularization plexus and fluorescence leakage were observed between perfusion and non-perfusion area. Non-perfusion and neovascularization have experienced a decrease in IGF-1 overexpression group but an increase in IGF-1 siRNA group. The number of neovascularization endothelial nuclei out of the internal limiting membrane in model group was remarkably higher than that in control group. This number in IGF-1 over-expression group decreases while in IGF-1 siRNA group it increases, with a significant statistical difference (p < 0.05). Histone IGF-1 expression level in the model group was lower than that in the control group, but Ang II and VEGF expression level were higher. IGF-1 in over-expression group was higher but with a lower expression level of Ang II and VEGF; however, the results in siRNA group were opposite. The difference was statistically significant (p < 0.05). CONCLUSIONS: The occurrence of retinal neovascularization is related to the reduction of IGF-1 expression and the increase of Ang II and VEGF.

[The effects of macrophages with high expression of TL1A on activation and proliferation of hepatic stellate cells in vitro].

Objective: To explore the effects of macrophages with high expression of TL1A on the activation and proliferation of HSCs in vitro. Methods: The Bone marrow-derived macrophages (BMMs) and peritoneal macrophages (PMs) from wild type (WT) and myeloid-overexpressed TL1A transgenic mice were isolated, differentiated and activated. HSCs were harvested from activated macrophages culture supernatant (CM). HSCs were detected by immunofluorescence and real-time Q-PCR. And the proliferation was detected by CCK-8 and BrdU assay kit. The levels of IL-1ß and PDGF-BB in macrophage culture supernatants were determined by enzyme-linked immunosorbent assay (ELISA). Results: BMMs-derived CM-intervention HSCs were used to detect the expression of α-smooth muscle actin (α-SMA) on the 2nd, 4th and 6th day respectively by immunofluorescence method. There was no significant difference between the two groups on the 2 nd and the 6th day, P > 0.05; On day 4, the CM/Tg group was significantly higher than that of CM/WT group, P < 0.01; the results of CMs derived from PMs were consistent with the above trend. The expression of α-SMA mRNA on the 2nd, 4th and 6th day was detected by real-time Q-PCR method using BM-derived CMs. No significant difference was found between the groups on the 2nd day (P > 0.05).α-SMA mRNA increased further on the 4th and 6th day, and the level of CM/Tg in CM/Tg group was significantly higher than that in CM/WT group (P < 0.05). The detection results of CMs derived from PMs were consistent with the above trend. The results of CCK-8 assay and BrdU assay showed that the proliferation rate of HSCs in CM Tg group was significantly higher than that in CM/WT group (P < 0.01). The CMs derived from PMs were used to interfere with HSCs. And the results were consistent with the above trend. For BMMs, the levels of IL-1ß and PDGF-BB in the lipopolysaccharide (LPS) + IFNγ/Tg culture supernatant were significantly higher than those in the LPS+IFNγ/WT group (P < 0.01). For the culture supernatants of PMs Liquid test results consistent with the above trend. Conclusion: Macrophages with high expression of TL1A could enhance the activation and proliferation of HSCs by increasing the secretion of IL-1ß and PDGF-BB.

[The relationship between oxygen saturation and related respiratory events in patients with obstructive sleep apnea-hypopnea syndrome].

Objective:To explore the relationship between variation of hemoglobin saturation and related respiratory events in patients with obstructive sleep apnea and hypopnea syndrome (OSAHS).Method:According to the SaO2, the respiratory events were divided into two groups, followed or not followed the second events (SRE and N-SRE). Four features were extracted from SaO2 and compared within groups under SRE versus N-SRE, and comparisons were also developed between moderate patients and severe patients.Result:ΔSaO2, max, the duration and Dvmax was significantly higher in SRE than N-SRE (P< 0.01), while Nadir was significantly lower in SRE than N-SRE (P< 0.01). There was also significant difference in the blood oxygen index between moderate and severe patients. The change of SaO2 is correlated with the ventilation restoration. The results also suggest that the severity of the patient's condition will affect the change of SaO2 related indicators. Conclusion:This study provides information on the further study of ventilation restoration. Moreover, this study may provide a possible solution for the treatment of OSAHS.

Avoiding perioperative dexamethasone may improve the outcome of patients with rectal cancer.

BACKGROUND: Perioperative administration of dexamethasone may augment recurrence and mortality after tumor resection possibly by immunosuppression, which, unfortunately, has never been noted. We therefore carried out a retrospective study in rectal cancer to validate the hypothesis. METHODS: Five hundreds and fifteen patients with stage I to III rectal cancers who underwent a curative resection from June 2007 and June 2011 were enrolled in the current study. Patients who had been given intravenous (IV) dexamethasone (4-10 mg) postoperatively and/or intraoperatively were assigned to dexamethasone group. The outcome of dexamethasone group and non-dexamethasone group were compared. The primary outcome was disease-free survival (DFS) and overall survival (OS). RESULTS: dexamethasone group had significant lower three-year DFS (62.3% vs 71.8%, P = 0.026) and OS (74.1% vs 82.9%, P = 0.031) rate in comparison to non-dexamethasone group, the hazard ratios (HRs) of which were 1.59 (95% CI 1.05-2.39, P = 0.028) and 1.77 (95% CI 1.05-3.01, P = 0.034), respectively. Multivariate analysis revealed that administration of systemic dexamethasone were independently associated with DFS [adjusted HR 1.60 (95% CI 1.03-2.49, p = 0.039)], but for OS, dexamethasone didn't remain significant in this model. In the analyses of a subgroup of 428 patients (55/428 in dexamethasone group) without perioperative blood transfusion, dexamethasone had independently impact on both DFS and OS. CONCLUSION: Patients not given dexamethasone had better three-year survival outcomes compared with patients given dexamethasone perioperatively. Our results indicate that rectal cancer patients treated with curative surgery may get survival benefit from avoiding low-dose perioperative dexamethasone.

Aberrant methylation of genes in stool samples as diagnostic biomarkers for colorectal cancer or adenomas: a meta-analysis.

BACKGROUND: An increasing number of hypermethylated genes in stool samples have been reported as biomarkers for the detection of colorectal cancer (CRC) or adenomas. We aimed to comprehensively review and compare the evidence for feasibility of using these biomarkers for the detection of colorectal neoplasia. METHODS: We searched Medline, the Web of Science and OVID for studies that used hypermethylated genes as biomarkers for the detection of CRC or adenomas. A meta-analysis was carried out using the random-effect model with diagnostic odd ratios (DOR) and 95% confidence intervals (CI) as effect measurements. RESULTS: A total of 19 studies including 2,356 patients were eligible for final analysis. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and DOR for the detection of CRC or adenomas were 0.62 (95% CI: 0.51-0.71), 0.89 (95% CI: 0.86-0.92), 5.66 (95% CI: 4.68-6.83), 0.43 (95% CI: 0.34-0.55) and 13.15 (95% CI: 9.82-17.60) respectively. Of these, the sensitivity and specificity for the detection of adenoma were 0.54 (95% CI: 0.39-0.68) and 0.88 (95% CI: 0.83-0.92) respectively. CONCLUSIONS: Hypermethylated gene panels are not currently accurate enough to be used alone for colorectal neoplasia screening. The discovery and evaluation of additional biomarkers with improved sensitivity and specificity is necessary.

[Variation of neurotrophic factors expression in spinal cord and muscle after root avulsion of brachial plexus].

OBJECTIVE: To investigate the variation of neurotrophic factors expression in spinal cord and muscle after root avulsion of brachial plexus. METHODS: Forty-eight Wistar rats were involved in this study and according to the observing time in 1st day, 1st week, 4th week, 8th week, and 12th week after avulsion, and the control, were divided into 6 groups. By immunohistochemical and hybridization in situ assays, the expression of nerve growth factor (NGF) on muscle, basic fibroblast growth factor(bFGF) and its mRNA on the neurons of corresponding spinal cord was detected. Computer image analysis system was used to calculate the result. RESULTS: After the root avulsion of brachial plexus occurred, expression of NGF increased and reached to the peak at the 1st day. It subsided subsequently but was still higher than normal control until the 12th week. While expression of bFGF and its mRNA increased in the neurons of spinal cord and reached to the peak at the 1st week. Then it dropped down and at the 12th week it turned lower than normal control. CONCLUSION: After root avulsion of brachial plexus, neurotrophic factors expression increase on target muscle and neurons of corresponding spinal cord. It maybe the autoregulation and may protect neuron and improve nerve regeneration.

[The early protective effects of basic fibroblast growth factor on acute spinal cord injury in rats].

OBJECTIVE: To study the early protective effects of basic fibroblast growth factor(bFGF) on the experimental acute spinal cord injury. METHODS: Thirty-four SD rats were randomly divided into three groups, and were subjected to contusion of thoracolumbar spinal cord. A thin plastic tube was placed in subarachnoid space below the injury level for perfusion. The bFGF-treated rats were received 20 microliters bFGF(containing bFGF 100 U) at once, 30 min, 1, 2, 3, 4, 6, 12, 24 and 48 hours after injury, and an equal volume of normal saline was given to the control group at the same time. The injured spinal cord was detected by morphological observation and biochemical index after injury. RESULTS: The degree of ionic disorder in bFGF-treated rats was significantly ameliorated and the contents of H2O were also markedly decreased. The morphological finding showed that the damages of gray and white matter in bFGF-treated rats were slighter than those of saline-treated rats. CONCLUSION: bFGF has some protective effects on the secondary lesion of early spinal cord injury in rats.

[A clinical analysis of intramuscular hemangioma in oral and maxillofacial regions: Report of 59 cases]

From 1978 to 1992,the clinical data of 59 patients with intramuscular hemangioma in oral and maxillofacial regions were reviewed and analysed.The average age and the duration were 23 years old and eight years respectively.All patients were treated surgically,53 cases (89.83%)were completely resected and those of other 6 cases(10.1%) partially resected without any complications,Follow-up for 11 months to 12 years showed that 2 cases relapsed,and thus the cure rate was 96.6%(57/59),The author affirmed the significance of surgical operation in treatment and put forward the view of classification of hemangioma the vascular deformities.

[The operative treatment of hip fracture in patient over 80 years old: report of 81 cases].

The treatment of hip fracture in 81 cases of elderly (age ranged from 80 to 95) were reviewed. 13 of them were over 90 years old and 42 (52%) were accompanied with more than three preexistent diseases, mainly cardiovascular and cerebrovascular diseases. The femoral neck fracture (31 cases) were treated by Smith-Petersen nail or femoral head prosthesis replacement, the intertrochanteric fracture of femur (50 cases) were treated by McLaughlin or Richard nail. 24 cases (29.6%) had post-operative complications, e.g. pneumonia in 9 cases, cerebrovascular disease in 7 cases, cardio-vascular disease in 5 cases. Most of them recovered promptly after appropriate treatment. 5 patients died of pneumonia, the mortality is 6%. Internal fixation of hip fractures in elderly is one of very important methods of relieving pain, lowering morbidity and mortality, and early recovery of motion and normal daily life. It is believed that the proper evaluation of patient's general condition, appropriate treatment of preexistent disease, smooth anesthesia, skillful technique and intensive nursing care are needed for getting good results. The large majority of them will tolerate the operation nicely, even in high risk.

Operational techniques and combination treatment for the recurrent sacro-coccygeal tumor.

This article presents 6 cases of recurrent sacro-coccygeal tumor with analysis of the causes of recurrence, operational technique for second-time operation and concomitant treatment. It is suggested that combined abdominal and sacro-coccygeal approaches be used to excise maximal mass of the tumor, surrounding affected tissues be curetted out and the space be filled up with adriamycin-bone-cement to destroy remaining tumor cells and to strengthen the stability of pelvis. Besides, the patients should be subject to supersegregation radiotherapy in order to minimize the possibility of recurrence.

[Applied anatomic study of the posterior interosseous artery in forearm].

The posterior interosseous artery (PIA) is the nutritive artery of the dorsal forearm flap. This article describes the dissection study for PIA in 40 cases. The results are as follows: 1. PIA is classified into different types; 2. the external diameter of PIA at the inferior margin of the supinator, the length of PIA and the distance between the artery and external epicondyle of the humerus are described; 3. the course of the artery and its neighboring structures are defined. The above study provides the foundation of designing of the posterior forearm pedicled flap in the repair of defects situated on the forearm and hand.

Experimental studies on peripheral nerve regeneration enhanced by nerve growth factor.

The effect of exogenous nerve growth factor (NGF) examined on the neural repair of adult rabbit sciatic nerve was evaluated in the present study. A nerve regeneration chamber was created by suturing the proximal and distal ends of a transected sciatic nerve into a silicone chamber. A gap of 6 mm in chamber was left after removal of a 3 mm piece of nerve in the distal ends and insertion of the proximal and distal stumps into the chamber. Animals were operated on bilaterally, one side of the chamber was filled with a 1 mg/ml NGF/normal saline (NS) (experimental) and the contralateral side with NS (control). The regenerated nerves from within the silicone chamber were dissected and fixed 1 to 5 weeks following surgery for histological studies at both the light microscopic and ultrastructural levels. The NGF chamber showed a more mature regenerated nerve based on a larger diameter of the regenerated nerve trunk, a great number of axons, and thicker myelin sheaths.