Precision functional sphincter-preserving surgery (PPS) for ultralow rectal cancer: a natural orifice specimen extraction (NOSE) surgery technique.

BACKGROUND: In patients with ultralow rectal cancer, surgical resection of the tumor without impairing sphincter function remains a technical challenge. The purpose of this study was to describe a new technique of transanal natural orifice specimen extraction (NOSE) surgery using our independently developed devices, aiming to achieve precise cancer resection and preserve sphincter function in patients with ultralow rectal cancer. METHODS: Precision functional sphincter-preserving surgery (PPS) was performed on nineteen patients with ultralow rectal cancer between June 2019 and April 2020. With the help of our independently developed devices, surgeons directly and accurately removed the lower edge of the tumor and retained healthy rectal tissue on the nontumorous side. Hand-sewn anastomosis with a mattress suture was used to achieve sturdy anastomosis. Preoperative baseline characteristics, operative details, 90-day postoperative complications, costs, and anal function score at 6 months after surgery were documented. RESULTS: Nineteen ultralow rectal cancer patients with a median distance to the dentate line of 2.0 cm successfully underwent PPS without serious postoperative complications. Six out of nineteen patients (31.6%) received a prophylactic stoma. The average cost was 62164.1 yuan. At 6 months after surgery, the average Wexner anal function score and the average Vaizey score were both 3 points. CONCLUSIONS: PPS can be employed to precisely resect rectal tumors and preserve sphincter function in ultralow rectal cancer patients. The use of our devices enhanced surgical efficiency, reduced the need for prophylactic stoma, reduced surgery-related costs, and prevented abdominal surgical incisions.

A comparison of four common malnutrition risk screening tools for detecting cachexia in patients with curable gastric cancer.

OBJECTIVE: Although there is international consensus regarding the importance of cachexia, no tools exist, to our knowledge, for cachexia screening among patients with cancer. The aim of this study was to evaluate whether patients with cancer and cachexia could be identified using the four most commonly used nutritional screening tools: the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Screening (NRS)-2002, the Malnutrition Screening Tool (MST), and the Short Nutritional Assessment Questionnaire (SNAQ). METHODS: Clinical data were prospectively collected for patients who underwent elective radical gastrectomy for gastric cancer in two large centers between August 2014 and February 2018. Patients were also screened using the MUST, NRS-2002, MST, and SNAQ tools. The screening results were subsequently compared with the international consensus diagnostic criteria for cancer cachexia. RESULTS: A total of 1001 patients were evaluated, including 363 patients (36.3%) with cancer cachexia. Among the patients "at nutritional risk" based on each tool, the proportions of cachexia were 87.3% for the MUST tool, 84.3% for the MST tool, 76.6% for the NRS-2002 tool, and 54.3% for the SNAQ tool. The MST tool provided the largest area under the curve for identifying cancer cachexia (0.914; P < 0.001). CONCLUSION: Among the tools examined, the MST had the greatest ability to detect cancer cachexia among patients with gastric cancer.

UCA1 promotes cell proliferation and invasion of gastric cancer by targeting CREB1 sponging to miR-590-3p.

Long noncoding RNAs (lncRNAs) have emerged as regulators in a variety of biological processes, including carcinogenesis in human cancer. UCA1 has been reported to be upregulated in gastric cancer (GC); however, the underlying functional roles of UCA1 in GC have not been established. In the current study, we showed that UCA1 is significantly higher in GC tissues and cells compared with adjacent normal tissues and a gastric epithelium cell line, respectively. Higher UCA1 expression was associated with lymph node metastasis, TNM stage, and poor overall survival (OS) in GC patients. In vitro functional studies confirmed that UCA1 promotes cell proliferation, colony formation ability, and cell invasion in GC cells. We demonstrated that knockdown of UCA1 inhibits tumor growth in vivo. The double luciferase reporter, RNA-binding protein immunoprecipitation assay, and RNA pull down assay demonstrated that miR-590-3p serves as a target for UCA1. UCA1 promoted cell proliferation and invasion by negatively regulating miR-590-3p expression. Moreover, we demonstrated that CREB1 is a downstream target of miR-590-3p and UCA1 activates CREB1 expression by sponging to miR-590-3p. Thus, these results showed that UCA1 functions as an oncogene in GC and may be a target for treatment of GC.

[Transumbilical single-port access laparoscopic surgery for colorectal cancer].

OBJECTIVE: To evaluate the surgical outcomes after transumbilical single-port access laparoscopic surgery for colorectal cancer. METHODS: Patients undergoing transumbilical single-port access laparoscopic radical resection for colorectal cancer at the Zhongshan Hospital of Xiamen University were included. RESULTS: Three patients underwent transumbilical single-port access laparoscopic radical resection for sigmoid colon cancer and 1 for rectal cancer between August 2010 and September 2010. There were no intraoperative or postoperative complications. No conversion was required. The mean operative time was 206 min and the mean estimated blood loss was 75 ml. The mean number of harvested lymph nodes was 21. Patients were ambulatory in the same day of surgery or postoperative day 1. Length of hospital stay ranged from 7 to 10 days. CONCLUSIONS: Transumbilical single-port access laparoscopic surgery is safe for colorectal cancer. Long-term outcomes warrant further investigation.

JNK1, JNK2, and JNK3 are involved in P-glycoprotein-mediated multidrug resistance of hepatocellular carcinoma cells.

BACKGROUND: Multidrug resistance (MDR) is extremely common in hepatocellular carcinoma (HCC) and is a major problem in cancer eradication by limiting the efficacy of chemotherapy. Modulation of c-Jun NH2-terminal kinase (JNK) activation could be a new method to reverse MDR. However, the relationship between JNK activity and MDR in HCC cells is unknown. This study aimed to explore the relationship between MDR and JNK in HCC cell lines with different degrees of MDR. METHODS: A MDR human HCC cell line, SMMC-7721/ADM, was developed by exposing parental cells to gradually increasing concentrations of adriamycin. The MTT assay was used to determine drug sensitivity. Flow cytometry was used to analyze the cell cycle distribution and to measure the expression levels of P-glycoprotein (P-gp) and MDR-related protein (MRP)-1 in these cells. JNK1, JNK2 and JNK3 mRNA expression levels were quantified by real-time PCR. Expression and phosphorylation of JNK1, JNK2, and JNK3 were analyzed by Western blotting. RESULTS: The MDR of SMMC-7721/ADM cells resistant to 0.05 mg/L adriamycin was mainly attributed to the overexpression of P-gp but not MRP1. In addition, these cells had a significant increase in percentage in the S phase, accompanied by a decrease in percentage in the G0/G1 phase, which is likely associated with a reduced ability for cell proliferation and MDR generation. We found that JNK1, JNK2, and JNK3 activities were negatively correlated with the degree of MDR in HCC cells. CONCLUSION: This study suggests that JNK1, JNK2, and JNK3 activities are negatively correlated with the degree of MDR in HCC cells.

[Expression of inductive nitric oxide synthase and vascular endothelial growth factor in colonic carcinoma, and their effects on tumor angiogenesis].

OBJECTIVE: To investigate the expression of inductive nitric oxide synthase (iNOS) and vascular endothelial growth factor (VEGF), and their relations with clinicopathological parameters in colonic carcinoma. METHOD: Immunohistochemistry (streptomycin avidin-biotin peroxidase complex, SP) was used to detect the expression of iNOS, VEGF, collagen IV, FVIII Ag in colonic adenocarcinoma, and micro vessel density (MVD) was counted. RESULTS: The positive rates of iNOS and VEGF in colonic carcinoma were 76% and 80% respectively. The MVD in iNOS-positive carcinoma and iNOS-negative carcinoma were 37.0+/- 5.7 and 30.5+/- 4.9. The MVD in VEGF-positive carcinoma and VEGF-negative carcinoma were 39.5+/- 8.5 and 30.7+/- 4.4. The expressions of iNOS and VEGF were positively correlated with MVD. The expression of VEGF was correlated with tumor invasion, differentiation and lymph no de metastasis, but not with patients age,sex and histologic type. CONCLUSION: The expression of iNOS and VEGF may play a role in the angiogenesis, metastasis and invasion of colonic carcinoma.

[Detection of APC mutation by real-time polymerase chain reaction and melting curve analysis].

OBJECTIVE: To establish a simple, reliable and low cost approach for clinical detection of APC mutation. METHODS: Using SYBR Green I as the real-time polymerase chain reaction (PCR) product indicator, a DNA fragment of 270 bp targeting APC_1309 mutation (5 bp deletion) was amplified from the sample DNA. A short fragment (40/35 bp) was then amplified from the 270 bp PCR product, followed by melting curve analysis from 65 degrees C to 99 degrees C at 0.5 degrees C/step. RESULTS: A total of 18 paraffin-embedded tumor samples were analyzed, of which 7 were tested positive for the mutation and 11 were negative. No mutation was detected in any of the 20 normal peripheral blood samples. CONCLUSIONS: Real-time PCR melting curve analysis can be used for routine APC mutation detection. The simple design, low cost and high reliability should allow similar applications to the analysis of a variety of other gene mutations.