Reliability of Pulse Contour Cardiac Output Analysis in a Piglet Model of Multi-step Intra-abdominal Hypertension.

BACKGROUND: Pulse contour cardiac output (PCCO) analysis is a minimally invasive technique for continuous cardiac output (CO) measurement monitoring. PCCO requires calibration by transpulmonary thermodilution (TPTD). Studies showed good agreement between PCCO, TPTD CO and CO measured by pulmonary artery thermodilution (PATD) during stable hemodynamics. However, data are limited in patients with intra-abdominal hypertension (IAH). The objective is to compare the agreement between PCCO, TPTD CO, and PATD CO in a piglet model of multi-step IAH. MATERIALS AND METHODS: Ten female domestic piglets were enrolled in this study. IAH was induced by stepwise carbon dioxide inflation into peritoneal cavity in anesthetized piglets. Following baseline registrations, intra-abdominal pressure (IAP) was increased and maintained at each IAP plateau of 10, 20, 30, and 40 mmHg for 15 min before CO measurements. CO was measured by PATD and simultaneously by 2 femoral artery PCCO catheters. One PCCO catheter was recalibrated by TPTD at each IAP plateau while the other was only calibrated at baseline. RESULTS: In pooled data of different IAP stages, TPTD CO and recalibrated PCCO (R-PCCO) showed excellent correlation (r2 = 0.94 and 0.93) and small bias (-0.09 and -0.09 L/min), respectively, compared with PATD CO. However, PCCO without recalibration (NR-PCCO) were not accurate during IAH (r2 = 0.58, bias: +0.32 L/min). When IAP increased to 30 mmHg, NR-PCCO failed to agree with PATD CO (r2 = 0.47, bias: +0.52 L/min). On the contrary, a clinically accepted agreement between TPTD CO, R-PCCO, and PATD CO was observed at different IAP stages. CONCLUSIONS: TPTD CO and R-PCCO agreed with PATD CO in this piglet model of multi-step IAH. On the contrary, NR-PCCO failed to agree with PATD CO when IAP increased to 30 mmHg or more. PCCO analysis needs recalibration in this condition.

Anticancer effect of inactivated Sendai virus strain Tianjin on human osteosarcoma HOS cells.

Ultraviolet-inactivated Sendai virus strain Tianjin (UV-Tianjin) has been proved to have antitumor effects in many kinds of tumor cells. Here, we investigated the anticancer properties of UV-Tianjin on human osteosarcoma HOS cells and the underlying molecular mechanism. Apoptosis, intracellular reactive oxygen species (ROS) levels and mitochondrial membrane potential were determined by flow cytometry analysis. The expression levels of apoptosis-related proteins were tested by western blotting. The results showed that UV-Tianjin concentration-dependently induced apoptosis in HOS cells. UV-Tianjin-induced apoptosis was mediated by the mitochondrial pathway, which was confirmed by mitochondrial dysfunction, downregulation of B-cell lymphoma 2 (Bcl-2), B-cell lymphoma-xL (Bcl-xL) and myeloid cell leukemia-1 (Mcl-1), upregulation of B-cell lymphoma 2 associated X protein (Bax) and Bcl-2 Homologous Antagonist/Killer (Bak), as well as the cleavage of caspase-9 and -3. Further analysis showed that UV-Tianjin augmented the phosphorylation of c-Jun N-terminal kinase, the extracellular-regulated kinase and p38, the major components of mitogen-activated protein kinase (MAPK) pathways, as well as the generation of ROS. Moreover, UV-Tianjin-induced apoptosis was remarkably attenuated by MAPK inhibitors and ROS inhibitor. Taken together, our results indicated that UV-Tianjin exerts antitumor effects by inducing mitochondria-dependent apoptosis involving ROS generation and MAPK pathway in human osteosarcoma HOS cells.

High Expression of Orai1 Enhances Cell Proliferation and is Associated with Poor Prognosis in Human Colorectal Cancer.

BACKGROUND: Store-operated Ca2+ entry (SOCE) is the predominant Ca2+ influx mechanism in non-excitable cells and regulates a variety of cellular functions. As the essential channel pore-forming protein of SOCE, Orai1 has recently been implicated in carcinogenesis and tumor progression in multiple malignancies. However, the role of Orai1 in colorectal cancer (CRC) has not been investigated. METHODS: The expression of Orai1 in 21 CRC specimens was examined by immunohistochemistry (IHC) staining, Western blot, and qRT-PCR. The results were compared with paired non-tumor tissues. The expression of Orai1 in additional specimens of 129 CRC patients was examined by IHC staining and the IHC scores were compared with clinicopathological features. After knock-down of the expression of Orai1 in LoVo cells, cell proliferation was examined using a MTT assay and colony formation assay. Flow cytometry was also used to detect apoptosis. RESULTS: The expression of Orai1 was upregulated in human CRC tissues, high expression of Orai1 was closely associated with depth of tumor invasion, lymph node metastasis, and perineural invasion, and patients with high expression of Orai1 had shorter overall survival. Moreover, the expression of Orai1 was also upregulated in CRC cell lines, knockdown of Orai1 inhibited cell proliferation, the effect of growth inhibition was not due to enhanced apoptosis, and stromal interaction molecule1 (STIM1) did not take part in the regulation of CRC cell proliferation. CONCLUSIONS: Orai1 is crucial to sustained CRC cell proliferation, high expression of Orai1 is associated with tumor progression and poor prognosis, and Orai1 may be a promising target for prognosis and treatment of CRC.

[Risk factors associated with incisional surgical site infection in colorectal cancer surgery with primary anastomosis].

OBJECTIVE: To investigate the incidence of surgical site infection (SSI) and risk factors in colorectal cancer surgery patients. METHODS: Between October 2003 and October 2013, 1 381 consecutive patients with colorectal cancer managed surgically with primary anastomosis were included in the study. There were 762 male and 619 female patients with mean body mass index (BMI) was (27.7 ± 3.7) kg/m², aged from 20 to 90 years with a median of 67 years. Patients undergoing emergency surgery and requiring stoma creation were excluded. The patients' characteristics, surgical conditions and prognosis were recorded. Univariate and multiple logistic regression analysis were used to identify any variable predictive factors of SSI. RESULTS: One hundred twenty-six (9.12%) cases developed incisional SSI. The occurrence time for SSI was from 2 to 20 days, mean (6.7 ± 2.9) days. According to multivariable logistic regression analysis, BMI (OR = 1.058, P = 0.030), intraoperative contamination (OR = 10.549, P = 0.000) and open operation as compared with a laparoscopic procedure (OR = 2.111, P = 0.001) were significant independent predictors of incisional SSI. There was a significant decrease in incisional SSI in wound protectors group (OR = 1.646, P = 0.012). CONCLUSION: BMI and intraoperative contamination are independent predictors of incisional SSI, and wound protectors and laparoscopic surgery are associated with a lower incidence of incisional SSI following colorectal cancer surgery.

[A prospective multicenter clinical trial of extralevator abdominoperineal excision for locally advanced low rectal cancer].

OBJECTIVE: To demonstrate the feasibility of extralevator abdominoperineal excision (ELAPE) for locally advanced low cancer in China. METHODS: A prospective multicenter clinical trial was carried out by 7 general hospitals across China from August 2008 to October 2011. A total of 102 patients underwent ELAPE for primary locally advanced low rectal cancer. There were 60 male and 42 female patients. The patients' characteristics, complications and prognosis were recorded. RESULTS: All patients underwent the ELAPE procedure successfully. The median operating time was 180 minutes (range 110-495 minutes) and median intraoperative blood loss was 200 ml (range 50-1000 ml). The rates of sexual dysfunction, perineal complications, urinary retention, and chronic perineal pain were 40.5%, 23.5%, 18.6% and 13.7%, respectively. Chronic perineal pain was associated with coccygectomy (12 months postoperatively, t = 8.06, P < 0.01), and the pain might gradually ease over time. Reconstruction of pelvic floor with biologic mesh was associated with lower rate of perineal dehiscence (χ(2) = 13.502, P = 0.006) and overall perineal wound complications (χ(2) = 5.836, P = 0.016) compared with primary closure. A positive circumferential margin (CRM) was demonstrated in 6 (5.9%) patients, and intraoperative perforations occurred in 4 (3.9%) patients. All CRM involvement and intraoperative perforation located at anteriorly and anterolaterally. The local recurrence was 4.9% at a median follow-up of 35 months (range, 18-58 months). CONCLUSIONS: ELAPE performed in the prone position for low rectal cancer leads to a reduction in CRM involvement, intraoperative perforations, and local recurrence, but it might result in a little high rate of perineal wound related complications. Reconstruction of pelvic floor with biologic mesh might lower the rate of perineal wound complications.

Clinical study of enhanced recovery after surgery in laparoscopic appendectomy for acute appendicitis.

BACKGROUND: Enhanced recovery after surgery (ERAS) protocol is a comprehensive management modality that promotes patient recovery, especially in the patients undergoing digestive tumor surgeries. However, it is less commonly used in the appendectomy. AIM: To study the application value of ERAS in laparoscopic surgery for acute appendicitis. METHODS: A total of 120 patients who underwent laparoscopic appendectomy due to acute appendicitis were divided into experimental group and control group by random number table method, including 63 patients in the experimental group and 57 patients in the control group. Patients in the experimental group were managed with the ERAS protocol, and those in the control group were received the traditional treatment. The exhaust time, the hospitalization duration, the hospitalization expense and the pain score between the two groups were compared. RESULTS: There was no significant difference in age, gender, body mass index and Sunshine Appendicitis Grading System score between the experimental group and the control group (P > 0.05). Compared to the control group, the patients in the experimental group had earlier exhaust time, shorter hospitalization time, less hospitalization cost and lower degree of pain sensation. The differences were statistically significant (P < 0.01). CONCLUSION: ERAS could significantly accelerate the recovery of patients who underwent laparoscopic appendectomy for acute appendicitis, shorten the hospitalization time and reduce hospitalization costs. It is a safe and effective approach.

[Surgical management of postoperative stricture of anastomosis after operation of intersphincteric resection for lower rectal cancer].

OBJECTIVE: To study surgical treatment of postoperative stricture of anastomosis for lower rectal cancer. METHODS: The data of 9 cases who were diagnosed as postoperative stricture of anastomosis after operation of intersphincteric resection for lower rectal cancer during January 2008 to June 2011 were analyzed retrospectively. Transanal excision of stricture were used in 3 cases diagnosed as membranous stricture. Transanal radial incision of stricture were used in 5 cases diagnosed as tubulous stricture. Biologic patch was used to repair the defect of the posterior wall of rectum after excision of severe stricture in 1 case. RESULTS: All 9 cases of postoperative stricture of anastomosis were cured by surgery. Anal dilation were performed every day by patients themselves after discharge. Digital examination showed that 1 to 2 fingers could pass through the anastomosis after operation. The patient whose rectal defect was repaired by biological patch underwent colonoscopy examination two weeks after operation. Colonoscopy showed that the biological patch had been filled with granulation and integrated into the surrounding intestinal tissue. All patients defecated without difficulty and the anal function of all patients was good after restoration of intestinal continuity. CONCLUSION: Aggressive surgery, combining with the use of biological patch if necessary is an effective therapy of postoperative stricture of anastomosis for lower rectal cancer.

[Technical improvements and results of individual cylindrical abdominoperineal resection for locally advanced low rectal cancer].

OBJECTIVE: To evaluate the safety and efficacy of individual cylindrical abdominoperineal resection (CAPR) for locally advanced low rectal cancer. METHODS: From June 2011 to February 2012, 11 patients with locally advanced low rectal cancer underwent individual CAPR. There were 7 male and 4 female patients, aged from 32 to 74 years with a median of 64 years. Forty-seven patients underwent classic CAPR from January 2008 to February 2012. Preoperative and postoperative parameters such as clinical information of patients, tissue morphometry and complications were compared. RESULTS: In the individual surgical group, 6 patients were treated with one side levator ani muscle totally or partially reserved, 3 patients with sacrococcyx reserved, and 2 patients with dissection close to the anterior rectal wall. Compared with classical surgery, the individual surgical specimens of horizontal section area ((2197 ± 501) mm(2)) and intrinsic muscle layer outer area ((1722 ± 414) mm(2)) were small, but the difference was not statistically significant (P = 0.150 and 0.167). The operative time, intraoperative blood loss, circumferential resection margin, total cross sectional tissue area, cross sectional tissue area outside the muscularis propria and bowel perforation rate between the two groups were not significantly different. Individual CAPR showed less incidence of chronic perineal pain (2/11, χ(2) = 6.116, P = 0.013) and sexual dysfunction (2/9, χ(2) = 4.412, P = 0.036) compared with classic CAPR. CONCLUSIONS: Individual CAPR has the potential to reduce the risk of chronic perineal pain and sexual dysfunction without influencing the radical effect when compare with classic CAPR for the treatment of low rectal cancer.

Elevated serum synuclein-gamma in patients with gastrointestinal and esophageal carcinomas.

BACKGROUND/AIMS: We aimed to evaluate whether elevated serum synuclein-gamma levels were of clinical significance as a serological marker in cancer diagnosis and monitoring. METHODOLOGY: Pre-treatment serum synuclein-gamma levels of patients with gastrointestinal and esophageal squamous cell carcinomas, benign disease and healthy controls were analyzed by a specific sandwich ELISA for synuclein-gamma. RESULTS: Statistically significant differences in serum synuclein-gamma levels between patients with colo rectal cancer, gastric adenocarcinomas, esophageal cancer and healthy individuals were observed (p<0.001). When a cut-off value for synuclein-gamma was determined at ≥4 ng/mL by receiver operating characteristic curves, sensitivity and specificity were 16.4% and 97.7% in colorectal cancer, 23.0% and 99.3% in gastric adenocarcinomas, and 19.5% and 98.7% in esophageal cancer, respectively. Compared with carcinoembryonic antigen and carbohydrate antigen 19-9, synuclein-gamma was more sensitive in early detection of colorectal cancer (17.3% vs. 9.6% and 7.5%), gastric adenocarcinomas (20.6% vs. 0% and 3.2%) and esophageal cancer (22.2% vs. 3.4% and 0%), respectively. A combined analysis of the above markers yielded incremental positive rates compared with anyone alone. CONCLUSIONS: These results indicated that serum synuclein-gamma provided a promising diagnostic biomarker for early detection and was a complementary biomarker of carcinoembryonic antigen and/or CA19-9 in gastrointestinal and esophageal cancer.

[Value of self-expanding metallic stent for obstructing left-sided colon cancer or rectal cancer].

OBJECTIVE: To investigate the therapeutic value of self-expanding metallic stent (SEMS) for resectable obstructing left-sided colon cancer or rectal cancer. METHODS: Clinical data of 73 patients who had acute obstruction due to left-sided colon cancer or rectal cancer during May 2007 to January 2012 were retrospectively analyzed. The patients were divided into 2 groups: SEMS group (34 cases) underwent surgical resection after insertion of SEMS; emergency surgery group (39 cases) underwent emergency operation. The 2 group patients were compared for the incidence of primary anastomosis, stoma rate, laparoscopic surgery rate, mortality, postoperative morbidity, ICU admission rate, length of ICU stay, hospital stay, and hospitalization costs. RESULTS: The incidence of primary anastomosis in SEMS group was significantly higher than that in emergency surgery group (97.1% vs. 56.4%, χ(2) = 16.256, P < 0.001), and the protective stoma rate and permanent stoma rate in SEMS group were both lower than those in emergency surgery group (33.3% vs. 86.3%, 2.9% vs. 43.6%, χ(2) value were 14.972 and 16.156, both P < 0.001). Patients in SEMS group underwent significantly more laparoscopic surgery than in emergency surgery group (47.1% vs. 0, χ(2) = 23.505, P < 0.001). There were no significant difference in postoperative mortality (2.9% vs. 10.3%, P = 0.364). The postoperative morbidity in SEMS group was significantly lower than that in emergency surgery group (35.3% vs. 66.7%, P = 0.007). Incisional infection was the most common complication in both groups, and the incidence of which seemed to be more higher in emergency surgery group (17.6% vs. 38.5%, χ(2) = 3.840, P = 0.050). There was a lower ICU admission rate in SEMS group (24.2% vs. 53.9%, χ(2) = 6.972, P = 0.008), and the mean length of ICU stay and hospital stay were both shorter in SEMS group ((69.5 ± 7.4) hours vs. (114.3 ± 10.9) hours, t = -20.23, P < 0.001; (19.6 ± 4.8) days vs. (23.4 ± 6.2) days, t = -2.90, P = 0.005). The cost of hospitalization was less in SEMS group (45 383 ± 15 648 vs. 61 485 ± 20 380, t = -3.74, P < 0.001). CONCLUSIONS: SEMS can effectively relieve the large intestinal obstruction caused by left-sided colon cancer or rectal cancer, and change the traditional emergency surgery into a selective surgery with better outcomes. SEMS appears to be a valuable technique for resectable obstructing left-sided colorectal cancer.

Human acellular dermal matrix in the surgical management of rectal anastomotic stricture.

Anastomotic stricture after rectal resection is an intractable complication of rectal sugery. We present a case to introduce a new method to deal with rectal defect after dissecting anastomotic stricture by using biomaterial. The patient was diagnosed with rectal anastomotic stricture after radical resection for rectal carcinoma and was treated by reoperation. There was a defect in the posterior wall of the rectum after the anastomotic stenosis was dissected. We rapaired the defect successfully by using human acellular dermal matrix (HADM). The repair of rectal defect using HADM was easily and safely performed and provided long-term clinical success. It might be considered an innovative method for rectal defect repair.

Successful diagnosis and treatment of jejunal diverticular haemorrhage by full-thickness enterotomy: A case report.

BACKGROUND: Jejunal diverticula are the rarest of all small bowel diverticula and usually have no classic clinical symptoms. Jejunal diverticular haemorrhage (JDH) is a rare complication and can be difficult to identify and manage, hence it always resulting in a diagnostic delay and unsatisfactory clinical outcomes. Although with the advances in endoscopic technology, no consensus have been reached on the diagnosis and management of JDH, the conventional surgical intervention still remains the mainstream for the management of JDH. We report an unique case of a 63-year-old male who presented with massive haemorrhage from jejunal diverticula, which was successfully managed by initial resuscitation and definitive surgery. CASE SUMMARY: A 63-year-old male was admitted as an emergency with 6 h history of haematemesis and melena. The haematemesis appeared to be bright red, with volume exceeding 100 mL. The amount of melena was estimated to be 200 mL. Initially, the patient received fluid resuscitation and three unit blood transfusion. Then, in order to localize the bleeding sites, colonoscopy, upper gastrointestinal endoscopy, and mesenteric angiography were utilized but failed to identify the source of haemorrhage. Informed consent form was obtained for further treatment, and he was treated with an exploratory laparotomy and the bleeding site was successfully located during the procedure. He was diagnosed with JDH. The postoperative period was uneventful, and he was discharged on day 18 after surgery. No rebleeding occurred at the 1-year follow-up. CONCLUSION: In patients with gastrointestinal bleeding, if various techniques fail to identify the cause of haemorrhage in small bowel and haemodynamic instability is sustained with continuous resuscitation, we recommend surgical intervention should be the ultimate treatment of choice.

Mycoplasma hyorhinis infection in gastric carcinoma and its effects on the malignant phenotypes of gastric cancer cells.

BACKGROUND: Mycoplasma hyorhinis infection has been postulated to play a role in the development of several types of cancer, but the direct evidence and mechanism remained to be determined. METHODS: Immunohistochemistry assay and nested polymerase-chain reaction (PCR) were performed to examine the mycoplasma hyorhinis infection in gastric cancer tissues. Statistical analysis was used to check the association between mycoplasma infection and clinicopathologic parameters. Transwell chamber assay and metastasis assay were used to evaluate mycoplasma hyorhinis' effects on metastasis in vitro and in vivo. Mycoplasma hyorhinis-induced extracellular signal-regulated kinase (ERK) and epidermal growth factor receptor (EGFR) activation were investigated by Western blot. RESULTS: Mycoplasma hyorhinis infection in gastric cancer tissues was revealed and statistical analysis indicated a significant association between mycoplasma infections and lymph node metastasis, Lauren's Classification, TNM stage, and age of the patients. Mycoplasma hyorhinis promoted tumor cell migration, invasion and metastasis in vitro and in vivo, which was possibly associated with the enhanced phosphorylation of EGFR and ERK1/2. The antibody against p37 protein of Mycoplasma hyorhinis could inhibit the migration of the infected cells. CONCLUSIONS: The infection of mycoplasma hyorhinis may contribute to the development of gastric cancer and Mycoplasma hyorhinis-induced malignant phenotypes were possibly mediated by p37.

Adipose-derived stem cells promote gastric cancer cell growth, migration and invasion through SDF-1/CXCR4 axis.

BACKGROUND/AIMS: The CXCR4/SDF-1 axis regulates the trafficking of various cell types. In the study we investigated whether adipose-derived stem cells can promote gastric cancer cell growth and migration through SDF-1/CXCR4 axis. METHODOLOGY: The expression of CXCR4 in gastric cancer cell line MGC-803 and SDF-1 in Adipose-derived stem cells was detected by using PCR method. Furthermore, cell proliferation, migration and invasion assays were examined and inhibitors of CXCR4 were used to determine the effect on cell migration. RESULTS: The cells isolated from subcutaneous adipose tissue show characteristics of stem cells. Gastric cancer cells express CXCR4 and Adipose-derived stem cells express SDF-1. Additionally, the tumor cells showed vigorous proliferative and migratory responses to ADSCs. AMD3100 can effectively reduce the migration of gastric cancer cells. CONCLUSIONS: Adipose-derived stem cells can promote gastric cancer cell growth, migration and invasion through SDF-1/CXCR4 axis. CXCR4 can be used in the treatment of gastric cancer as a potential therapeutic target.

When omeprazole met with asymptomatic Clostridium difficile colonization in a postoperative colon cancer patient: A case report.

RATIONALE: Clostridium difficile infection (CDI) is a symptomatic infection due to the spore-forming bacterium, C. difficile. Asymptomatic C. difficile colonization is the stage in absence of symptoms, with a prevalence of 1.4% to 21% on hospital admission. Proton-pump inhibitors (PPIs) was implicated as a novel potential contributor to CDI. PPIs injection could make asymptomatic C. difficile colonization progress to C. difficile associated diarrhea (CDAD). PATIENT CONCERNS: A postoperative colon cancer patient, who had been taking omeprazole for 4 years after operation, got asymptomatic C. difficile colonization. When he developed clinical symptoms of digestive tract, tumor recurrence was first suspected and intravenous omeprazole was prescribed, which ultimately led to progression to symptomatic CDI. In this report, we tell the confusing differential diagnosis of cancer-associated diseases and CDAD, and discuss the possibility of solving the PPIs overuse problem by making clinical pathway of PPIs use in Chinese hospitals. DIAGNOSES: CDAD, incomplete intestinal obstruction, postoperation of colon cancer. INTERVENTION: Electrolyte replacement and rehydration. Parenteral nutrition support. Omeprazole was prescribed but withdrawn later, and oral vancomycin was given at a dose of 0.25 g 4 times per day for 10 days. OUTCOMES: Diarrhea was resolved, so long as the acid reflux and vomiting. LESSONS: We have 2 lessons here: Be aware of PPIs induced CDI, especially the asymptomatic C. difficile colonization. Making clinical pathway specified on PPIs use by pharmacists could be a practical way to solve the problem of PPIs overuse.

[Laparoscopy combined with transperineal extralevator abdominoperineal excision for locally advanced low rectal cancer].

OBJECTIVE: To evaluate the laparoscopy combined with transperineal extralevator abdominoperineal excision (TP-ELAPE) for locally advanced low rectal caner. METHODS: Clinical data of 12 patients with locally advanced low rectal cancer undergoing laparoscopy combined with TP-ELAPE in our department from May 2013 to March 2015 were retrospectively analyzed. There were 8 male and 4 female patients with median aged of 63 (46 to 72) years. The median distance from tumor lower margin to anal verge was 3.5(2.0 to 4.0) cm. A self-made transanal suit for minimally invasive operation was used to make a sealed lacuna outside the sphincter, thus laparoscope can be applied to perform transperineal operation. RESULTS: All the patients underwent operations successfully without conversion to open abdominal operation. The median operating time was 206 (180 to 280) minutes with perineal operating time 95(80 to 120) minutes. The median intraoperative blood loss was 120(50 to 200) ml. The median postoperative hospital stay was 12(9 to 18 ) days. Postoperative pathology revealed that all circumferential margins (CRM) were negative. The area of sample horizontal section was (2 824±463) mm(2), and of outer muscularis propria was(2 190±476) mm(2). Postoperative complications included chronic sacrococcygeal region pain in 2 cases, urinary retention in 3 cases, perineal wound infection in 1 case. No perineal seroma, perineal hernia, wound dehiscence and sinus tract formation were observed. Among 8 patients with preoperative normal sexual function, sexual dysfunction occurred in 2 patients. There was no local recurrence and metastasis during a median follow-up of 21(12 to 34) months. CONCLUSION: Laparoscopy combined with TP-ELAPE has the potential to simplify the operation procedure for low rectal cancer, can ensure the radical treatment and safety of operation, and may be carried out in experienced centers.

Preliminary study on proteomics of gastric carcinoma and its clinical significance.

AIM: To explore the preliminary identification of serum protein pattern models that may be novel potential biomarkers in the detection of gastric cancer. METHODS: A total of 130 serum samples, including 70 from patients with gastric cancer and 60 from healthy adults, were detected by surface-enhanced laser desorption and ionization time-of-flight mass spectrometry (SELDI-TOF-MS). The data of spectra were analyzed by Biomarker Patterns Software (BPS). Thirty serum samples of gastric cancer patients and 30 serum samples of healthy adults were grouped into the training group to build models, and the other 70 samples were used to test and evaluate the models. The samples of the test group were judged only with their peaks' height and were separated into cancer group or healthy control group by BPS automatically and the judgments were checked with the histopathologic diagnosis of the samples. RESULTS: Sixteen mass peaks were found to be potential biomarkers with a significant level of P< 0.01. Among them, nine mass peaks showed increased expression in patients with gastric cancer. Analyzed by BPS, two peaks were chosen to build the model for gastric cancer detection. The sensitivity, specificity, and accuracy of the model were 90%, 36/40, 86.7%, 26/30, and 88.6%, 62/70, respectively, which were greatly higher than those of clinically used serum biomarkers CEA (carcinoembryonic antigen), CA19-9 and CA72-4. Stage I/II gastric cancer samples of the test group were all judged correctly. CONCLUSION: The novel biomarkers in serum and the established model could be potentially used in the detection of gastric cancer. However, large-scale studies should be carried on to further explore the clinical impact on the model.

Extensively infiltrating colon adenocarcinoma similar to Crohn's disease: a case report.

A 38-year-old Chinese man presenting with chronic diarrhea and secondary incomplete intestinal obstruction was hospitalized in April 2010. Electronic colonoscopy and barium enema examination initially showed longitudinal scar-like strictures and cobblestone appearance in the colon that was similar to those in Crohn's disease. After subtotal colectomy and partial intestinal resection, the pathological examination indicated colon adenocarcinoma that diffusely infiltrated along the colon longitudinal axis rather than the initial diagnosis of Crohn's disease. Pathological examination revealed colon adenocarcinoma with excessive desmoplastic reaction and infiltrating cancer cells along the colon longitudinal axis that may have accounted for the morphological similarities to Crohn's disease in this case. The findings in the present case suggest that colon carcinoma should be considered when Crohn's disease-like findings are encountered, not only in individuals with concurrent cancer in other sites, but also in patients with a long history of gastrointestinal symptoms such as chronic diarrhea or abdominal pain.

Colonic transit time in patient with slow-transit constipation: comparison of radiopaque markers and barium suspension method.

BACKGROUND: Colonic transit study provides valuable information before surgical treatment is considered for patient with constipation. The radiopaque markers method is the most common way for evaluating colon transit time. The aim of this study is to compare the barium suspension with the radiopaque makers to assess the colonic mobility in patient with constipation. METHODS: Colonic transit time was measured in 11 female patients with slow-transit constipation using both radiopaque markers and barium suspension method. In radiopaque markers method, the patient ingested 20 markers on the first day, and an abdominal radiograph was performed every 24h until 80% markers were excreted. In barium suspension method, the patient swallowed up to 50 ml of 200% (w/v) barium meal. The abdominal radiographs were taken at the same time point as the former. RESULTS: The total or segmental colonic transit time were obviously prolonged in all patients. Segmental transits time spent in the right colon, left colon and rectosigmoid for radiopaque markers and barium suspension method was, respectively, 30 ± 6 h and 34 ± 7 h; 38 ± 9h and 32 ± 6 h; 40 ± 8 h and 38 ± 10 h. In the radiopaque markers method, total colonic transit time was 108 ± 14 h and it was 103 ± 13 h in the barium suspension method (P>0.05). CONCLUSION: The barium suspension and radiopaque markers gave the similar results for colonic transit time. The barium suspension was a simple and cheap method for evaluating the colonic mobility.

CXCR4/SDF-1 axis is involved in lymph node metastasis of gastric carcinoma.

AIM: To investigate the role of CXC chemokine receptor-4 (CXCR4) and stromal cell-derived factor-1 (SDF-1) in lymph node metastasis of gastric carcinoma. METHODS: In 40 cases of gastric cancer, expression of CXCR4 mRNA in cancer and normal mucous membrane and SDF-1 mRNA in lymph nodes around the stomach was detected using quantitative polymerase chain reaction (PCR) (TaqMan) and immunohistochemistry assay. SGC-7901 and MGC80-3 cancer cells were used to investigate the effect of SDF-1 on cell proliferation and migration. RESULTS: Quantitative reverse transcription PCR and immunohistochemistry revealed that the expression level of CXCR4 in gastric cancer was significantly higher than that in normal mucous membrane (1.6244 ± 1.3801 vs 1.0715 ± 0.5243, P < 0.05). The expression level of CXCR4 mRNA in gastric cancer with lymph node metastasis was also significantly higher than that without lymph node metastasis (0.823 ± 0.551 vs 0.392 ± 0.338, P < 0.05). CXCR4 expression was significantly related to poorly differentiated, high tumor stage and lymph node metastasis. Significant differences in the expression level of SDF-1 mRNA were found between lymph nodes in metastatic gastric cancer and normal nodes (0.5432 ± 0.4907 vs 0.2640 ± 0.2601, P < 0.05). The positive expression of SDF-1 mRNA in lymph nodes of metastatic gastric cancer was consistent with the positive expression of CXCR4 mRNA in gastric cancer (r = 0.776, P < 0.01). Additionally, human gastric cancer cell lines expressed CXCR4 and showed vigorous proliferation and migratory responses to SDF-1. AMD3100 (a specific CXCR4 antagonist) was also found to effectively reduce the migration of gastric cancer cells. CONCLUSION: The CXCR4/SDF-1 axis is involved in the lymph node metastasis of gastric cancer. CXCR4 is considered as a potential therapeutic target in the treatment of gastric cancer.