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Totally laparoscopic total gastrectomy is the most comlex procedure in gastric surgery, which involves the entire stomach removal, lymph node dissection and digestive tract recons-truction through minimally invasive techniques, among which laparoscopic esophagojejunostomy is a technological difficulty. Currently, three types of anastomoses are widely used, including stapled anastomosis with circular staplers or linear staplers, and hand suturing, but which is the best and safe anastomosis remains controversial. Based on team experience, the authors review the progress of esophagojejunostomy on stapled anastomosis or hand suturing, promote that how to select an appropriate esophagojejunostomy according to surgeon′s individual technical capabilities, operating habits and patient conditions, strive to achieve the precise and minimally invasive effect with the least trauma for patients.
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Objective:To investigate the short-term efficacy of laparoscopic total gastrec-tomy with hand-sewn esophagojejunostomy versus Roux-en-Y anastomosis.Methods:The propen-sity score matching and retrospective cohort study was conducted. The clinicopathological data of 159 patients who underwent laparoscopic total gastrectomy in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from October 2014 to July 2021 were collected. There were 107 males and 52 females, aged 63(range, 28?79)years. Of 159 patients, 71 cases undergoing totally laparoscopic total gastrectomy with hand-sewn esophagojejunostomy were allocated into totally laparoscopic group and 88 cases undergoing laparoscopic-assisted total gastrectomy with Roux-en-Y anastomosis were allocated into laparoscopic-assisted group, respectively. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and postoperative conditions; (3) perioperative complications. Propensity score matching was done by the 1:1 nearest neighbor matching method. Measurement data with normal distribution were expressed as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(range), and the Mann-Whitney U test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher's exact probability method. The rank sum test was used for comparison of ordinal data. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of 159 patients, 112 cases were successfully matched, including 56 cases in the totally laparoscopic group and 56 cases in the laparoscopic-assisted group. Before propensity score matching, age, cases with tumor located in cardia or gastric body in the totally laparoscopic group were 61(range, 30?76)years, 26, 45, respectively. The above indicators in the laparoscopic-assisted group were 65(range, 28?79)years, 50, 38, respectively. There were significant differences in the above indicators between the two groups ( Z=?2.89, χ2=6.43, P<0.05). After propensity score matching, the males and females, age, body mass index, cases of American Society of Anesthesiologists classification Ⅰ, Ⅱ, Ⅲ and Ⅳ, tumor diameter, cases with tumor located in cardia or gastric body, cases in TNM stage Ⅰ, Ⅱ and Ⅲ of patients in the totally laparoscopic group were 40, 16, (62±9)years, (22.7±2.8)kg/m 2, 22, 26, 7, 1, 3.5(range, 0.6?17.0)cm, 24, 32, 22, 9, 25. The above indicators of patients in the laparoscopic-assisted group were 38, 18, (62±10)years, (22.7±3.2)kg/m 2, 19, 32, 5, 0, 4.0(range, 0.6?15.0)cm, 23, 33, 21, 7, 28, respectively. There was no significant difference in the above indicators between the two groups ( χ2=0.17, t=?0.09, ?0.04, Z=?0.12, ?0.82, χ2=0.04, Z=?0.42, P>0.05). The elimination of age and tumor location confounding bias ensured comparability between the two groups. (2) Intraoperative and postoperative conditions: after propensity score matching, the total operation time, time of esophagojejunostomy, postopera-tive 24-hour pain numerical score and time to first out-off bed activities were (310±49)minutes, (37±10)minutes, 2.3±0.8 and (2.4±0.7)days for patients in the totally laparoscopic group, versus (344±77)minutes, (44±12)minutes, 3.1±1.2 and (2.9±1.0)days in the laparoscopic-assisted group, showing significant differences between the two groups ( t=?2.85, ?3.05, ?4.20, ?3.10, P<0.05). (3) Perioperative complications: after propensity score matching, 6 cases of the patients in the totally laparoscopic group had Clavien-Dindo grade 2 or higher complications, including 2 cases of anas-tomotic leak, 1 case of anastomotic stenosis, 1 case of pleural effusion, 1 case of abdominal infection and 1 case of intestinal obstruction. The incidence of Clavien-Dindo grade 2 or higher complications was 10.7%(6/56). In the laparoscopic-assisted group, 5 patients had Clavien-Dindo grade 2 or higher complications, including 2 cases of anastomotic leak, 1 case of abdominal infection, 1 case of intestinal obstruction and 1 case of cholangitis. The incidence of Clavien-Dindo grade 2 or higher complications was 8.9%(5/56). There was no significant difference in the incidence of Clavien-Dindo grade 2 or higher complications between the two groups ( χ2=0.10, P>0.05). Patients with anas-tomotic leak were improved after puncture and drainage, secondary surgery and conservative treat-ment, and other complications were improved after symptomatic treatment. Conclusions:Com-pared with Roux-en-Y anastomosis in laparoscopic total gastrectomy, the time of hand-sewn esophagojejunostomy and esophago-jejunal anastomosis are shorter, patients have less postopera-tive pain and faster postoperative recovery. Both methods have good peri-operative safety.
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Due to the particularity of tumor location, the surgery of esophagogastric junc-tion(EGJ) carcinoma needs to meet the safety of negative tumor margin, lymph node dissection and digestive tract reconstruction at the same time, which attracted more and more attention of esopha-gogastric surgeons. The current Siewert and Nishi classifications are based on the tumor epicenter, which is difficult to be accurately evaluated and measured before and during operation, and also lack of significance in determining the surgical methods and approach and lymph node dissection. The authors systematically analyze the limitations of Siewert and Nishi classification, discuss the relationship between esophageal invasion length and mediastinal lymph node metastasis and the role of esophageal invasion length on selection of surgical approach, and propose a modified classi-fication based on esophageal invasion length, including (1) malignant tumors with the upper or lower edge of tumor involving the zone of EGJ are defined as EGJ carcinoma; (2) EGJ carcinoma with the upper edge of tumor located 3.0 cm above the EGJ is classified as type Ⅰ; (3) EGJ carcinoma with the upper edge of tumor located 0?3.0 cm above the EGJ is classified as type Ⅱ; (4) EGJ carcinoma with the upper edge of tumor located 0?2.0 cm below the EGJ is classified as type Ⅲ.
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Objective:To investigate the application value of hand-sewn esophagojejunal anastomosis (EJA) in totally laparoscopic total gastrectomy (TLTG).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 35 patients with early or advanced upper gastric cancer who were admitted to Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between July 2018 and December 2019 were collected. There were 24 males and 11 females, aged (60±10)years, with a range of 35-75 years. All the 35 patients underwent TLTG combined with hand-sewn EJA. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) postoperative pathological examination; (4) follow-up and survival. Follow-up was conducted using telephone interview, outpatient examination, short message service and WeChat to detect tumor recurrence, metastasis and survival of patients up to January 2020.Measurement data with normal distribution were repressented as Mean± SD. Measurement data with skewed distribution were represented as M (range). Count data were expressed as absoulte numbers or persentages. Results:(1) Intraoperative situations: all the 35 patients underwent TLTG combined with hand-sewn EJA successfully. The operation time, volume of intraoperative blood loss, time of hand-sewn EJA, costs of consumables used in the intraoperative resection and reconstruction, and costs of consumables used in EJA of the 35 patients were 305 minutes(range, 232-406 minutes), 94 mL(range, 50-300 mL), 37 minutes(range, 20-65 minutes), 13 674 yuan(range, 11 929-15 255 yuan) and 491 yuan(range, 223-1 044 yuan), respectively. Of the 35 patients, 4 received intraoperative blood transfusion. (2) Postoperative situations: time to first out-of-bed activity, postoperative indwelling time of gastric tube, time to initial liquid diet intake, the time to abdominal drainage tube removal and duration of postoperative hospital stay of the 35 patients were 2 days(range, 1-3 days), 4 days(range, 2-11 days), 5 days(range, 4-12 days), 8 days(range, 5-15 days) and 9 days(range, 7-16 days), respectively. Of the 35 patients, 3 had perioperative complications. One patient had inflammation and infection in the pancreatic tail and was discharged at postoperative 16 days after conservative treatment of fasting, somatostatin to reduce the pancreatic secretion, adequate drainage, anti-infection and nutritional support. One had postoperative intestinal incomplete obstruction and was discharged at postoperative 12 days after treatment with gastrointestinal decompression and enema for relief of obstruction. One had pulmonary infection who was discharged at postoperative 9 days after symptomatic and supportive treatment. None of the 35 patients had perioperative anastomotic leakage or bleeding. Of the 35 patients, 1 was diagnosed with esophagojejunostomy stenosis at postoperative 2 months and was improved after endoscopic dilatation. The incidence of long-term anastomosis-related complications of the 35 patients was 2.9%(1/35). (3) Postoperative pathological examination: the pathological examination of the upper margin of intraoperative frozen section and postoperative paraffin section showed negative in the 35 patients. Of the 35 patients, 16 had tumor located at cardia including 4 cases with tumor involving in lower esophagus, 19 had tumor located at stomach; 21 had tumor pathological type as highly or moderately differentiated adenocarcinoma, 11 had poorly differentiated adenocarcinoma, 3 had signed-ring cell carcinoma; 14 had early gastric cancer, 21 had advanced gastric cancer; 7 had tumor invaded at mucosa lamina propria and muscularis, 7 had tumor invaded at submucosa, 1 had tumor invaded at muscularis, 1 had tumor invaded at subserosal, 17 had tumor invaded at serosal, 2 had tumor invaded at extra-serosal adipose tissue. The TNM staging of the 35 patients: 14 were in stage ⅠA , 2 in stage ⅠB, 4 in stage ⅡB, 3 in stage ⅢA, 4 in stage ⅢB and 8 in stage ⅢC. Of the 35 patients, 15 had vascular invasion and 16 had nerve invasion. The tumor diameter, the number of lymph nodes dissected and the number of positive lymph nodes of the 35 patients were 3.9 cm(range, 0.6-12.0 cm), 24(range, 10-40) and 2(range, 0-11). (4) Follow-up and survival: all the 35 patients were followed up for 1-18 months, with a median time of 5 months. Of the 35 patients, tumor recurrence or metastasis was not found in 34 patients, and the other 1 patient was diagnosed with liver metastases of tumor at postoperative 6 months and survived with tumor.Conclusion:Hand-sewn EJA in TLTG is safe and feasible.
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The world-wide incidence of adenocarcinoma of the esophagogastric junction has been on a rise in recent years.Surgical resection plays the most important role in the multimodal management for adenocarcinoma of esophagogastric junction.However,due to distinct anatomical position,biological features,epidemiology and surgical teams,many controversies and different cognitions exist among surgeons from the East and the West,including tumor staging and classification,regional lymphadenectomy,surgical approaches and extents of esophageal and gastric resection.A new TNM classification has renewed the staging system,while traditional Siewert classification still decides clinical surgical strategies.With the development of minimally invasive surgery and early detection for the lesion,it is possible to perform the operations combining laparoscopy and thoracoscopy in the future.A multidisciplinary team from digestive surgery,oncology,radiology and anesthesiology will be essential for optimal diagnosis and management.
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Objective To investigate the efficacy and safety of the enhanced recovery after surgery (ERAS) protocol in patients with gastric gastrointestinal stromal tumors (GISTs) in favorable sites.Methods Between March 2015 and January 2017,86 gastric GISTs patients undergoing laparoscopic resection in favorable sites were retrospectively analyzed.The patients were divided into ERAS protocol group (n =44) and conventional protocol group (n =42).Perioperative data and postoperative recovery parameters were compared.Results Compared with conventional group,postoperative recovery parameters in ERAS group such as time to first flatus,the first defecation,return to normal diet,physical activity outof-bed,and the hospital stay were obviously shortened.The postoperative pain score [(3.1 ± 3.0) vs.(5.2±3.2),P ＜0.05] and insulin resistance [(4.0±7.5) vs.(9.5 ±2.2),P ＜0.05] were significantly reduced in the ERAS protocol group than in the conventional protocol group.However,no statistically significant differences were observed in terps of operation time and intraoperative blood loss (P ＞ 0.05).There were no martality in both groups.The postoperative complications were 4.5％ and 4.7％ respectively.Conclusion Laparoscopic technique in favorable sites combined with the ERAS protocol enhance postoperative recovery and shorten hospital stay in gastric GIST patients.
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<p><b>OBJECTIVE</b>To investigate the clinical application effects of enhanced recovery after surgery (ERAS) during perioperative period on patients undergoing laparoscopic radical gastrectomy.</p><p><b>METHODS</b>A total of 127 patients with gastric cancer receiving laparoscopic radical gastrectomy in our department from July 2013 to February 2015 were prospectively enrolled. Patients were randomly divided into ERAS group (n=67) treated with ERAS method and conventional group (n=60) treated with the traditional perioperative management. The perioperative efficacy and postoperative short-term outcomes were compared between the two groups.</p><p><b>RESULTS</b>All the patients were recovery with no mortality during perioperative period. Compared with conventional group, patients in ERAS group showed shorter time of nasogastric tube placement[(1.4±0.6) days vs. (2.2±0.6) days, P=0.000], shorter time to first flatus [(3.2±0.9) days vs. (3.8±1.1) days, P=0.004], shorter time to first ambulation [(2.3±1.1) days vs. (4.2±6.4) days, P=0.026], shorter time to initiate oral intake (1.9±0.7) days vs. (4.0±1.1) days, P=0.000] and shorter postoperative hospital stay [(13.9±4.0) days vs. (18.7±9.1) days, P=0.000]. Visual pain scores were all significantly lower in the ERAS group as compared to the traditional group 2 hours after anesthesia awakening, 12, 24, 48 hours after operation and at the first ambulation respectively(all P<0.05). The overall complication rate was significantly lower in ERAS group than that in conventional group[14.9%(10/67) vs. 30.0%(18/60), P = 0.041]. Patients in the ERAS group had shorter postoperative hospital stay [(13.9±4.0) days vs. (18.7±9.1) days, P=0.000].</p><p><b>CONCLUSION</b>ERAS during perioperative period in laparoscopic radical gastrectomy is safe and effective, which is associated with quicker postoperative rehabilitation, better pain control and shorter hospital stay.</p>
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Humanos , Gastrectomia , Laparoscopia , Tempo de Internação , Manejo da Dor , Período Pós-Operatório , Estudos Prospectivos , Neoplasias Gástricas , Cirurgia Geral , Resultado do TratamentoRESUMO
Neuroendocrine tumors in the digestive tract are rare, however their incidences increased obviously for the past few years. The purpose of this paper is to elucidate the surgical management of locally advanced digestive tract neuroendocrine neoplasms(NENs) with or without liver metastasis and to discuss the present classification of gastrointestinal NENs in order to provide reference for clinicians. WHO re-classified the gastroenteropancreatic NENs in 2010, but this classification remains many questions and needs further clinical trials to answer. Up to now, radical resection of the lesions is the only cure for the gastrointestinal NENs. For resectable locally advanced gastrointestinal NENs, standard radical or extended resection should be performed according to gastrointestinal cancer. For patients who can not receive radical procedure because of unresectable primary lesions or diffuse metastases, cytoreductive operation should be considered when endocrine symptoms exist. Palliative surgery is beneficial to the improvement of bleeding or obstruction by tumor. For unresectable liver metastatic lesion and resectable primary lesion, the primary lesion should be resected. For tolerable patients with resectable liver metastatic lesion, one-stage resection involving the primary and the liver metastatic lesions should be performed. For unresectable liver metastasis, hepatic arterial chemoembolization, systematic chemotherapy, biotherapy, targeted therapy or radio frequency ablation (RFA) should be considered to control symptoms and prevent the tumor progression.
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Humanos , Ablação por Cateter , Neoplasias Gastrointestinais , Cirurgia Geral , Hepatectomia , Neoplasias Hepáticas , Metástase Neoplásica , Tumores Neuroendócrinos , Cirurgia Geral , Cuidados PaliativosRESUMO
The incidence of adenocarcinoma of esophagogastric junction is increasing worldwide during recent decades.The therapeutic strategies have been transformed from surgery alone to multimodal treatments involing also perioperative chemoradiotherapy.Although there are still many problems on preoperative staging,surgical approach,excisional extent and perioperative chemoradiotherapy regimen,multidisciplinary team collaboration can provide an optimal diagnosis and treatment to achieve the principles of standardization and individualization in malignant tumor,which will prolong the survival and improve the quality of life for every patient.
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Objective To investigate the clinical efficacy of laparoscopic radical gastrectomy in elderly patients with advanced gastric cancer.Methods The clinical data of 85 elderly patients with advanced gastric cancer who were admitted to the Ningbo First Hospital from January 2012 to June 2014 were retrospectively analyzed.Laparoscopic radical gastrectomy was performed on 46 patients (LRG group) and open radical gastrectomy on 39 patients (ORG group).All the patients underwent primary tumor resection for gastric cancer + D2 lymph node dissection,and the postoperative recovery plans were done according to enhanced recovery program.The volume of blood loss,number of lymph node dissected,operation time,intraoperative arterial partial pressure of carbon dioxid (PaCO2),time to anal exsufflation,indwelling time of gastric tube,time for out-off-bed activity,time for fluid diet intake,postoperative hemoglobin,duration of hospital stay and occurrence of complications in the 2 groups were analyzed.The follow-up by outpatient examination and telephone interview was carried out on patients up to August 2014.The count data were analyzed by the chi-square test and Fisher exact probability.The measurement data with normal distribution were presented as x ± s and analyzed using the t test.The t' test was used if the data were deficient.Results Surgical procedures in the 2 groups were successfully carried out and no perioperative death occurred.There was no conversion to open surgery in the LRG group.The resection margins in all the patients were negative.The operation time and number of lymph node dissection in the LRG group were (239 ±68)minutes and 27 ± 10,compared with (227 ±50)minutes and 26 ± 10 in the ORG group,with significant differences (t =0.919,0.179,P ＞ O.05).PaCO2 in the LRG group was (41 ± 5) mmHg (1 mmHg =0.133 kPa),which was significantly higher than(36 ± 5) mmHg in the ORG group (t =4.745,P ＜ 0.05).The volume of blood loss was (102 ± 44)mL in the LRG group,which was significantly less than (200 ± 120) mL in the OPG group (t' =-4.807,P ＜ 0.05).The postoperative level of hemoglobin in the LRG was (110 ± 15) g/L,which was significantly higher than (98 ± 27)g/L in the ORG group (t' =2.471,P ＜ 0.05).The time to anal exsufflation,indwelling time of gastric tube,time for out-off-bed activity,time for fluid diet intake,duration of hospital stay in the LRG group were (2.6 ± 0.7) days,(2.1 ± 0.7) days,(1.1 ± 0.3) days,(4.1 ± 0.7) days and (11 ± 4) days,which were significantly different from (4.8 ± 1.5) days,(4.0 ± 1.8) days,(4.5 ± 0.6) days,(5.9 ± 1.8) days and (18 ± 3) days in the OR G group (t' =-8.415,-6.206,-33.831,-5.879,t =9.632,P＜0.05).Eight patients in the LRG group and 15 patients in the ORG group had complications,with the incidence of complications of 17.4％ (8/46) and 38.5％ (15/39),respectively,showing a significant difference (x2 =4.748,P ＜ 0.05).Forty-four patients in the LRG group and 36 patients in the ORG gorup were followed up for 2-25 months,1 patient in the LRG group and 2 patients in the ORG group died and others had full recovery.Conclusions Laparoscopic radical gastrectomy could provide a safe and complete tumor resection for elderly patients with advanced gastric cancer compared with open radical gastrectomy,meanwhile,it can improve postoperative recovery and reduce postoperative complications in elderly patients with advanced gastric cancer.
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Objective To investigate the expression of transcription factor Oct 4 in gastric carcinoma and its effects on gastric cancer cell proliferation and apoptosis after Oct 4 gene interfered by lentivirus vector.Methods Real time PCR and Western blot were used to observe the expression of Oct 4 in different differentiated gastric cancer cell lines.Gastric cancer cell lines with high expression of Oct 4 was cultured and infected by siRNA-Oct 4-lentivirus vector.Cell proliferation and apoptosis were observed after Oct 4 gene was interfered.Results Oct 4 was highly expressed in poorly and moderately differentiated gastric cancer cells.Gene interfered with siRNA inhibits the expression of Oct 4 in gastric cancer cells and show significant effects on cell proliferation and mobility as well as apoptosis after down-regulation of Oct 4.Condusions Oct 4 expression is in close relationship with gastric cancer cell proliferation and invasive ability.
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Objective To determine the probability of identification of differential expression of biliary proteins induced by cholangiocarcinoma using 2D-DIGE. Methods Bile was obtained from 12patients with obstructive jaundice (including 6 cases of cholangiocarcinoma and 6 of cholelithiasis).Each sample was labeled with three different CyDyes (y3,Cy5,Cy2) including one internal standard,pooled from all the samples, and separated with 2-D DIGE in triplicate experiments. MALDI-TOF-MS and bioinformatics were adopted to identify and elucidate the significance of differentially expressed proteins in bile induced by cholangiocarcinoma. Results 55 matched protein spots differences in abundance were detected with statistical variance of two groups(Average Volum Ratio ≥1.5, t-test, P＜0. 05). Among these proteins, 13 PMF were obtained by MALDI-TOF-MS analysis. Eight proteins were identified by searching a protein database. Conclusion The differentially displayed proteomes between the pathological bile obtained from benign and malignant obstructive jaundice indicates the potential application of 2D-DIGE to identify the biomarker of cholangiocarcinoma.
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Objective:To compare the clinical value of early enteral nutrition(EEN) with total parenteral nutrition(TPN) in postoperative elder patients with esophageal and cardiac cancer. Methods: 102 cases of postoperative elder patients with esophageal and cardiac cancer were randomly divided into EEN group(n=51)and TPN group(n=51).The weight loss,serum albumin, prealbumin,liver function were measured before operation and on the eighth day after operation. The anal exsufflation time, infectious complication, duration of hospital stay and treatment cost were observed. Results: The weight loss in EEN group were less than those of TPN group(P<0.05). The levels of ALT, AST, BIL and GGT in EEN group on the eighth day after operation was lower than those in TPN group(P<0.05). The anal exsufflation time and duration of hospital stay in EEN group were shorter than those of TPN group(P<0.05). The treatment cost of EEN group was significantly less than that of TPN group(P<0.05). The infectious complication rate of EEN group was lower than that of TPN group(P<0.05). Conclusion: EEN in postoperative elder patients with esophageal and cardiac cancer can decrease the postoperative infectious complication and the treatment cost, shorten the duration of hospital stay, improve nutritional status and recovery of gastrointestinal function with less side effects of liver function.
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Objective To observe the effects of cystamine, a tissue transglutaminase (tTG) inhibitor, on the development of rat liver fibrosis induced by carbon tetrachloride. Methods One hundred male SD rats were randomly divided into control group (n=20), hepatic fibrosis group (n=40) and cystamine group (n=40) . Liver fibrosis model was induced by intraperitoneal injection of carbon tetrachloride. Cystamine (112 mg·kg-1·d-1) was administered by intraperitoneal injection 2 days before injection of carbon tetrachloride. The rats were sacrificed at weeks 4 and 8, and the liver tissues and serum specimens were obtained. The mRNA expression of tTG, smooth muscle-alpha (α-SMA), collagen-Ⅰ and tissue inhibitors of metalloproteinase-1 (TIMP-1) were detected by real time PCR. The protein expression of tTG and α-SMA, liver function and content of hydroxyproline in liver tissues were determined by Western blot. Histological changes of the liver was observed under microscope. The fibrosis conditions of rat liver in each group were evaluated according to the semi-quantita-tive scoring system. All the data were analyzed by one-way ANOVA. Results Eight weeks after the injection of carbon tetrachloride, obvious injury of the liver in liver fibrosis group was observed. The levels of alanine trans-aminase (ALT), total bile acid, total bilirubin, hydroxyproline, tTG, α-SMA, collagen-Ⅰ and TIMP-1 were (1313±157)U/L, (99.9±18.5)μmol/L, (10.9±1.6)μmoL/L, (55±12)μg/g, 145.6±51.2, 130.3±44.6, 211.3±75.1 and 162.4±53.5. After administration of cystamine, the levels of ALT, total bile acid, total bilirubin, hydroxyproline, tTG, α-SMA, collagen-Ⅰ and TIMP-1 were (378±87) U/L, (61.0±12.7) μmol/L, (9.8±1.7) μmol/L, (70±14 ) μg/g, 48.6±12.3, 40.7±12.3, 63.9±16.0, 59.2μ23.4. Conclusion Cystamine can alleviate the carbon tetrachloride-induced rat liver fibrosis by inhibiting the tTG pathway.
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Objective To investigate the anti-fibrosis effect of a 5-lipoxygenase (5-LO)specific inhibitor AA-861 on liver fibrosis. Methods Liver fibrosis was induced in male Sprague Dawley rats by intraperitoneal injection of carbon tetrachloride(CCI4).AA-861(0.2 mg/100 g/d)was administrated by intraperitoneal injection starting 2 days before the first dosage of CCI4 and rats were killed at weeks 2,4,and 6.Liver specimens were obtained from each animal and fixed with 4%formaldehyde for histological analysis. The Mrna expression of 5-LO,smooth muscle-alpha(α-SMA),Collagen-1,matrix metalloproteinase-2(MMP-2)and tissue inhibitors of metalloproteinase-1(TIMP-1),the protein expression of 5-LO were evaluated by real time PCR and Western blot respectively. Histological analysis was performed by microscopy observation. Fibrosis conditions in rat liver in each group were evaluated according to the semi-quantitative scoring system (SSS), Hyp in rat livers and the hepatic functional biochemistry were also detected. Results Along with the aggravation of liver fibrosis, the gene expression of 5-Lo,α-SMA,Collagen-1,MMP-2 and TIMP-1 increased gradually, and the level of ALT, TBA, Hyp and SSS score also increased gradually. With the administration of AA-861,the Mrna expression of 5-LO,α-SMA,Collagen-1,MMP-2,TIMP-1 and the protein expression of 5-LO decreased remarkably, and the reduction in TIMP-1 Mrna expression was more significant than that in MMP-2.Six weeks after AA-861 treatment, the level of ALT, TBA, Hyp and SSS score were also decreased significantly. Conclusion AA-861 ameliorates CCI4 induced rat liver fibrosis by inhibiting the 5-LO pathway and decreasing the expression of 5-LO,α-SMA,Collagen-1,MMP-2 and TIMP-1.
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0.05).Histological type,gross type,tumor site,lymph node metastasis and depth infiltration were related to the prognosis of gastric cancer(P
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Objective To evaluate the effects of endothelial nitric oxide synthase (eNOS) gene transfer on intrahepatic vascular resistance (IHVR) and portal venous pressure (PVP) in cirrhotic rats. Methods (1) 5 days after eNOS gene transfer, the in situ liver perfusion system (ISLP) was prepared and in different groups of controls and eNOS treated rats, the followings were analyzed: portal perfusion pressure (PP) dose-response curve to norepinephrine (NE); the effects on PP caused by specific nitric oxide synthase (NOS) inhibitor N-monomethyl-L- arginine (L-NMMA) or the nitric oxide (NO) synthesis substrate L-arginine (L-Arg). (2) The experiment of perfusion via portal vein in vivo was performed and the effects of L-NMMA on the PVP was observed. Results (1) In ISLP model, after L-NMMA was added into the perfusate of the control rats, PP dose-respose to NE increased remarkably and the peak of PP increased to (26.7?0.9) mm?Hg. The increased PP response to NE caused by L-NMMA was offsetted by L-Arg and the peak of PP decreased to (23.2?0.9) mm?Hg. In eNOS treated rats, PP response to NE was significantly lower than that in controls (P