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Objective:To explore the relationship between microsatellite instability (MSI) and Ki-67 expression level and the clinicopathological features of colorectal cancer, and investigate their impact for prognosis, so as to provide reference for prognostic judgment of colorectal cancer.Methods:The data of 183 patients who underwent radical colorectal cancer surgery and were diagnosed pathologically in the Department of General Surgery, the First Affiliated Hospital of Xinxiang Medical University from January 2017 to December 2019 were retrospectively analysed, including 101 males (55.2%)and 82 females(44.8%), ranged from 20 to 86 years and the mean age was(60.27±13.13)years. According to the results of mismatch repair protein immunohistochemical staining, the patients were divided into MSI-H group ( n=32) and MSI-L/MSS group ( n=151). According to the results of Ki-67 antigen immunohistochemical staining, the patients were divided into low Ki-67 expression group (<82.5%, n=136) and high Ki-67 expression group (≥82.5%, n=47) , among which 62 cases (78.5%) with low Ki-67 expression and 17 cases (21.5%) with high Ki-67 expression were in patients with Ⅲ+ Ⅳ stage colorectal cancer. The data of clinicopathological features, disease-free survival, and overall survival were collected and analyzed. The cotegorical variables were presented as n(%), and the comparisons between groups were performed using Chi-square test or Fisher′s exact test. The multivariate Logistic regression model was used to estimate the correlation between microsatellite instability and Ki-67 expression level and clinicopathologic characteristics of colorectal cancer. Kaplan-Meier survival curve and COX proportional hazards regression model were used to analyze the correlation between microsatellite instability and Ki-67 expression level and disease-free survival and overall survival. Results:Single factor analysis showed that the differences in gender ( χ2=4.37, P=0.037), tumor site ( χ2=26.40, P<0.001), tumor maximum diameter ( χ2=11.12, P=0.001) and nerve invasion ( χ2=5.53, P=0.019) between MSI-H group and MSI-L/MSS group were statistically significant. Multivariate Logistic regression model analysis showed that only gender ( OR=3.013, 95% CI: 1.183-7.672, P=0.021), tumor location ( OR=0.167, 95% CI: 0.067-0.419, P<0.001) and nerve invasion ( OR=0.202, 95% CI: 0.042-0.968, P=0.045) were independently correlative factors for MSI status. In Ⅲ+ Ⅳ stage colorectal cancers, the difference in tumor site between low Ki-67 expression group and high Ki-67 expression group was statistically significant( χ2=3.91, P=0.048). Multivariate Cox proportional hazards regression model analysis revealed that high Ki-67 expression ( HR=0.301, 95% CI: 0.118-0.768, P=0.012; HR=0.275, 95% CI: 0.083-0.912, P=0.035) and MSI-H ( HR=0.072, 95% CI: 0.010-0.525, P=0.009; HR=0.122, 95% CI: 0.017-0.900, P=0.039) were independently protective factors for disease-free survival and overall survival. Conclusions:MSI-H colorectal cancer is common in males, right-sided colonic cancers and non-neuroinvasive patients. In stage Ⅲ+ Ⅳ colorectal cancer, the expression level of Ki-67 in right-sided colonic cancer was lower than in left-sided colorectal cancer. Patients with MSI-H and high Ki-67 expressive colorectal cancer had longer disease-free survival, longer overall survival and better prognosis.
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Objective:To explore the characteristics of Siewert classification and microsatellite instability(MSI) and HER2 expression in adenocarcinoma of esophagogastric junction (AEG).Methods:The clinicopathological data of gastric adenocarcinoma from May 2019 to November 2020 were retrospectively analyzed. The patients were divided into two groups: AEG group and non AEG group. The composition ratio of Siewert type of AEG was counted, and the relationship between tumor size and Siewert type was analyzed. The MSI status and HER2 expression status of AEG and non AEG were statistically compared. The measurement data of normal distribution were expressed as mean ± standard deviation( Mean± SD), the comparison between groups were by t test, the comparison of count data between groups were by Chi-square test. Results:A total of 328 consecutive cases of gastric adenocarcinoma were collected, including 242 cases of AEG and 86 cases of non AEG. The Siewert classification of AEG was mainly type Ⅱ (151 cases, 62.40%), followed by type Ⅲ (86 cases, 35.54%) and type Ⅰ (5 cases, 2.07%). The analysis of the relationship between the size of the tumor length and the number of Siewert type showed that the number of Siewert type Ⅱ cases decreased and the number of Siewert type Ⅲ cases increased with the increase of the tumor size. MSI status was detected non selectively in 192 cases of gastric adenocarcinoma (140 cases of AEG and 52 cases of non AEG). There were 12 cases of MSI (6.25%), 2 cases of MSI-H (1.04%) and 10 cases of MSI-L (5.21%). There was no significant difference in MSI ratio between AEG group and non AEG group ( P>0.05). All MSI cases were negative or weakly positive for PMS2. The expression of HER2 was detected by immunohistochemistry in 313 cases of gastric adenocarcinoma, except 15 cases of PTIS/T1a. There were 30 cases (9.58%) with HER2 expression 3+ . Thirty-two cases (10.22%) expressed HER2 (2+ ), of which 7 cases were detected by fluorescence in situ hybridization (FISH), and 3 cases were positive. The proportion of HER2 (3+ ) in AEG was significantly higher than that in non AEG group ( P<0.05). Conclusions:The main type of AEG was Siewert type Ⅱ. AEG may mostly occur between 1 cm above the esophagogastric junction and 2 cm below the esophagogastric junction; For endoscopic screening of early AEG, more attention should be paid to this area of stomach. Siewert type Ⅲ may be derived from the development of Siewert type Ⅱ. The incidence of microsatellite instability in gastric cancer is low. Compared with other gastric adenocarcinoma, AEG has no specificity in MSI. The MSI of AEG was mainly the expression defect of PMS2. Compared with other gastric adenocarcinoma, there are more HER2 overexpression in AEG.
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Objective To investigate the molecular mechanism of miR-139-5p targeting transforming growth factor-β1 (TGF-β1) in the regulation of epithelial mesenchymal transition (EMT),thus inhibiting invasion and metastasis of hepatoma cells.Methods Bioinformatics methods were used to determine whether miR-139-5p was the best binding miRNA of TGF-β1.Correlation between the TGF-β1 expression as detected by immunohistochemistry and Western blot,and the miR-139-5p level by qRT-PCR in 56 hepatoma tissues and 20 normal tissues,respectively,was analyzed.The relationship between the miR-139-5p level as detected by qRT-PCR,and TGF-β1,E-cadherin and Vimentin by Western blot in the high and low metastatic hepatoma cell lines were investigated.In recombinant cell lines,whether miR-139-5p could bind to the 3'UTR site of TGF-β1 was evaluated,and the effect on invasive ability after modulating miR-139-5p level was also tested by the transwell method.Results A total of 20 miRNAs were found to be able to bind with TGF-β1 by bioinformatics methods and among these mRNAs,miR-139-5p was the best target miRNA with the highest specificity and strongest stability to bind TGF-β1.The positive expression rates of TGF-β1 in hepatoma tissues and adjacent normal liver tissues were 80.4％ (45/56) and 15.0％ (3/20),respectively,(P ＜0.05).There were significant differences on the expressions of TGF-β1,E-cadherin and Vimentin among the different metastatic cell lines (all P ＜ 0.05).After miR-139-5p was transfected into hepatoma cells,miR-139-5p could bind to the 3'UTR site of TGF-β1,resulting in downregulating TGF-β1 expression.When compared to the other three groups,the cell line with a high expression of miR-139-5p had a significantly lower count of invasive cells (53 ± 4/high magnification field) (P ＜ 0.05).Conclusion miRNA139-5p could specifically bind to the 3'UTR site of TGF-β1 and regulate the EMT signaling pathway,thus suppressing invasion and metastasis of hepatoma cells.
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ObjectiveTo summarize the experience of gastric D2 operation and evaluate the feasibility and safety of peripheral vascular choroid of lymph node dissection.Methods A retrospective study was adopted to analyze the redical D2 operation procedure and operation results 24 advanced gastric cancer cases,summarizing the experience of D2 radical gastrectomy operation for gastric cancer.The number of resected lymph nodes,operation bleeding volume,postoperative complications were analyzed to evaluate the feasibility and safety of operation.Results All 24 cases undergoing D2 radical gastrectomy operation of advanced gastric cancer were successful,and got the R0 resection.A total of 634 lymph nodes were excised in all the cases,averaged 26.42.A totle of 206 metastatic lymph nodes were found,metastasis rate being 32.49％.Operation bleeding volume was averaged 264.58 mL.The postoperative complication rate was 25％,anastomotic bleeding in 1 case,input loop jejunum fistula of esophageal jejunum anastomosis in 1 case,hyperamylasemia and 2 cases reflux esophagitis in 2 cases respectively.Conclusions D2 radical gastrectomy operation of gastric cancer is safe and feasible on the basis of mastering perigastric anatomy and master of lymph node excision technology and anatomical hierarchy separation.
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Objective To describe the interpositional omentum and demonstrate its clinical significance.MethodsCT and clinical data of the cases whose suprahepatic gaps widen were reviewed and the contrast of CT was adjusted to observe further.ResultsIn 1 916 cases with upper abdominal CT data,suprahepatic gap was widen in all 152 cases,and 119 cases showed fat density(6.21％ ).There were 3 cases of trauma and 3 cases of acute abdomen in the 119 cases CT in the 119 cases displayed free gas under diaphragma,but displayed fat density after contrast adjusted.There were 11 cases undergoing operations,1 for sigmoid rupture 4 liver cirrhosis and portal hypertension,3 gastric cancer,and 1 acute cholecystitis,1 bile duct carcinoma and Ⅰ case congenital cystic dilatation of common bile duct.The other 108 cases did not undergo surgical operation.ConclusionsInterpositional omentum is a clinical phenomenon that the omentum was shift in suprahepatic gap covering the liver surface.It is not rarely,the incidence rate being 6.21％ ( 119/1 916) in our study.The occurrence mechanism may be similar to that of Chilaiditi syndrome.It is difficult to differentiate interpositional omentum from free gas under diaphragms on CT plain scan picture,but it is easy after contrast adjusted of CT.Free gas under diaphragma should not be identify incorrecdied and patients should not undergo unnecessary surgical procedure.
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Objective To evaluate effection of Milrinone in patients with pneumocardial disease at acute exacerbation stage .Methods Eighty-three patients were randomly divided into two groups , both in the same conventional therapy , the treatment group received 10mg of Milrinone dissolve in 250ml 5% glu-cose intravenous infusion , 1 second /day, 10 days for a course of treatment .Observation group were treated with 5%glucose infusion 250ml, 1 time /day.The arterial blood gas, echocardiography measurements with mean pulmonary artery pressure , left ventricular ejection fraction and clinical evaluation to improve cardiop-ulmonary function efficiently were compared before and after treatment .Results Arterial blood gas analy-sis, pulmonary artery pressure and left ventricular function were improved and comprehensive evaluation of the efficiency of cardiopulmonary function in treatment group were significantly better than the control group ( Pall<0.05).Conclusion There is satisfactory of Milrinone in acute exacerbation of chronic pulmonary heart disease .
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Objective To investigate the clinical features and management of bile duct injury caused by laparoscopic cholecysteetomy by using harmonic scalpel (UHS-LC), and its prevention. Methods The clinical data of 1863 UHS-LC cases from April 2003 to February 2008 were retrospectively analyzed. There were 11 patients suffering from UHS-LC related iatrogenic bile duct injury including intraoperatively immediate recognized injuries in 9 cases, and postoperatively found injuries in 2 cases. For those patients in which bile duct injury was found during the UHS-LC procedure, the patient was converted to open surgery, the injury was repaired accordingly by end-to-end bile duet anastomosis or Roux-en-Y procedure. For the injuries found postoperatively (all two cases were of CBD perforation), CBD was sutured by second stage. Results All the 11 patients recovered well and no biliary stricture occurred during the follow up of 1-5 years. Conclusions While UHS-LC is suitable for most cases of choleeystectomy, it causes significant porcentage of bile duct injury (0. 6% ) in hands of unskillful surgeons. It is important to be on alert against iatrugenic bile duct injuries.
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@#目的观察膝关节置换术后功能锻炼和康复指导对减少术后并发症、尽早恢复关节功能、提高患者术后生存质量的作用。方法对23例(26膝)膝关节置换术后患者进行早期主动和被动功能锻炼,预防关节屈曲挛缩和下肢深静脉栓塞。结果经平均13个月随访,23例患者的优良率达85.8%。结论膝关节置换术后进行早期康复训练可减少术后并发症,尽早恢复关节功能,并获得长期稳定的疗效。
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Objective To study the effects of different doses of propofol on the changes in lung Ca content and pulmonary ultrastructure caused by intestinal ischemia-reperfusion (IIR) induced lung injury. Methods Forty male SD rats weighing 200-250g were randomly divided into 5 groups of 8 rats each: group I sham operation (control group): group II small intestinal ischemia-reperfusion; group III propofol 4 mg-kg-1-h-1; group IV propofol 8mg-kg-h-1; group V propofol 10 mg-kg-1-h-1. The rats were anesthetized with 3% pentobarbital 40mg-kg-1 ip. Right carotid artery and left internal jugular vein were cannulated for BP and pulmonary arteral pressure (PAP) monitoring and fluid and drug administration. The animals were tracheotomized and mechanically ventilated. PETCO2 was maintained at 4 .67- 5.60 kPa. Abdomen was opened. Superior mesenteric artery (SMA) was isolated and clamped for 60 min followed by 120min reperfusion. In group III , IV and V 10min before SMA occlusion was released different doses of propofol was continuously infused until the end of experiment. In group I and II isovolemic normal saline was infused instead of propofol. Lung Ca2+ content was measured and ultrastructure of the lung examined. Results The lung tissue Ca2+ content increased significantly after IIR in group II and III as compared with group I , IV and V ( P
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Objective To investigate the effects of desflurane inhalation on pulmonary alveolar-capillary membrane permeability and the inflammatory cell counts in broncho-alveolar lavage fluid (BALF) during endotoxin-induced acute lung injury in rats. Methods Forty-eight Wistar rats weighing 200-290 g were anesthetized with intraperitoneal pentobarbital 100mg?kg-1 , tracheotomized and mechanically ventilated. PETCO2 was maintained at 35-45 mm Hg (VT 8 ml?kg-1 , RR 65-70 bpm). Right carotid artery and left femoral vein were cannulated for BP monitoring and fluid and drug administration. The animals were randomly divided into four group with 12 animals in each group : (1) control group received normal saline (NS) 1.2 ml i.v. followed by 4 h mechanical ventilation; (2) LPS group received LPS (055:B5, Sigma) 5 mg?kg-1 followed by 4h mechanical ventilation; (3)Desflurane group A and B received LPS 5 mg? kg-1 followed by desflurane inhalation for 4 h at 1 MAC (desflurane group A) or 1.5 MAC (desflurane group B) . Six animals in each group received Evans blue 50 mg?kg-1 at the beginning of the experiment for determination of pulmonary alveolar-capillary membrane permeability at the end of the experiment. The animals were sacrificed by exsanguinations at the end of 4h mechanical ventilation. Blood was collected for determination of total plasma protein concentration. Lungs were removed. The right lung was lavaged and BALF was collected for determination of protein content, and differential inflammatory cell counts. The left lung was used for microscopic examination. The morphologic changes were scored 0-3 (0 = normal, 3 = severe morphologic changes). In addition wet/dry lung weight ratio, pulmonary permeability index (BALF protein concentration /total plasma protein concentration?10-3 ) and mortality rate were also determined. Results In group 3 (desflurane 1 MAC) W/D lung weight ratio and lung water content significantly increased compared with those in LPS group. In group 4 ( desflurane 1.5 MAC) W/D lung weight ratio, lung water content, pulmonary permeability index, Evans blue content in lung tissue, morphological change scores and mortality rate were all significantly increased compared with LPS group (group 2). There was no significant difference in total and differential inflammatory cell counts in BALF between group 2 and 4.Conclusion Desflurane inhalation is detrimental to the lungs acutely injured by endotoxin in a dose-dependent manner.