Safety and effectiveness of esophagojejunostomy through extracorporeal versus intracorporeal methods after laparoscopic total gastrectomy / 中华胃肠外科杂志

Objective: To compare the safety and effectiveness of esophagojejunostomy (EJS) through extracorporeal and intracorporeal methods after laparoscopic total gastrectomy (LTG). Methods: A retrospective cohort study was carried out. Clinicopathological data of 261 gastric cancer patients who underwent LTG, D2 lymphadenectomy, and Roux-en-Y EJS with complete postoperative 6-month follow-up data at the General Surgery Department of Nanfang Hospital from October 2018 to June 2021 were collected. Among these 261 patients, 139 underwent EJS with a circular stapler via mini-laparotomy (extracorporeal group), while 122 underwent intracorporeal EJS (intracorporeal group), including 43 with OrVil(TM) anastomosis (OrVil(TM) subgroup) and 79 with Overlap anastomosis (Overlap subgroup). Compared with the extracorporeal group, the intracorporeal group had higher body mass index, smaller tumor size, earlier T stage and M stage (all P<0.05). Compared with the Overlap subgroup, the Orvil(TM) subgroup had higher proportions of upper gastrointestinal obstruction and esophagus involvement, and more advanced T stage (all P<0.05). No other significant differences in the baseline data were found (all P>0.05). The primary outcome was complications at postoperative 6-month. The secondary outcomes were operative status, intraoperative complication and postoperative recovery. Continuous variables with a skewed distribution are expressed as the median (interquartile range), and were compared using Mann-Whitney U test. Categorical variables are expressed as the number and percentage and were compared with the Pearson chi-square, continuity correction or Fisher's exact test. Results: Compared with the extracorporeal group, the intracorporeal group had smaller incision [5.0 (1.0) cm vs. 8.0 (1.0) cm, Z=-10.931, P=0.001], lower rate of combined organ resection [0.8% (1/122) vs. 7.9% (11/139), χ(2)=7.454, P=0.006] and higher rate of R0 resection [94.3% (115/122) vs. 84.9 (118/139), χ(2)=5.957, P=0.015]. The morbidity of intraoperative complication in the extracorporeal group and intracorporeal group was 2.9% (4/139) and 4.1% (5/122), respectively (χ(2)=0.040, P=0.842). In terms of postoperative recovery, the extracorporeal group had shorter time to liquid diet [(5.1±2.4) days vs. (5.9±3.6) days, t=-2.268, P=0.024] and soft diet [(7.3±3.7) days vs. (8.8±6.5) days, t=-2.227, P=0.027], and shorter postoperative hospital stay [(10.5±5.1) days vs. (12.2±7.7) days, t=-2.108, P=0.036]. The morbidity of postoperative complication within 6 months in the extracorporeal group and intracorporeal group was 25.9% (36/139) and 31.1%, (38/122) respectively (P=0.348). Furthermore, there was also no significant difference in the morbidity of postoperative EJS complications [extracorporeal group vs. intracorporeal group: 5.0% (7/139) vs. 82.% (10/122), P=0.302]. The severity of postoperative complications between the two groups was not statistically significant (P=0.289). In the intracorporeal group, the Orvil(TM) subgroup had more estimated blood loss [100.0 (100.0) ml vs.50.0 (50.0) ml, Z=-2.992, P=0.003] and larger incision [6.0 (1.0) cm vs. 5.0 (1.0) cm, Z=-3.428, P=0.001] than the Overlap subgroup, seemed to have higher morbidity of intraoperative complication [7.0% (3/43) vs. 2.5% (2/79),P=0.480] and postoperative complications [37.2% (16/43) vs. 27.8% (22/79), P=0.286], and more severe classification of complication (P=0.289). Conclusions: The intracorporeal EJS after LTG has similar safety to extracorporeal EJS. As for intracorporeal EJS, the Overlap method is safer and has more potential advantages than Orvil(TM) method, and is worthy of further exploration and optimization.

Effect of perioperative and postoperative chemotherapy on the prognosis of patients with advanced gastric carcinoma after resection / 中国实用外科杂志

OBJECTIVE: To explore the effect of perioperative and postoperative chemotherapy on the prognosis of patients with advanced gastric cancer after resection. METHODS: From January 2004 to December 2016, a retrospective cohort of 277 stage IV gastric cancer patients after surgical treatment of gastric resection was enrolled in Department of General Surgery,Nanfang Hospital, Southern Medical University. Among them, 228 underwent surgical resection combined with postoperative adjuvant chemotherapy(postoperative chemotherapy group, group A), and preoperative chemotherapy plus surgery resection and postoperative chemotherapy in 49 cases(perioperative chemotherapy group, group B). After generating propensity scores with eight covariates, including gender, age, biological classifications, completion of chemotherapy, depth of tumor infiltration, lymph nodemetastasis, the extent of lymph nodes dissection and type of gastrectomy, 49 patients in group A were one-to-one matched with 49 patients in group B. Kaplan-merier method was used for survival analysis, and Cox proportional risk regression model was used to analyze independent survival risk factors of patients with advanced gastric cancer undergoing surgical resection. RESULTS: Before propensity scores matching(PSM), biological classifications(P<0.001),the completion of chemotherapy(P<0.001), depth of tumor infiltration(P<0.001), lymph node metastasis(P=0.049), the extent of lymphnode dissection(P=0.001) and the type of gastrectomy(P=0.001) significantly differed between two groups. While after PSM, only the completion of chemotherapy were vital different between two groups. After PSM,median survival time of group A and B were 16(95% CI 10.36-21.64) vs 29(95% CI 17.24-40.76) months, which showed not significant difference(P=0.191). The univariate analysis showed that biological classifications, the completion of chemotherapy, lymph node metastasis and the extent of lymphnode dissection were survival prognosis factors. And the multivariate analysis showed that the chemotherapy cycles≤ 2 cycles, lymph node metastasis and the extent of lymphadenectomyless than D2 were independent poor prognostic factors for advanced gastric cancer patients performed with gastrectomy. Notably, the order of chemotherapy and surgery was not independent variate of prognosis(perioperative chemotherapy vs. postoperative chemotherapy: HR 0.986,95%CI 0.539-1.806,P=0.964). CONCLUSION: Perioperative chemotherapy is not the independent variable to improve prognosis of resected advanced gastric cancer patients.Nonetheless, perioperative chemotherapy could benefit patient's chemotherapy tolerance and compliance, which could be attributed to the superiority in survival compared to postoperative chemotherapy. The finding could offer reference and guidance for further design of perspective studies for advanced gastric cancer patients.

Analysis of risk factors and intervention measures of esophagojejunal anastomotic leakage in gastric cancer patients after laparoscopic total gastrectomy / 中国实用外科杂志

OBJECTIVE: To identify the risk factors of esophagojejunal anastomotic leakage and its intervention measures of gastric cancer patients after laparoscopic total gastrectomy. METHODS: The clinical and follow-up data of 440 gastric cancer patients who underwent laparoscopic total gastrectomy with negative margins at the Department of General Surgery, Nanfang Hospital of Southern Medical University from April 2006 to December 2016 were analyzed retrospectively. Risk factors of esophagojejunal anastomotic leakage and intervention measures of patients were analyzed respectively. RESULTS: Esophagojejunal anastomotic leakage occurred in 12 of 440 patients(2.7%). The leakage was diagnosed at a median of 4(range,1 to 8) days after surgery. Univariate analysis showed that gender, age, neoadjuvant chemotherapy, anastomosis method, combined organ resection, invasion of the esophagus were risk factors affecting esophagojejunal anastomotic leakage after laparoscopic total gastrectomy, with statistically significant differences(P<0.05). Multivariate analysis showed that age, neoadjuvant chemotherapy, anastomosis method, combined organ resection,invasion of the esophagus were independent risk factors affecting esophagojejunal anastomotic leakage after laparoscopic total gastrectomy, with statistically significant differences(P<0.05). CONCLUSION: For the elderly patients, who are older than 65 years old, received neoadjuvant chemotherapy, had tumor invasion of the esophagus, undergone total laparoscopic anastomosis, combined organ resection, when they are treating with laparoscopic total gastrectomy, esophagojejunal anastomosis should be careful about. Esophagojejunal anastomotic leakage can be treated effectively with self-expanding metalstents, but the risk of migration still exists.

Curative effect of compound Xuesaitong combined with Conbercept in the treatment of choroidal neovascularization in pathological myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze the effect of compound xuesaitong combined with conbercept on central macular retinal thickness (CMT), fluorescein fundus angiography and best corrected visual acuity(BCVA) in pathological patients with choroidal neovascularization (CNV).METHODS:A total of 60 cases (60 eyes) with pathological myopia and CNV who were admitted to our hospital during January to October 2016 were enrolled in the study.They were divided into observation group and control group, 30 cases in each group.Observation group was treated with compound xuesaitong combined with conbercept.Control group was treated with conbercept only.Changes of CMT, intraocular pressure (IOP), area of CNV, BCVA and serum vascular endothelial growth factor (VEGF) before surgery, 4 and 12wk after surgery were compared.Complications during follow-up were statistically analyzed.RESULTS: At 12wk after surgery, the total effective rate was 97% in observation group, 80% in control group and the difference was significant (P<0.01).The CMT, IOP, area of CNV and serum VEGF levels were significantly lower or smaller than those before surgery while BCVA was significantly higher than that before surgery (P<0.01).There were no local complications of systematic severe complications.CONCLUSION: Compound xuesaitong combined with conbercept can effectively reduce CMT and IOP, reduce the area of CNV and significantly improve visual acuity.Its anti-VEGF effect is obvious, safe and feasible.

Mechanism of ablation with nanosecond pulsed electric field / 浙江大学学报·医学版

Nanosecond pulsed electric field ablation has been widely applied in clinical cancer treatment, while its molecular mechanism is still unclear. Researchers have revealed that nanosecond pulsed electric field generates nanopores in plasma membrane, leading to a rapid influx of Ca²⁺; it has specific effect on intracellular organelle membranes, resulting in endoplasmic reticulum injuries and mitochondrial membrane potential changes. In addition, it may also change cellular morphology through damage of cytoskeleton. This article reviews the recent research advances on the molecular mechanism of cell membrane and organelle changes induced by nanosecond pulsed electric field ablation.

Effect of human epididymis protein 4 gene silencing on the malignant phenotype in ovarian cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Human epididymis secretory protein 4 (HE4) has been proved to be a promising novel biomarker for the detection of epithelial ovarian carcinomas. Compared with CA125, HE4 assay demonstrated an improved ability to discriminate between pelvic mass with malignant and benign disease. Though it is well known that HE4 is overexpressed in ovarian cancer, however, the role of HE4 in the carcinogenesis and progression of ovarian cancer remains unkown.</p><p><b>METHODS</b>In this study, we explored the role of HE4 in the carcinogenesis and progression of ovarian cancer. We screened nine ovarian cancer cell lines for HE4 expression, and using RNA interference (RNAi), we silenced HE4 gene expression in CaoV3 and SKOV3.ip1 ovarian cancer cell lines. We assessed the effect of HE4 gene silencing on the transformed phenotype by examining the cell cycle, apoptosis, proliferation and transwell migration/invasion in vitro.</p><p><b>RESULTS</b>HE4 gene silencing induces G0/G1 arrest and blocks the progression from the G1 to S phase in CaoV3 and SKOV3.ip1 cells. HE4 knockdown also inhibited cell proliferation, migration and invasion in SKOV3.ip1 cells in vitro.</p><p><b>CONCLUSION</b>HE4 may be involved in the regulation of the cell cycle and promote ovarian cancer migration and invasion.</p>

Expression of Human Kallikrein Gene 4 and 5 in Ovarian Cancer / 上海第二医科大学学报

Objective To study the expression of human kallikrein gene(KLK) 4 and KLK5 in ovarian cancers,and to investigate the pathogenesis in malignant tumors. Methods Fifty specimens of ovarian cancers were divided into three groups: malignant tumor group(n=23),borderline tumor group(n=6) and control group(normal or benign tumor,n=21).Fluorescent quantitative RT-PCR was employed to determine the expression of KLK4 and KLK5 in these specimens. Results The expression of KLK4 in ovarian cancers was significantly higher than that of the control group(P

Progress of studies on multidrug resistance in hematological malignancies--review / 中国实验血液学杂志

Chemotherapy remains a major route of intervention in hematological malignancies. However, a key issue in the treatment of hematological malignancies is the development of multidrug resistance (MDR) to chemotherapeutic drugs. Several mechanisms may account for this phenomenon, including biochemical mechanisms, such as the overexpression of resistance-conferring proteins and physiological mechanisms involving the hematopoietic microenvironment. In this article the pathomechanism, diagnostic approach, interpretation of results from clinical samples and correlations with hemopoietic microenvironment were briefly reviewed. The aspects of development and problems in MDR study as well as detection methods for MDR were also discussed.

Construction of subtracted cDNA library in human Jurkat T cell line induced by arsenic trioxide in vitro / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the differentially expressed genes in human T lymphocytes induced by arsenic trioxide (As(2)O(3)) and to explore mechanism of its immunotoxicity and immune suppression.</p><p><b>METHODS</b>Human Jurkat T cell line was treated by arsenic trioxide (5 micromol/L, 24 h) in vitro, as a sample model. Then, the differentially expressed genes were cloned and the subtractive cDNA library from Jurkat T cell line was constructed by suppression subtractive hybridization (SSH). Polymerase chain reaction (PCR) and sequencing techniques were applied to identify positive clones.</p><p><b>RESULTS</b>The forward subtracted cDNA library contained differentially expressed genes from Jurkat T cell line induced by arsenic trioxide was constructed, including 29 different gene fragments and only replicated one in the subtracted cDNA library identified by PCR and sequencing analysis. These gene sequences were 95%-100% analogous to the genes in public database (GenBank/EMBL). The cDNA library contained oxidative metabolic genes in mitochondria (triose phosphate dehydrogenase, NADH4, pyrophosphate synthase, 16S rRNA ribosome, succinate-CoA ligase and ATP synthase 6); transcriptional and translation genes poly (A) binding protein, t-RNA-guanine transglycoslase, ribosomal protein L23, ribosomal protein S15A, eukaryotic translation initiation factor 3, Rab interaction protein 5, splicing factor-arginine serine rich 5, and ADP-ribosylation factor-like 6 interacting protein), oxide stress related genes (ferritin high chain and high-mobility group protein 2); protein activating and signaling pathway related genes (casein kinase, serine kinase 2 and phosphatidylinositol-four-phosphate adaptor protein-1-associated protein); cell differentiation and apoptosis associated genes (NB4 cell apoptosis related protein and myeloid differentiation primary response protein) and five genes with unknown function (KIAA0092, CGI-147protein, GCI-35, nucleolar phosphoprotein Nopp34 and Mus muscular partial mRNA for hypothetical protein), as well as a novel gene unmatched to the sequence in GenBank.</p><p><b>CONCLUSIONS</b>The forward subtracted cDNA library contained differentially expressed genes from Jurkat T cell line induced by arsenic trioxide was successfully constructed. And, genes not involved in previous research on arsenic were found. Results of analysis for these genetic function suggested that there should be many genes involved in process of T lymphocytes apoptosis or injury induced by arsenic trioxide and that there should still be many genes associated with arsenic that were not reported in the past.</p>