[Study of introperitoneal hyperthermic perfusion chemotherapy combined with systemic neoadjuvent chemotherapy in treatment of gastric cancer patients with peritoneal carcinomatosis].

OBJECTIVE: The aim of this study is to discuss the curative effect of introperitoneal hyperthermic perfusion chemotherapy(IHPC) combined with systemic neoadjuvant chemotherapy on the gastric cancer patients with peritoneal carcinomatosis. METHODS: Sixty-four patients with gastric cancer and peritoneal carcinomatosis who were hospitalized in the Department of Gastrointestinal Surgery of First Hospital of Jilin University from December 2006 to December 2013. After peritoneal carcinomatosis was confirmed during laparoscopic exploration, FOLFOX6 (oxaliplatin and calcium folinate and 5-Fu) was performed for systemic chemotherapy. One course was 14 days and a complete treatment includes four courses. At the same time, patients underwent peritoneal catheter insertion and received IHPC(5-Fu 1 500 mg/m(2) and Cisplatin 35 mg/m(2) were added into 0.9% NaCl solution 2 000 ml, the infusion velocity was 35-45 ml/min, infusion time was 45-60 minutes, the temperature was controlled to 41°C). A comprehensive evaluation was taken after the fourth course of treatment before operation. Further surgical therapy was performed according to the assessment result. RESULTS: Sixty-four patients received IHPC combined with systemic chemotherapy. Thirty-two patients(50.0%) had partial response, 18(28.1%) stable disease, and 14(21.9%) progressive disease after chemotherapy. No severe complications or death occurred during the neoadjuvant chemotherapy. Thirty-two patients(50.0%) received radical resection, 10(15.6%) palliative operation, and another 22 patients(37.4%) didn't comply with inclusion criteria of operation. Patients receiving operation had a median survival time of 678 days, which was significantly longer than patients without operation, with a median survival time of 251(χ(2)=23.34, P=0.02). CONCLUSIONS: IHPC combined with systemic chemotherapy is an effective therapeutic method for gastric cancer patients with peritoneal carcinomatosis in terms of reducing preoperative tumor load and achieving radical resection.

[Effects of omega-3 polyunsaturated fatty acids on postoperative inflammatory reaction and clinical efficacy].

OBJECTIVE: To investigate the effect of omega-3 polyunsaturated fatty acids (PUFA) on postoperative inflammatory response and clinical efficacy in gastric cancer patients with nutritional risk. METHODS: All patients with gastric cancer in our department from June 2013 to January 2014 undergoing radical gastrectomy were prospectively enrolled in the study. Patients who matched the selection criteria were randomly divided into two groups: trial group (with omega-3 PUFA in parenteral nutrition) and control group (without omega-3 PUFA in parenteral nutrition). Levels of inflammatory factors (serum CRP, TNF-α, IL-1, IL-6, IL-10) and nutrition-related proteins (prealbumin, retinol conjugated protein and transferrin) were compared between the two groups before operation and 2, 4 and 6 days after operation. Incidence of postoperative systemic inflammatory response syndrome (SIRS) and other indicators associated with efficacy were compared between the two groups as well. RESULTS: Forty-seven patients were finally included in this study with 21 patients in the trial group and other 26 in the control group. There were no significant differences of inflammatory factors and nutrition-related proteins between the two groups before operation (all P>0.05). In the 6th days after operation, the levels of proinflammatory cytokines, including CRP, IL-1 and IL-6 were significantly lower in the trial group as compared to the control group, while the level of IL-10 (inhibiting inflammatory cytokine) was higher in the trial group, as well as levels of nutrition proteins(all P<0.05). The trial group had significantly lower rate of SIRS than the control group [57.1%(12/21) vs. 84.6% (22/26), P=0.036]. Compared with the control group, patients in the trial group had shorter bowel sound recovery time [(12.3±1.1) d vs. (3.1±1.3) d, P=0.025], earlier passage of flatus [(3.1±1.0) d vs. (3.9±1.2) d, P=0.025] and shorter hospital stay [(9.4±2.1) d vs. (10.9±2.5) d, P=0.038], but there was no difference in postoperative complication rate between the two groups (P=0.678). CONCLUSIONS: Omega-3 PUFA can reduce the release of inflammatory promoters, promote the release of inhibiting inflammatory cytokine IL-10, decrease the incidence of SIRS, improve patients' nutritional state, expedite the recovery of gastrointestinal function and shorten patients' recovery time.

Catalpol provides protective effects against cerebral ischaemia/reperfusion injury in gerbils.

OBJECTIVES: To investigate the protective effect of catalpol on cerebral ischaemia/reperfusion (CI/R) injury in gerbils and further explore the underlying mechanism. METHODS: A gerbil model of CI/R was prepared by bilateral common carotid occlusion for 10 min followed by 6 h reperfusion. Catalpol (5, 10 or 20 mg/kg per day) was injected intraperitoneally for 3 days before the carotid occlusion. Stroke index was measured during the reperfusion. The contents of endogenous neuropeptides, endothelin-1 (ET-1) and calcitonin gene-related peptide in plasma were evaluated by radioimmunoassay. Superoxide dismutase (SOD) and malondialdehyde (MDA) in brain tissue homogenate were also examined. KEY FINDINGS: The results showed that catalpol significantly improved the stroke index compared with CI/R control group (P < 0.05 or P < 0.01). Catalpol significantly increased the activity of SOD at the doses of 10 and 20 mg/kg (P ≤ 0.05), decreased the brain MDA content and the plasma level of ET-1 at the doses of 10 and 20 mg/kg (P ≤ 0.01). CONCLUSIONS: These data suggested that the efficacy of catalpol pretreatment on CI/R injury may be attributed to reduction of free radicals and inhibition of lipid peroxidation and ET-1 production.

Visceral myopathy presenting as acute appendicitis and ogilvie syndrome.

Background. Visceral myopathy is rare pathological condition of gastrointestinal tract with uncertain clinical presentation and unknown etiology. It often presents with symptoms of chronic intestinal pseudoobstruction of colon. We report a case of visceral myopathy which presented to us as acute appendicitis and Ogilvie syndrome, and we managed it surgically. Method and Result. A case report of 20-year female clinically presented as acute appendicitis and we performed laparoscopic exploration which revealed inflamed appendix with grossly dilated ascending colon. We performed laparoscopic appendectomy and postoperatively managed the patients with IV fluids, antibiotics, neostigmine, and extended length rectal tube for enema and decompression. During postoperative period, she developed abdomen distension and peritonitis, and we ordered abdomen CT which revealed colon pseudo- obstruction. We performed right hemicolectomy with permanent ileostomy, and the histopathology reports of resected colon were visceral myopathy. Conclusion. Visceral myopathy is very rare group of disease and poorly understood condition that may present with chronic or acute intestinal pseudo-obstruction and often mimic other more common gastrointestinal disease. VM should be considered as differential diagnosis whenever the patient presents with acute appendicitis, uncharacteristic abdominal symptoms, recurrent attacks of abdominal distention, and pain with no radiological evidence of intestinal obstruction.