Prognosis of laparoscopic surgery for colorectal cancer in middle-aged patients.

Background: The prognosis of middle-aged patients with colorectal cancer (CRC) treated by laparoscopic resection (LR) is unclear. This study aimed to evaluate the survival outcomes of LR compared with open resection (OR) for middle-aged patients with CRC. Patients and Methods: This retrospective cohort study used the data from a database of all consecutive colorectal resections performed between January 2009 and December 2017. Propensity score matching (PSM) was performed to handle the selection bias based on age, gender, body mass index, tumour location, AJCC stage and admission year. Univariate and multivariate COX regression model was used to identify risk factors of overall survival (OS) and disease-free survival (DFS). Results: After PSM, 154 patients were included in each group. Compared with the OR group in the total cohort, there were better survival outcomes in the LR group for 5-year OS and 5-year DFS (both P < 0.001). These differences were observed for Stage II and III diseases and for all CRC, irrespective of location. The multivariate analysis showed that tumour ≥5 cm (hazard ratio [HR] = 1.750, 95% confidence interval [CI]: 1.026-2.986, P = 0.040), Stage III (HR = 14.092, 95% CI: 1.894-104.848, P = 0.010) and LR (HR = 0.300, 95% CI: 0.160-0.560, P < 0.001) were independently associated with OS. Pre-operative carcinoembryonic antigen ≥5 ng/ml (HR = 3.954, 95% CI: 1.363-11.473, P = 0.011), Stage III (HR = 6.206, 95% CI: 1.470-26.200, P = 0.013) and LR (HR = 0.341, 95% CI: 0.178-0.653, P = 0.001) were independently associated with DFS. Conclusions: In middle-aged patients with CRC, LR achieves better survival than OR. Complications are similar, except for less blood loss and shorter post-surgical hospital stay with LR.

Long Noncoding RNA GAS5 Targeting miR-221-3p/Cyclin-Dependent Kinase Inhibitor 2B Axis Regulates Follicular Thyroid Carcinoma Cell Cycle and Proliferation.

INTRODUCTION: Follicular thyroid carcinoma (FTC) is more aggressive than the most common papillary thyroid carcinoma (PTC). However, the current research on FTC is less than PTC. Here, we investigated the effects of long noncoding RNA (lncRNA) GAS5 and miR-221-3p in FTC. METHODS: Quantitative real-time polymerase chain reaction (qRT-PCR) was employed to detect GAS5 and miR-221-3p expression in the FTC tissues and cells. Cell proliferation was assessed by CCK8 and EdU assays. Flow cytometry was performed to determine the cell cycle. The dual-luciferase reporter assay was employed to validate the binding relationship of GAS5/miR-221-3p and miR-221-3p/cyclin-dependent kinase inhibitor 2B (CDKN2B). Western blot was conducted to measure the protein level of CDKN2B. RESULTS: Our results displayed that GAS5 was downregulated, while miR-221-3p was upregulated in FTC tissues and cells. What's more, overexpression of GAS5 or miR-221-3p inhibition induced G0/G1 phase arrest and inhibited cell proliferation of FTC cells. GAS5 acted as a sponge of miR-221-3p, and CDKN2B was a target gene of miR-221-3p. Additionally, GAS5 inhibited cell cycle and proliferation of FTC cells via reducing miR-221-3p expression to enhance CDKN2B expression. CONCLUSION: GAS5 induced G0/G1 phase arrest and inhibited cell proliferation via targeting miR-221-3p/CDKN2B axis in FTC. Thus, GAS5 may be a potential therapeutic target for the treatment of FTC.

Quantum Mechanisms of Electron and Positron Acceleration through Nonlinear Compton Scatterings and Nonlinear Breit-Wheeler Processes in Coherent Photon Dominated Regime.

Electric force is presently the only means in laboratory to accelerate charged particles to high energies, corresponding acceleration processes are classical and continuous. Here we report on how to accelerate electrons and positrons to high energies using ultra intense lasers (UIL) through two quantum processes, nonlinear Compton scattering and nonlinear Breit-Wheeler process. In the coherent photon dominated regime of these two processes, the former can effectively boost electrons/positrons and the latter can produce high energy electrons and positrons with low energy γ photons. The energy needed for such quantum acceleration (QA) is transferred from large numbers of coherent laser photons through the two quantum processes. QA also collimate the generated high energy electrons and positrons along the laser axis and the effective acceleration distance is of microscopic dimensions. Proof of principle QA experiment can be performed on 100 petawatt (PW) scale lasers which are in building or planning.

Effects of Involved Laser Photons on Radiation and Electron-Positron Pair Production in one Coherence Interval in Ultra Intense Lasers.

Electron radiation and γ photon annihilation are two of the major processes in ultra intense lasers (UIL). Understanding their behavior in one coherence interval (CI) is the basis for UIL-matter interaction researches. However, most existing analytic formulae only give the average over many CIs. Present understanding of these two multi-photon processes in one CI usually assume that they emit forward and their spectra have a cutoff at the energy of the electron/γ. Such assumptions ignore the effects of involved laser photons (EILP). We deduced the formulae for these two processes in one CI with EILP included and give the conditions for the EILP to be significant. Strong EILP introduces new behaviors into these two processes in one CI, such as large angle emission and emit particles above the usually assumed cutoff. Simulations show that the EILP would be significant when laser intensity reaches 2 × 1022 W/cm2, which is within the reach of state-of-art lasers.

Factors influencing lymph node skip metastasis in colorectal cancer: a retrospective study.

BACKGROUND: The risk factors for lymph node skip metastasis (LNSM) have not been thoroughly clarified in patients with advanced colorectal cancer (CRC). This study aimed to identify the risk factors for LNSM in CRC patients who underwent laparoscopic radical resection with D3 lymphadenectomy. METHODS: This retrospective cohort study included a total of 167 consecutive patients who underwent laparoscopic radical resection with D3 lymphadenectomy for CRC between April 2005 and June 2017. The patients were sorted into the LNSM-positive (skip+ group) and LNSM-negative (skip- group) groups. Logistic regression was used to identify the risk factors for LNSM. RESULTS: Compared with the skip- group, the frequency of tumour size <5 cm, pT1-2 stage, and pN1 stage were significantly higher in the skip+ group (tumour size <5 cm: 68.8 versus 46.7%, P = 0.025; pT1-2 stage: 18.8 versus 4.4%, P = 0.012; pN1 stage: 78.1 versus 57.0%, P = 0.028), respectively. Multivariate logistic regression analysis revealed that pT1-2 stage (odds ratio (OR) = 4.3, 95% confidence interval (CI): 1.1-16.6, P = 0.034) and pN1 stage (OR = 2.6, 95% CI: 1.1-6.8, P = 0.047) were independent risk factors for LNSM. CONCLUSIONS: pT1-2 stage and pN1 stage are significantly associated with LNSM. Radical D3 lymphadenectomy should remain standard practice for CRC.

Metavir and FIB-4 scores are associated with patient prognosis after curative hepatectomy in hepatitis B virus-related hepatocellular carcinoma: a retrospective cohort study at two centers in China.

Although Metavir and Fibrosis-4 (FIB-4) scores are typically used to assess the severity of liver fibrosis, the relationship between these scores and patient outcome in hepatocellular carcinoma (HCC) is unclear. The aim of this study was to evaluate the prognostic value of the severity of hepatic fibrosis in HBV-related HCC patients after curative resection. We examined the prognostic roles of the Metavir and preoperative FIB-4 scores in 432 HBV-HCC patients who underwent curative resection at two different medical centers located in western (Chongqing) and eastern (Shanghai) China. In the testing set (n = 108), the Metavir, FIB-4, and combined Metavir/FIB-4 scores were predictive of overall survival (OS) and recurrence-free survival (RFS). Additionally, they were associated with several clinicopathologic variables. In the validation set (n = 324), the Metavir, FIB-4, and combined Metavir/FIB-4 scores were associated with poor prognosis in HCC patients after curative resection. Importantly, in the negative alpha-fetoprotein subgroup (≤ 20 ng/mL), the FIB-4 index (I vs. II) could discriminate between patient outcomes (high or low OS and RFS). Thus Metavir, preoperative FIB-4, and combined Metavir/FIB-4 scores are prognostic markers in HBV-HCC patients after curative hepatectomy.

Continuous regional arterial infusion and laparotomic decompression for severe acute pancreatitis with abdominal compartment syndrome.

AIM: To evaluate the therapeutic effects of abdominal decompression plus continuous regional arterial infusion (CRAI) via a drug delivery system (DDS) in severe acute pancreatitis (SAP) patients with abdominal compartment syndrome (ACS). METHODS: We presented our recent experience in 8 patients with SAP. The patients developed clinical ACS, which required abdominal decompression. During the operation, a DDS was inserted into the peripancreatic artery (the catheter was inserted from the right gastroepiploic artery until it reached the junction between the pancreaticoduodenal and gastroduodenal artery). Through this DDS, a protease inhibitor, antibiotics and octreotide were infused continuously. The duration of the regional artery infusion ranged from 8 to 41 d. The outcomes and the changes in the APACHE II score, computed tomography (CT) severity index and intra-abdominal pressure (IAP) of the patients were retrospectively evaluated. RESULTS: Eight patients with an initial APACHE IIscore of 18.9 (range, 13-27) and a Balthazar CT severity index of 9.1 (range, 7-10) developed severe local and systemic complications. These patients underwent subsequent surgical decompression and CRAI therapy because of intra-abdominal hypertension (IAH). After a mean interval of 131.9 ± 72.3 d hospitalization, 7 patients recovered with decreased APACHE II scores, CT severity indexes and IAP. The mean APACHE II score was 5.4 (range, 4-8), the CT severity index was 2.3 (range, 1-3), and IAP decreased to 7.7 mmHg (range, 6-11 mmHg) 60 d after operation. One patient died of multiple organ failure 1 wk after surgery. CONCLUSION: CRAI and laparotomic decompression might be a therapeutic option for SAP patients with ACS.

[The effect of allogenic hematopoietic stem cell transplantation on tumor recurrence and metastasis of hepatocellular carcinoma after hepatectomy and the relationship with presence of AFP mRNA and VEGF-C mRNA in peripheral blood].

OBJECTIVE: To evaluate the effect of alloHST on recurrence and metastasis of HCC after hepatic radical resection and investigate the relationship between AFP mRNA, VEGF-C mRNA and recurrence and metastasis of HCC after hepatic radical resection. METHODS: 22 SCID mice were randomized into 3 groups: group A-the scheduled transplantation, group, B-the single transplantation, and group C-the normal saline group as control. Human umbilical cord blood was transplanted into SCID mice by tail vein, Six weeks after AlloHST, the orthotopic tumor model in SCID mice was established by implanting histologically intact tissue under the embrane of liver. Ten days later, the mice received resection of lobe bearing tumor. The condition of recurrence and metastasis was observed 4 weeks after operation. All groups were compared by routine pathological test and the expression of AFP mRNA and MAGE-1 mRNA in peripheral blood were examined by real time quantitative reverse transcription-polymerase chain reaction (RQ-PCR). RESULTS: All of the incidence of intrahepatic recurrence rate after operation in 3 groups were 100%, but recurrent tumor volume [(367.18 +/- 31.86) mm3, (648.26 +/- 155.22) mm3, (811.38 +/- 127.36) mm', P < 0.01)] and the incidence of lung metastasis (14.3%, 66.7%, 100%, P < 0.01) were different among groups,The inhibitory rate of group A and B was 54.7% and 20.1%. The expression of AFP mRNA in peripheral blood (1.95 +/- 0.92 vs. 5.23 +/- 1.96, 6.36 +/- 3.38, P = 0.02) and VEGF-C mRNA (2.48 +/- 2.25, 3.45 +/- 2.81, 6.60 +/- 5.81, P = 0.27) were also different that suggested the AFP mRNA and VEGF-C mRNA in peripheral blood were significantly correlated with recurrence and metastasis. CONCLUSION: AlloHST is a useful method for decreasing metastasis and recurrence in liver cancer after radical resection in early stage and appears to be quantity-effect relationship.

Measures for increasing the safety of donors in living donor liver transplantation using right lobe grafts.

BACKGROUND: The safety of donors in living donor liver transplantation (LDLT) should be the primary consideration. The aim of this study was to report our experience in increasing the safety of donors in LDLTs using right lobe grafts. METHODS: We retrospectively studied 37 living donors of right lobe grafts from January 2002 to March 2006. The measures for increasing the safety of donors in LDLT included carefully selected donors, preoperative evaluation by ultrasonography, angiography and computed tomography; and necessary intraoperative cholangiography and ultrasonography. Right lobe grafts were obtained using an ultrasonic dissector without inflow vascular occlusion on the right side of the middle hepatic vein. The standard liver volume and the ratio of left lobe volume to standard liver volume were calculated. RESULTS: There was no donor mortality in our group. Postoperative complications only included bile leakage (1 donor), biliary stricture (1) and portal vein thrombosis (1). All donors recovered well and resumed their previous occupations. In recipients, complications included acute rejection (2 patients), hepatic artery thrombosis (1), bile leakage (1), intestinal bleeding (1), left subphrenic abscess (1) and pulmonary infection (1). The mortality rate of recipients was 5.4% (2/37); one recipient with pulmonary infection died from multiple organ failure and another from occurrence of primary disease. CONCLUSIONS: The first consideration in adult-to-adult LDLT is the safety of donors. The donation of a right lobe graft is safe for adults if the remnant hepatic vasculature and bile duct are ensured, and the volume of the remnant liver exceeds 35% of the total liver volume.

[Safety of donor of right lobe graft in living donor liver transplantation].

OBJECTIVE: To evaluate the safety of donors of right lobe graft. METHODS: We retrospectively studied 13 living donors of right lobe graft from January 2002 to June 2005. The right lobe grafts were obtained by transecting the liver on the right side of the middle hepatic vein. Liver transection was done by using an ultrasonic dissector without inflow vascular occlusion. The standard liver volume and the ratio of left lobe volume to the standard liver volume were calculated. RESULTS: The mean blood loss was 490 ml. The mean blood transfusion was 440 ml. In the perioperative period the mean albumin administered was 85 g. One donor had portal vein trifurcation, two had a right posterior bile duct and a right anterior bile duct draining into the left bile duct, respectively. One had bile ducts from left lateral and left internal segment and right duct draining into common hepatic duct. On postoperative day 1 the donors' liver functions were found impaired to some extent, but all the indices rapidly returned to the normal level at the end of the first week. Postoperative complications included 1 case of abdominal bleeding, 2 wound steatosis and 1 chyle leak. There was no donor mortality. All donors are well and have returned to their previous occupations. CONCLUSIONS: The donation of right lobe graft for adult living donor liver transplantation is safe provided that the patency of the remnant hepatic vasculature and bile duct is ensured, the volume of the remnant liver exceeds 30% of the total liver volume, and there is no injury to the remnant liver.