[Laparoscopic with extralevator abdominoperineal excision for low rectal carcinoma].

OBJECTIVE: To explore the feasibility of laparoscopic with extralevator abdominoperineal excision (LELAPE group) for low rectal cancer. METHODS: From June 2011 to January 2013, 35 patients with low rectal cancer undergoing laparoscopic abdominoperineal excision at the Department of Gastroenterological Surgery, Beijing Hospital were analyzed retrospectively. Among them, 20 received laparoscopic abdominoperineal excision (LAPE group). There were 12 males and 8 females with an average age of (63 ± 6) years old. Another 15 patients underwent laparoscopic extralevator abdominoperineal excision (LELAPE group). There were 10 males and 5 females with an average age of (61 ± 7) years old. Operative duration, blood loss volume, time of postoperative out-of-bed activity, recovery of gastrointestinal function, removal time of drainage tube, edge of perineal position take out stitches time, postoperative hospital stay and complication rates were relative analyzed. RESULTS: There was no significant difference in operative time, time of postoperative out-of-bed activity, recovery of gastrointestinal function, removal time of perineal stitches, postoperative hospital stay and complication rates between 2 groups ((259 ± 52) vs (246 ± 55) min, (35 ± 13) vs (33 ± 9) d,(61 ± 25) vs (63 ± 20) h, (15.7 ± 2.5 ) vs (16.8 ± 2.9) d, (12 ± 3) vs (15 ± 4) d, 2/15 vs 3/20, all P > 0.05). Blood loss volume of perineal position in LELAPE group was less than those in LAPE group ((76 ± 31) vs (148 ± 36) ml, P < 0.05). Removal of perineal drainage tube in LELAPE group was earlier than that in LAPE group ((6.2 ± 1.6) vs (10.3 ± 1.8) d, P < 0.05). CONCLUSION: LELAPE is a safe and feasible surgical approach for low rectal cancer.

Integrin-linked kinase in gastric cancer cell attachment, invasion and tumor growth.

AIM: To investigate the effects of integrin-linked kinase (ILK) on gastric cancer cells both in vitro and in vivo. METHODS: ILK small interfering RNA (siRNA) was transfected into human gastric cancer BGC-823 cells and ILK expression was monitored by real-time quantitative polymerase chain reaction, Western blotting analysis and immunocytochemistry. Cell attachment, proliferation, invasion, microfilament dynamics and the secretion of vascular endothelial growth factor (VEGF) were also measured. Gastric cancer cells treated with ILK siRNA were subcutaneously transplanted into nude mice and tumor growth was assessed. RESULTS: Both ILK mRNA and protein levels were significantly down-regulated by ILK siRNA in human gastric cancer cells. This significantly inhibited cell attachment, proliferation and invasion. The knockdown of ILK also disturbed F-actin assembly and reduced VEGF secretion in conditioned medium by 40% (P < 0.05). Four weeks after injection of ILK siRNA-transfected gastric cancer cells into nude mice, tumor volume and weight were significantly reduced compared with that of tumors induced by cells treated with non-silencing siRNA or by untreated cells (P < 0.05). CONCLUSION: Targeting ILK with siRNA suppresses the growth of gastric cancer cells both in vitro and in vivo. ILK plays an important role in gastric cancer progression.

[FTY720-induced lymphocyte apoptosis inhibits acute graft versus host disease in rat small bowel transplantation].

OBJECTIVE: To investigate the effect and mechanism of FTY720 on acute graft versus host disease (GVHD) in rat small bowel transplantation (SBTx). METHODS: Heterotopic SBTx was performed using a parent (WF)-into-F1 (WFxACI) rat combination. Recipient rats were divided into experimental group (n=6) and control group (n=6). Rats in the experimental group were administered with FTY720 at 0.5 mg/kg for 14 days. Lymphocyte apoptosis in the liver and the mucosa of intestine and graft was detected by TUNEL and flow cytometry 15 days after transplantation. Recipient survival and lymphocyte apoptosis were compared between the two groups. RESULTS: Recipients in the control group died of GVHD after a mean survival time of (16+/-2.1) days. FTY720-treated recipients had a significantly longer survival (>100 days). After administration of FTY720, the percentage of apoptotic lymphocytes was significantly increased in the graft as compared to that in the control group by flow cytometry. The ratio of apoptotic lymphocyte in the liver and graft was also significantly higher in the experimental group by TUNEL. CONCLUSION: FTY720 effectively induces the lymphocyte apoptosis, inhibits the lesion of target tissues by GVHD, and prolongs the recipient survival.

The impact of PET/CT on therapeutic strategy of patients with colorectal cancer metastasis.

BACKGROUND/AIMS: The study's aim was to assess the impact of the PET/CT on the therapeutic strategy of the patients with colorectal cancer metastasis. METHODOLOGY: Fifteen patients who were suspicious of postoperative colorectal cancer metastasis were included in the study. Each patient received a positron emission tomography/computed tomography (PET/CT) after received contrast-enhanced computed tomography (ceCT). The therapeutic strategies were made before and after the PET/ CT respectively. The lesions confirmed by pathology or periodic follow up of ceCT (3 and 6 mo). RESULTS: Intrahepatic metastases were present in 5 of the 15 patients, total 9 lesions. The specificities of the PET/CT and ceCT were 100%. The patients with intrahepatic metastases were detected by PET/CT and ceCT with a sensitivity of 100% and 80%, respectively (p = 0.0009). Extrahepatic metastases were present in 11 of the 15 patients, total 32 lesions. The specificities of the PET/CT and ceCT were 75% and 50%, respectively. PET/ CT and ceCT were with a sensitivity of 100% and 63.6%, respectively (p = 0.0177). The therapeutic strategies were changed after received PET/CT in 6 (40%) of the 15 patients. CONCLUSIONS: PET/CT is superior to ceCT for the detection of the metastatic lesions of the colorectal cancer, and is a valuable tool to help select the correct therapeutic strategies.

[Risk factors of operation and reoperation in patients with Crohn disease].

OBJECTIVE: To explore the operative rate and reoperative rate of Crohn disease(CD) in China, and to assess the relative risk factors indicating surgical treatment in CD patients. METHODS: Data of initial operation and reoperation were evaluated retrospectively in a cohort of 142 patients with CD. The influence of concomitant risk factors was assessed using multivariate analyses. RESULTS: Of the 142 cases of CD patients, 64.8% required at least one operation and the cumulative rate of operation was 52% at 5 years after onset. The relative risk of operation was increased in male patients, older than 40 years of age at onset, and those with CD involving small bowel. Of the patients undergone operation, 33.9% relapsed and required reoperation subsequently. The cumulative reoperation rate was 21% at 3 years after first operation. Male gender, a perforating indication for initial operation, as well as colonic and ileocolonic disease, increased the relative risks of reoperation. CONCLUSIONS: Half of patients with CD will undergo an operation at 5 years after onset, and 20% of them will relapse and require reoperation at 3 years after first operation. Men run a higher risk of operation and reoperation than women do. A perforating indication for initial operation predict a higher risk of reoperation.

[Treatment of mouse liver metastasis by intraportal injection of Adv-p53].

OBJECTIVE: To investigate the anti-tumor effect of intraportal administration of Adv-p53 in the treatment of the liver metastasis in mice. METHODS: 2 x 10(5) of MCA-205 cells were injected into the mouse portal vein to establish a murine liver metastasis model. The spleen was transpositioned subcutaneously to enable the administration of Adv-p53 continually into the portal system. Different doses of Adv-p53 were injected intraportally, while HBSS and Adv-CMV were injected intraportaly in the control group. Tumors in the liver were examined on day 21 after Adv-p53 administration. RESULTS: The liver weight in the Adv-p53 treated mice on day 0 group (1.20 +/- 0.34 g) was significantly less than that in the Adv-CMV group (2.59 +/- 0.48 g, P < 0.05). The number of metastatic nodules in the Adv-p53 treated mice on day 0 group (9.0 +/- 9.9) was significantly less than that in the Adv-CMV group (57.1 +/- 11.3, P < 0.05), indicating that intraportal administration of Adv-p53 inhibited the formation of liver metastasis. This anti-tumor effect was in a dose-dependent manner. After the liver metastasis was formed, Adv-p53 was administered intraportally. The liver weight in the Adv-p53 treated mice on day 5 group (1.22 +/- 0.09 g) was significantly less than that in the Adv-CMV group (3.98 +/- 1.01 g , P < 0.05). The number of metastatic nodules in the Adv-p53 treaed mice on day 5 group (5.5 +/- 3.5) was significantly less than that in the Adv-CMV group (113.2 +/- 5.8, P < 0.05). Repeatedly intraportal administration of Adv-p53 could enhance this anti-tumor effect. CONCLUSION: Local administration of Adv-p53 into the portal system would be a useful strategy for the liver metastasis treatment.

[Effect of laparoscopic radical operation on systemic immunity in patients with colorectal cancer].

OBJECTIVE: To compare the effect of laparoscopic radical operation and open operation on systemic immunity in patients with colorectal cancer. METHODS: Sixty patients with colorectal cancer were randomly divided into laparoscopic and open operation groups from March 2004 to December 2004, each group had 30 cases. CRP, IgA, IgM, IgG, CD3 (+) cells, CD4 (+) cells, CD8 (+) cells, NK cells, CD4 (+) CD5RA (+) cells, CD4 (+) CD45RO (+) cells and lymphocytes in peripheral blood were counted and compared on the 1st day before operation, 3rd and 7th day after operation. RESULTS: The two groups were comparable as for age, tumor location and stages. In open operation group, lymphocyte counts were (1.09+/- 0.29) x 10(9)/L, CD4 (+) cell (0.54 +/- 0.14) x 10(9)/L, CD8 (+) cell (0.31 +/- 0.08) x 10(9)/L, CD4 (+) CD45RO (+) (61.1+/- 8.9)%, and IgM level (136.9+/- 52.8) IU/ml, IgG (115.2 +/- 45.7) IU/ml on the 3rd day after operation, CD8 (+) cell counts were (0.32 +/- 0.09) x 10 (9)/L, CD4 (+) CD45RO (+) cell (63.2 +/- 9.1)% on the 7th day after operation, were all significantly lower than those on the 1st day before operation respectively(P< 0.05, P< 0.01). In laparoscopic operation group, the decreases of such parameters except CD4 (+) CD45RO (+) cell (62.7 +/- 12.5)% were not obvious on the 3rd day after operation. There were significant difference in lymphocyte counts (1.29 +/- 0.37) x 10( 9 )/L, IgM (164.5 +/- 48.2) IU/ml and CD8 (+) cell counts (0.38 +/- 0.09) x 10 (9) /L on the 3rd day after operation between two groups (P< 0.05). CONCLUSION: Compared with open radical operation, laparoscopic radical operation has predominance in protecting systemic immunity to treat colorectal carcinoma.

[Alternation and significance of CD4(+)CD45RA(+) and CD4(+)CD45RO(+) T cells in peripheral blood of colorectal cancer patients].

OBJECTIVE: To investigate the alternation and significance of CD4(+)CD45RA(+) T cells and CD4(+)CD45RO(+) T cells in peripheral blood of colorectal cancer patients. METHODS: The expression of CD4(+) T cells, CD4(+)CD45RA(+) T cells and CD4(+)CD45RO(+) T cells in peripheral blood of 60 colorectal cancer patients were detected with flow cytometry pre-operatively and 1, 3 months post-operatively, compared with those of 10 healthy persons. RESULTS: CD4(+) T cells expression of colorectal cancer patients was the same as the healthy persons. The proportion of CD4(+)CD45RO(+) T cells of colorectal cancer patients was higher, which descended post-operatively, especially in Dukes A and B patients, while CD4(+)CD45RA(+) T cells showed the opposite findings. CONCLUSION: CD4(+)CD45RA(+) T cells and CD4(+)CD45RO(+) T cells, playing an important immune effect in colorectal cancer patients, is closely related to stage and prognosis.