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Objective: To investigate the features of contrast-enhanced ultrasound (CEUS) in hepatic epithelioid hemangioendothelioma (HEHE) in order to improve the preoperative diagnosis rate. Methods: CEUS images of 32 pathologically-proven cases of hepatic epithelioid hemangioendothelioma from January 2004 to August 2021 were collected. Lesions were analyzed to observe the features of enhancement mode, enhancement intensity, and distinct enhancement phases. Results: Among the 32 cases, one had a solitary lesion, 29 had multiple lesions, and two had diffuse-type lesions. Contrast-enhanced ultrasound revealed a total of 42 lesions in 32 cases. In terms of arterial phase enhancement, 18 lesions had overall enhancement, six lesions had uneven dendritic enhancement, 16 lesions had rim-like enhancement, and two lesions had just slight peripheral spot enhancement around the lesions. Among the three cases, there were multiple lesions that had overall enhancement and ring enhancement. In terms of the enhancement phase, 20 lesions showed "fast progression", 20 lesions showed "same progression", and two lesions showed "slow progression". During the late arterial or early portal venous phases with rapid washout, all lesions manifested as hypoechoic. With peaked enhanced intensity, 11 lesions had a lower enhancement intensity than the surrounding normal liver parenchyma; 11 lesions had the same enhancement degree as the surrounding normal liver parenchyma; and 20 lesions had a higher enhancement degree than the surrounding normal liver parenchyma. All 16 ring-enhancing lesions had marked hyperenhancement. In the typical enhancing lesions, four showed hyperenhancement, five showed low enhancement, and nine showed isoenhancement. In the dendrite-enhancing lesions, there were two isoenhancing and four hypoenhancing. Contrast-enhanced ultrasound delineated the boundaries of all lesions more clearly than two-dimensional ultrasound. Conclusion: Contrast-enhanced ultrasound has certain value in the diagnosis of hepatic epithelioid hemangioendothelioma.
Subject(s)
Humans , Hemangioendothelioma, Epithelioid/pathology , Contrast Media , Retrospective Studies , Liver Neoplasms/pathology , Portal Vein/pathology , UltrasonographyABSTRACT
Four cyclic peptides were isolated from the 75% ethanol extract of the fibrous roots of Pseudostellaria heterophylla by silica gel, Sephadex LH-20 column chromatography, and semi-preparative HPLC. Through mass spectrometry, NMR and other methods, they were identified as pseudostellarin L(1), heterophyllin B(2), pseudostellarin B(3), and pseudostellarin C(4). Among them, compound 1 was a new cyclic peptide, and compounds 2-4 were isolated from the fibrous roots of P. heterophylla for the first time. None of these compounds displayed cytotoxic activities against MCF-7, A549, HCT-116, and SGC-7901 cells.
Subject(s)
Caryophyllaceae/chemistry , Chromatography, High Pressure Liquid , Magnetic Resonance Spectroscopy , Peptides, Cyclic/pharmacology , Plant Roots/chemistryABSTRACT
Objective To explore the relationship between the expression of DEAO-box helicase 5(DDX5) and transcription factor 12(TCF12) with amyotrophic lateral sclerosis ( ALS ) hippocampal lesions by detecting the expressions and the interaction of DDX5 and TCF12 in the hippocampus of SOD1-G93A mutant ALS transgenic mice. Methods Forty- two pairs of SOD1-G93A mutant ALS transgenic mice and wild-type mice were divided into three groups at the age of 95 days (early onset stage), 108 days (middle onset stage) and 122 days (late onset stage). RT-PCR, Western blotting and double immunofluorescence labeled technique were used to detect the expressions of DDX5 and TCF12 in the hippocampus. Co-immunoprecipitation assasy was used to detect the interaction between DDX5 and TCF12. Results Compared with the wild-type mice of the same age, DDX5 and TCF12 mRNA in the hippocampus of SOD1-G93A mutant ALS transgenic mice were unchanged, but DDX5 and TCF12 protein were up-regulated significantly at day 95, 108 and 122. DDX5 and TCF12 positive cells were found in both DG area and hippocampus proper, and DDX5 and TCF12 were co-localized with neurons. The immunoreactivities of DDX5 and TCF12 in the hippocampus of SOD1-G93A mutant transgenic mice were elevated compared with wild-type mice at the same time point. Co-immunoprecipitation assasys confirmed that there existed interactions between DDX5 and TCF12 protein. Conclusion DDX5 and TCF12 protein are up-regulated in the hippocampal tissues of SOD1-G93A mutant ALS transgenic mice. The abnormal expressions of DDX5 and TCF12 are involved in the hippocampal lesions of ALS.
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OBJECTIVE:To optim ize the ultrafiltration technology of enzymatic hydrolysate from Eucommia ulmoides peel. METHODS:The single factor test was adopted to investigate the effects of molecular weight of ultrafiltration membrane ,liquid temperature,operating pressure ,operating frequency ,membrane filtration time ,liquid concentration and pH on transfer rates of aucubin,geniposide and chlorogenic acid as well as solid removal rate in enzymatic hydrolysate from E. ulmoides peel. Setting the molecular cut off of fixed ultrafiltration membrane of 100 000,liquid concentration of 7 g/L,and pH value of 7,the ultrafiltration technology was optimized by Box-Behnken design response-surface methodology and validated with liquid temperature ,operating pressure,operating frequency and membrane passing time as factors ,using comprehensive scores calculated from transfer rates of aucubin,geniposide and chlorogenic acid as well as solid removal rate as indexes. RESULTS :The optimal ultrafiltration technology of enzymatic hydrolysate from E. ulmoides peel was as follows as liquid temperature of 35 ℃,operating pressure of 0.5 MPa,operating frequency of 35 Hz and membrane passing time of 42 min. Results of validation tests showed that the comprehensive scores of the transfer rates of aucubin ,geniposide and chlorogenic acid as well as solid removal rate in enzymatic hydrolysate from E. ulmoides peel was 78.06%(RSD=1.43%,n=3),and its relative error with the predicted value (77.18%) was 1.14%. CONCLUSIONS :The optimized ultrafiltration technology is stable and reliable ,and can be used for the ultrafiltration purification of enzymatic hydrolysate from E. ulmoides peel.
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Objective:To establish high performance liquid chromatography (HPLC) fingerprint and multi-component determination for the substance benchmark of Yiweitang, and to evaluate its quality in combination with chemical pattern recognition method. Method:Fifteen batches of substance benchmark of Yiweitang were prepared, the "Chinese medicine chromatographic fingerprint similarity evaluation system" (2012 edition) was used to calculate similarity. Cluster analysis, principal component analysis and orthogonal partial least squares-discriminant analysis were employed to handle the common peaks for evaluating the quality difference among 15 batches of the substance benchmark. The contents of catalpol, verbascoside and methylophiopogonanone A were determined with mobile phase system of acetonitrile-phosphoric acid solution at detection wavelengths of 210 nm and 334 nm. Result:There were 22 common peaks in HPLC fingerprint of the substance benchmark, among them, peaks 1, 9, 12, 14-17, 19 and 20 belonged to Rehmanniae Radix, peaks 3, 4, 6, 7 and 21 belonged to Glehniae Radix, peaks 5 and 22 belonged to Ophiopogonis Radix, peaks 2 and 18 belonged to Polygonati Odorati Rhiaoma, peak 8 was the common peak of Ophiopogonis Radix and Rehmanniae Radix, peak 10 was shared by Ophiopogonis Radix, Polygonati Odorati Rhiaoma<italic> </italic>and<italic> </italic>Rehmanniae Radix, peak 11 was the common peak of these four herbs, and peak 13 was shared by Polygonati Odorati Rhiaoma and Rehmanniae Radix. The similarities between HPLC fingerprints of 15 batches of the substance benchmark and the control fingerprint were all >0.90, the samples could be divided into four categories by three chemical pattern recognition methods. Quantitative analysis showed that the contents of catalpol, verbascoside and methylophiopogonanone A among 15 batches of samples ranged from 0.37% to 1.14%, 0.002% to 0.054% and 0.016% to 0.079%, respectively. Conclusion:The established fingerprint and determination for the substance benchmark of Yiweitang have good separation and high accuracy, which reflect the overall chemical composition characteristics of Yiweitang, and can provide experimental basis for the further development and quality control of the compound preparations of this famous classical formula.
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@#Objective To compare vein valve function following pharmacomechanical thrombolysis (PMT) with simple catheter-directed thrombolysis (CDT) for deep vein thrombosis. Methods We retrospectively analyzed the clinical data of sixty patients who suffered acute lower extremity deep vein thrombsis in our hospital between October 2016 and March 2017. All patients underwent contralateral preprocedural duplex and bilateral postprocedure duplex to access patency and valve function. The patients were divided into three groups including a group A with catheter-directed thrombolysis (CDT) alone (36 patients with 20 males and 16 females at average age of 56 years), a group B with PMT alone (15 patients with 8 males and 7 females at average age of 55 years), and a group C with PMT combined CDT (9 patients with 4 males and 5 females at average age of 56 years). The valve function was compared among the Group A, Group B and Group C. Results There were 40.0% (24/60) patients with bilateral femoral vein valve reflux, 40.0% (24/60) patients with unilateral femoral vein valve reflux (all in the treated limbs), 20% (12/60) patients had no reflux in both limbs. Of the limbs treated with CDT alone, PMT alone and PMT combined CDT, the rate of valve reflux was 38.9% (14/36), 33.3% (5/15), and 55.6% (5/9) respectively (P=0.077). Conclusion In the patients suffering acute DVT, PMT or PMT combined CDT does not hamper valve function compared with CDT alone.
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To study the effect of serum containing Xihuang pill on the proliferation of human breast cancer cell lines MDA-MB-435 and MCF-7 and the gene and protein expressions of Bcl-2, Bax, TP53, in order to explore the effect and mechanism of Xihuang pill in resisting breast cancer. The serum of the rats was prepared by the method of MTT assay. The expressions of Bcl-2 and Bax were detected by RT-PCR. The serum levels of Bcl-2 and Bax and the mRNA expression of TP53 were detected by immunofluorescence. The rats with serum containing Xihuang pill could inhibit the proliferation of MDA-MB-435 cells and MCF-7 cells (<0.05). The serum containing Xihuang pill increased TP53 and Bax in MDA-MB-435 cells (<0.05), and the ratio of Bcl-2/Bax was decreased (<0.05). Meanwhile, the serum containing Xihuang pill could up-regulate the mRNA expression of Bax in MCF-7 cells and decrease the expression of Bcl (<0.05), but there was no significant difference between the expression of TP53mRNA and Bax protein expressions after the treatment of MCF-7 cells with Xihuang pill serum. Serum containing Xihuang pill can induce the apoptosis of human breast cancer cells, and the mechanism of estrogen receptor-negative breast cancer cell apoptosis may be induced by up-regulating the mRNA expression of TP53, which can induce the expression of Bax and promote the metastasis of Bax to mitochondria, and ultimately play the role of inducing apoptosis.
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<p><b>OBJECTIVE</b>To investigate the expression and the subcellular localization of HDAC9 in different brain regions of mice after cerebral ischemic injury and explore the association between HDAC9 and ischemic stroke.</p><p><b>METHODS</b>Twenty-one male C57BL/6 mice were randomly divided into sham-operated group (n=9) and operated group (n=12). In the latter group, the mice with Zea-Longa neurological deficit scores of 2 or 3 following middle cerebral artery occlusion (MCAO) were assigned into MCAO group (n=9). Immunofluorescence was performed to investigate the subcellular localization of HDAC9 in the brain tissues on day 3 after MCAO. Western blotting and qRT-PCR were used to analyze the expression of HDAC9 in different regions of the brain. Results Immunofluorescence showed more intense HDAC9 expressions in the brain tissues around the infarct focus, and in the cells surrounding the infarct, HDAC9 expression was obviously increased in the cytoplasm and reduced in the cell nuclei. Compared with the other brain regions, the ipsilesional cortex with MCAO showed more abundant HDAC9 expressions at both the mRNA and protein levels (P<0.05).</p><p><b>CONCLUSION</b>HDAC9 may be closely related to cerebral ischemic injury and participate in the pathophysiological process of ischemic stroke.</p>
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To investigate the effects of Kluyveromyces marxianus M3 isolated from Tibetan mushrooms on diet-induced hypercholesterolemia in rats, female Wistar rats were fed a high-cholesterol diet (HCD) for 28 d to generate hyperlipidemic models. Hyperlipidemic rats were assigned to four groups, which were individually treated with three different dosages of K. marxianus M3+HCD or physiological saline+HCD via oral gavage for 28 d. The total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels in the serum and liver of the rats were measured using commercially available enzyme kits. In addition, the liver morphology was also examined using hematoxylin and eosin staining and optical microscopy. According to our results, the serum and liver TC, TG, LDL-C levels and atherogenic index (AI) were significantly decreased in rats orally administered K. marxianus M3 (p <0.01), and the HDL-C levels and anti atherogenic index (AAI) were significantly increased (p <0.01) compared to the control group. Moreover, K. marxianus M3 treatment also reduced the build-up of lipid droplets in the liver and exhibited normal hepatocytes, suggesting a protective effect of K. marxianus M3 in hyperlipidemic rats.
Subject(s)
Animals , Biological Therapy/methods , Cholesterol/analysis , Diet/methods , Hypercholesterolemia/therapy , Kluyveromyces/growth & development , Kluyveromyces/metabolism , Agaricales , Histocytochemistry , Kluyveromyces/isolation & purification , Liver/chemistry , Liver/pathology , Microscopy , Rats, Wistar , Serum/chemistryABSTRACT
<p><b>OBJECTIVE</b>To classify colorectal carcinoma (CRC) by TNM staging integrated with the gene expression profile and copy number variation (CNV).</p><p><b>METHODS</b>Profile data of gene expression and CNV of CRC were downloaded from public database and processed with batch bias adjustment, quartile normalization, missing value estimation and feature filtration. The processed profiles of mRNA and CNV were introduced into the codes of Bayesian consensus clustering (BCC) method and were used to calculate the subclasses of CRC. With the follow-up information of disease free survival of CRC patients, the prognostic values of the subclasses was investigated and the software of function enrichment analysis was employed to discover the major pathway signaling to each interesting subclass. All statistic analyses were performed under R-3.0.1 environment or by using SPSS 16.0 software.</p><p><b>RESULTS</b>Profile data of gene expression and corresponding CNV from 335 CRC patients with TNM stage Ⅱ-Ⅲ and followed-up information were obtained. After feature filtering, the profiles contained 1578 probes of mRNA and 345 location of CNV. Four CRC subclasses were identified by the integrative analysis with BCC, and the concordances of BCC subclasses and each of gene-based subclasses (Cramer's V=0.49), CNV-based subclasses (Cramer's V=0.51) and Marisa's subclasses (Cramer's V=0.32) were statistically significant (Ps<0.001). Among BCC subclasses, BCC-I had a favorable prognosis, while BCC-Ⅳ had more unfavorable prognosis. The differences of prognosis were significant among BCC-I, BCC-(Ⅱ+Ⅲ) and BCC-Ⅳ with an overall log-rank P<0.001. The top enriched function was DNA damage and repair signaling when BCC-I compared to BCC-Ⅳ, and the new subgroups classified by the genes associated with enriched signaling had the better prognostic value than BCC subclasses but both of them were significantly correlated (Cramer's V=0.39, P<0.001).</p><p><b>CONCLUSION</b>BCC method is effective to integrate multi-type genomic data for molecular classification of colorectal carcinoma, and the BCC-Ⅳ subclass has poor prognosis, which may be associated with the decreased repairing function of DNA damage.</p>
Subject(s)
Humans , Colorectal Neoplasms , Classification , Genetics , Pathology , DNA Copy Number Variations , Gene Expression Profiling , Neoplasm Recurrence, Local , Postoperative Period , Prognosis , TranscriptomeABSTRACT
<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of colonoscopy-guided placement of self-expandable metallic stent without fluoroscopic monitoring in the emergence management for acute malignant colorectal obstruction.</p><p><b>METHODS</b>Clinical data of 42 patients (24 males and 18 females with a mean age of 64.3 years) undergoing colonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring for acute malignant colorectal obstruction between January 2010 and June 2012 were reviewed retrospectively.</p><p><b>RESULTS</b>The obstruction was located in the rectum (n=19), sigmoid (n=9), descending colon (n=8), splenic flexure (n=1), hepatic flexure (n=3), and ascending colon (n=2). Technical success was achieved in all the 42 patients (100%). The mean time of operation was (11.8±10.4) min (range 1.1-51.0 min). No serious procedure-related complication occurred. Minor bleeding occurred in 3 cases (7.1%). One patient died on the second day after surgery because of heart failure.</p><p><b>CONCLUSIONS</b>Colonoscopy-guided placement of self-expandable metallic stents without fluoroscopic monitoring in emergence management for acute malignant colorectal obstruction is effective and safe with shorter operative time.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Colonoscopy , Colorectal Neoplasms , Intestinal Obstruction , Therapeutics , Retrospective Studies , StentsABSTRACT
The protective effects of Da Chai Hu Granules (DCHKL) on islet cells which were incubated with 4 mmol x L(-1) alloxan (AXN) were studied. The viability of islet cells were measured with MTT. Insulin released into medium and in islets was detected by radioimmunoassay. Cell apoptosis rate was determined by flow cytometry. The expression of anti-apoptotic gene Bcl-2 and pro-apoptotic gene Bax in islet cells were measured with RT-PCR (reverse transcription polymerase chain reaction). Serum containing DCHKL can promote the activity of islet cells significantly (P < 0.01). Basal insulin secretion and high glucose-stimulated insulin secretion increased significantly (P < 0.01). Serum containing DCHKL can inhibit apoptosis of islet cells, the ratio of apoptosis was decreased. Serum containing DCHKL increased expression of Bcl-2 mRNA and decreased expression of Bax mRNA. DCHKL can significantly promote proliferation of islet cells and increase the amount of basal secretion of pancreatic islet cells and high glucose-stimulated insulin secretion. The expression of Bcl-2 increased significantly. The expression of Bax decreased significantly. DCHKL have a protective effect on the islet cells.
Subject(s)
Animals , Rats , Alloxan , Toxicity , Apoptosis , Cell Proliferation , Cells, Cultured , Drug Combinations , Drugs, Chinese Herbal , Pharmacology , Insulin , Metabolism , Bodily Secretions , Islets of Langerhans , Cell Biology , Metabolism , Plants, Medicinal , Chemistry , Protective Agents , Pharmacology , Proto-Oncogene Proteins c-bcl-2 , Genetics , Metabolism , RNA, Messenger , Metabolism , Rats, Sprague-Dawley , bcl-2-Associated X Protein , Genetics , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To investigate the emergency therapeutic strategy for sigmoid vovulus in the elderly.</p><p><b>METHODS</b>Clinical data of 14 elderly patients with sigmoid vovulus were analyzed retrospectively.</p><p><b>RESULTS</b>The mean age was(79.1±7.2) years(range, 70-93), and 11 patients (78.6%) were male. Emergency decompression and restoration with colonoscopy was performed in all the patients with a success rate of 100%. No patient required emergent surgery. Four patients(28.6%) recurred and they were managed well by repeat colonoscopic restoration.</p><p><b>CONCLUSION</b>Emergency colonoscopic restoration is the first treatment of choice for sigmoid vovulus in the elderly because it is safe and effective, and can be performed repeatedly.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Colon, Sigmoid , General Surgery , Colonoscopy , Decompression, Surgical , Emergencies , Intestinal Volvulus , General Surgery , Recurrence , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of surgical treatment for recurrent colorectal carcinoma in the elderly.</p><p><b>METHODS</b>The clinical and follow up data of 24 elderly patients with recurrent colorectal carcinoma who were treated between January 2000 and June 2009 at the Changhai hospital of the Second Military Medical University were analyzed retrospectively.</p><p><b>RESULTS</b>Among the 24 patients there were 14 men and 10 women. The mean age of the patients was 76.9 ± 5.3 years. The local recurrence was found in 15 patients. In 9 patients, both distant metastases and local recurrence were found. A total of 24 patients received operation, including radical resection in 15 patients and palliative resection in 8 patients. One patient had laparotomy only because of diffuse metastases in the abdomen and involvement of the duodenum and common bile duct.The patient received stent placement in the common bile duct and chemotherapy after the surgery. Postoperative complication occurred in 7(29.2%) patients, which included ileus(n=1), pulmonary infection(n=1), urinary infection(n=1), wound infection(n=2), wound dehiscence(n=1), and wound fat liquefaction(n=1). There were no perioperative deaths. The median survival time was 6 months in the entire cohort. The median survival time was 33 months in patients undergoing radical resection, and the 1-, 3-, and 5-year survival rate was 71.4%, 28.6%, and 14.3%. The median survival time was 3 months in patients who underwent palliative resection, and the 1-year survival rate was 0. The difference between the two groups was statistically significant(P<0.01).</p><p><b>CONCLUSION</b>Outcomes are acceptable after radical resection for elderly patients with recurrent colorectal cancer if careful preoperative evaluation and perioperative management are performed.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Colorectal Neoplasms , Pathology , General Surgery , Neoplasm Recurrence, Local , General Surgery , Prognosis , Retrospective Studies , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To evaluate the accuracy and value of the placement of metallic clips during colonoscopy in the localization of colorectal cancer and incision selection.</p><p><b>METHODS</b>A total of 30 patients received metallic clip placement by colonoscopy before operation. Abdominal plain film (supine and upright position) was taken and incision was determined by the projection of clips on the abdominal wall.</p><p><b>RESULTS</b>The inaccuracy rate of localization by colonoscopy was 30%(9/30). Colonoscopy combined with the placement of metallic clips achieved an accurate incision rate of 100% (30/30).</p><p><b>CONCLUSIONS</b>There is a considerable rate of inaccuracy for localization in colonic cancer by colonoscopy. Colonoscopy combined with placement of metallic clips should be considered in order to select a reasonable incision.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Colon , General Surgery , Colonic Neoplasms , General Surgery , Colonoscopy , Surgical InstrumentsABSTRACT
Apoptosis-inducing factor (AIF) is a mitochondrial flavoprotein that mediates both NADH-oxidizing and caspase-independent apoptosis. Further, the proapoptotic activity of AIF is located in the C-terminus of AIF, although the precise minimum sequence responsible for apoptosis induction remains to be investigated. In the present study, we generated two truncated AIFs, AIFΔ1-480-FLAG, which is a FLAG-tagged C-terminal peptide comprising amino acids from 481 to 613, and AIF360-480 containing amino acids from 360 to 480 of AIF. We used confocal microscopy to demonstrate that both the truncated proteins are expressed and located in the cytoplasm of transfected cells. AIFΔ1-480 but not AIF360-480 induces apoptosis in transfected cells. We also found that the expression of AIFΔ1-480 could initiate the release of cytochrome c from the mitochondria. The suppression of caspase-9 via siRNA blocked the proapoptotic activity of AIFΔ1-480. Therefore, AIFΔ 1-480 is sufficient for inducing caspase-9-dependent apoptotic signaling, probably by promoting the release of cytochrome c. At last, we generated a chimeric immuno-AIFΔ 1-480 protein, which comprised an HER2 antibody, a Pseudomonas exotoxin A translocation domain and AIFΔ 1-480. Human Jurkat cells transfected with the immuno-AIFΔl-480 gene could express and secrete the chimeric protein, which selectively recognize and kill HER2-overexpressing tumor cells. Our study demonstrates the feasibility of the immuno-AIFΔl-480 gene as a novel approach to treating HER2-overexpressing cancers.
Subject(s)
Humans , Alcohol Oxidoreductases/drug effects , Apoptosis Inducing Factor/pharmacology , Apoptosis/drug effects , DNA, Complementary/drug effects , DNA-Binding Proteins/drug effects , Alcohol Oxidoreductases/genetics , Alcohol Oxidoreductases/metabolism , Apoptosis Inducing Factor/genetics , Apoptosis Inducing Factor/metabolism , Apoptosis/genetics , Blotting, Western , DNA, Complementary/genetics , DNA, Complementary/metabolism , DNA-Binding Proteins/genetics , DNA-Binding Proteins/metabolism , Fluorescent Antibody Technique, Indirect , Jurkat Cells , Microscopy, Confocal , Reverse Transcriptase Polymerase Chain Reaction , TransfectionABSTRACT
<p><b>OBJECTIVE</b>To analyze the factors associated with anastomotic leakage after anterior resection in rectal cancer with the technique of total mesorectal excision (TME).</p><p><b>METHODS</b>From January 2005 and December 2007, 738 consecutive patients with rectal cancer underwent anterior resection. The data of those patients was collected and reviewed retrospectively. The associations between anastomotic leakage and 9 patient-related variables as well as 7 surgical-related variables were examined.</p><p><b>RESULTS</b>Low rectal cancer (located 7 cm or less above the anal edge), non-specialized surgeon and transanal tube use were the risk factors associated with anastomotic leakage on univariate analysis. The anastomotic leakage rate of low-rectal cancer was significantly higher than that of high-rectal cancer (5.9% vs. 0.9%, P = 0.003). The anastomotic leakage rate of the cases operated by colorectal surgeon was significantly lower than that of the cases operated by non-specialized surgeon (3.9% vs. 11.3%, P = 0.031). There was a tendency for colorectal surgeons to operate on a greater proportion of low rectal cancer than non-specialized surgeons (72.1% vs. 52.8%, P = 0.003). The leakage rate of transanal tube group was unexpectedly higher than that in patients without transanal tube (14.5% vs. 3.6%, P < 0.001). On multivariate logistic regression analysis, diabetes mellitus (P = 0.027), distance less than 1 cm from tumor to distal resection margin (P = 0.009) and defunctioning stoma (P = 0.031) were also associated with anastomotic leakage rate besides low rectal cancer, non-specialized surgeon and transanal tube use. In a further analysis of 522 patients with low rectal cancer, the leakage rate of defunctioning stoma group was significantly lower than that of non-stoma group (2.9% vs. 8.5%, P = 0.007). By contract, the leakage rate of transanal tube group was still higher than that in patients without transanal tube (15.1% vs. 4.9%, P = 0.008) because of its poor protective effect as well as the selection bias.</p><p><b>CONCLUSIONS</b>Low-rectal cancer, non-specialized surgeons and diabetes mellitus are risk factors of anastomotic leakage after rectal surgery. A defunctioning stoma was effective in preventing leakage after low-rectal cancer surgery.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anastomosis, Surgical , Logistic Models , Postoperative Complications , Rectal Fistula , Rectal Neoplasms , General Surgery , Rectum , General Surgery , Retrospective Studies , Risk Factors , Surgical StomasABSTRACT
<p><b>OBJECTIVE</b>To introduce the experiences of pull-through transection and double stapling anastomosis for early lower rectal cancer.</p><p><b>METHODS</b>From May 2001 to March 2008, 25 patients with early stage lower rectal cancer were operated by using pull-through transection and double stapling anastomosis. The average distance between the dentate line and lower margin of the tumor is (3.2 +/- 0.5) cm (2.0 - 4.5 cm). The average tumor diameter is (2.8 +/- 0.8) cm (2.0 - 3.5 cm).</p><p><b>RESULTS</b>The average distance between the lower margin of the tumor and transection line is (1.5 +/- 0.4) cm (1.1 - 2.2 cm). All the resection margins were negative. Eighteen cases of the anastomosis were above the dentate line, 0.3 - 2.1 cm [(1.7 +/- 0.2) cm] and the other 7 were below, 0.1 - 0.5 cm (average 0.3 cm). Anastomotic leakage occurred in 1 case, and cured with conservative treatment. Local recurrence occurred in 1 case (4.0%), liver metastasis in 3 (12.0%) and lung metastasis in 2(8.0%), respectively. Mild fecal incontinence occurred in 7 cases.</p><p><b>CONCLUSION</b>Compared with trans-abdominal transection of distal rectum in low anterior resection of rectal cancer, pull-through transection and anastomosis provides more precise control of the cutting line and simpler resection.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Anal Canal , General Surgery , Anastomosis, Surgical , Methods , Follow-Up Studies , Rectal Neoplasms , Pathology , General Surgery , Rectum , General Surgery , Retrospective Studies , Surgical Stapling , MethodsABSTRACT
<p><b>OBJECTIVE</b>To evaluate the value of positron emission tomography (PET) in diagnosing liver metastases from colorectal cancer.</p><p><b>METHODS</b>Eighteen patients suspected with liver metastases after resection of colorectal cancer and three patients suspected with other diseases were diagnosed by PET and CT before operation. The result of both diagnostic approaches was compared with the result of exploratory operation.</p><p><b>RESULTS</b>Seventeen of 18 patients were confirmed as liver metastases after resection of colorectal cancer, in whom 14 patients had other synchronous metastases outside liver metastasis including lung metastasis (n= 2), abdominal wall metastasis (n= 2 ), bone metastasis (n= 1), peritoneal cavity lymph nodes metastasis (n= 6), mediastinal lymph nodes (n= 2), virchow lymph node metastasis (n= 1). One patient with negative PET diagnosis was still alive with cancer- free after 1 year followed- up. Three patients suspected with other diseases were also diagnosed as liver metastases from colorectal cancer by PET.</p><p><b>CONCLUSION</b>PET has higher sensitivity in diagnosing liver metastases or other synchronous metastases after resection of colorectal cancer, which suggests that PET can guide the determination of second operative surgery for liver metastases after resection of colorectal cancer.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Colorectal Neoplasms , Pathology , Liver Neoplasms , Diagnostic Imaging , Lymphatic Metastasis , Diagnostic Imaging , Positron-Emission Tomography , Sensitivity and Specificity , Tomography, X-Ray ComputedABSTRACT
<p><b>OBJECTIVE</b>To investigate the diagnosis and surgical management of adult Hirschsprung's disease.</p><p><b>METHODS</b>Clinical data of 15 patients with adult Hirschsprung's disease were reviewed retrospectively from June 1992 to June 2004.</p><p><b>RESULTS</b>Patients age ranged from 17 to 54 years old. The main manifestations included long-term (ranged from 9.5 month to 50 years) constipation and abdominal distention. Acute abdominal pain occurred in six patients, but no sign of de hydration and malnutrition occurred in all patients. Bowel stenosis and dilation could be examined by barium enema. Soave procedure was performed in 3 patients, subtotal colectomy with coloanal anastomosis was performed in twelve patients. The function of defecation was improved in all patients after operation.</p><p><b>CONCLUSIONS</b>The diagnosis of adult Hirschsprung's disease mainly depends on the history of constipation from infant and barium enema. Subtotal colectomy with coloanal anastomosis is an effective and safe operative procedure.</p>