Early detection of colorectal cancer based on circular DNA and common clinical detection indicators.

BACKGROUND: Colorectal cancer (CRC) is the third most common cancer worldwide, and it is the second leading cause of death from cancer in the world, accounting for approximately 9% of all cancer deaths. Early detection of CRC is urgently needed in clinical practice. AIM: To build a multi-parameter diagnostic model for early detection of CRC. METHODS: Total 59 colorectal polyps (CRP) groups, and 101 CRC patients (38 early-stage CRC and 63 advanced CRC) for model establishment. In addition, 30 CRP groups, and 62 CRC patients (30 early-stage CRC and 32 advanced CRC) were separately included to validate the model. 51 commonly used clinical detection indicators and the 4 extrachromosomal circular DNA markers NDUFB7, CAMK1D, PIK3CD and PSEN2 that we screened earlier. Four multi-parameter joint analysis methods: binary logistic regression analysis, discriminant analysis, classification tree and neural network to establish a multi-parameter joint diagnosis model. RESULTS: Neural network included carcinoembryonic antigen (CEA), ischemia-modified albumin (IMA), sialic acid (SA), PIK3CD and lipoprotein a (LPa) was chosen as the optimal multi-parameter combined auxiliary diagnosis model to distinguish CRP and CRC group, when it differentiated 59 CRP and 101 CRC, its overall accuracy was 90.8%, its area under the curve (AUC) was 0.959 (0.934, 0.985), and the sensitivity and specificity were 91.5% and 82.2%, respectively. After validation, when distinguishing based on 30 CRP and 62 CRC patients, the AUC was 0.965 (0.930-1.000), and its sensitivity and specificity were 66.1% and 70.0%. When distinguishing based on 30 CRP and 32 early-stage CRC patients, the AUC was 0.960 (0.916-1.000), with a sensitivity and specificity of 87.5% and 90.0%, distinguishing based on 30 CRP and 30 advanced CRC patients, the AUC was 0.970 (0.936-1.000), with a sensitivity and specificity of 96.7% and 86.7%. CONCLUSION: We built a multi-parameter neural network diagnostic model included CEA, IMA, SA, PIK3CD and LPa for early detection of CRC, compared to the conventional CEA, it showed significant improvement.

Low microRNA150 expression is associated with activated carcinogenic pathways and a poor prognosis in patients with breast cancer.

Breast cancer is the most common type of cancer amongst women worldwide, and numerous microRNAs (miRNAs/miRs) are involved in the initiation and progression of breast cancer. The aim of the present study was to identify hub miRNAs and determine the underlying mechanisms regulated by these miRNAs in breast cancer. Breast invasive carcinoma transcriptome data (including mRNAs and miRNAs), and clinical data were acquired from The Cancer Genome Atlas database. Differential gene expression analysis, co­expression network analysis, gene set enrichment analysis (GSEA) and prognosis analysis were used to screen the hub miRNAs and explore their functions. Functional experiments were used to determine the underlying mechanisms of the hub miRNAs in breast cancer cells. The results revealed that low miR150 expression predicted a more advanced disease stage, and was associated with a less favorable prognosis. Through the combined use of five miRNA­target gene prediction tools, 31 potential miR150 target genes were identified. GSEA revealed that low miR150 expression was associated with the upregulation of several cancer­associated signaling pathways, and the downregulation of several tumor suppressor genes. Furthermore, miR150 independently affected overall survival in patients, and interacted with its target genes to indirectly affect overall and disease­free survival. Functional experiments demonstrated that miR150 positively regulated B and T lymphocyte attenuator (BTLA), and the downregulation of miR150 and BTLA combined promoted cell migration. In conclusion, the present study revealed that low miR150 expression was associated with less favorable clinical features, upregulation of several carcinogenic signaling pathways, and poor patient survival. Additionally, a miR150­BTLA axis was suggested to regulate cell viability and migration.

MFAP2 is overexpressed in gastric cancer and promotes motility via the MFAP2/integrin α5ß1/FAK/ERK pathway.

Gastric cancer (GC) is one of the most common malignancies and its prognosis is extremely poor. This study identifies a novel oncogene, microfibrillar-associated protein 2 (MFAP2) in GC. With integrative reanalysis of transcriptomic data, we found MFAP2 as a GC prognosis-related gene. And the aberrant expression of MFAP2 was explored in GC samples. Subsequent experiments indicated that silencing and exogenous MFAP2 could affect motility of cancer cells. The inhibition of silencing MFAP2 could be rescued by another FAK activator, fibronectin. This process is probably through affecting the activation of focal adhesion process via modulating ITGB1 and ITGA5. MFAP2 regulated integrin expression through ERK1/2 activation. Silencing MFAP2 by shRNA inhibited tumorigenicity and metastasis in nude mice. We also revealed that MFAP2 is a novel target of microRNA-29, and miR-29/MFAP2/integrin α5ß1/FAK/ERK1/2 could be an important oncogenic pathway in GC progression. In conclusion, our data identified MFAP2 as a novel oncogene in GC and revealed that miR-29/MFAP2/integrin α5ß1/FAK/ERK1/2 could be an important oncogenic pathway in GC progression.

SSRP1 silencing inhibits the proliferation and malignancy of human glioma cells via the MAPK signaling pathway.

Structure-specific recognition protein 1 (SSRP1) has been considered as a potential biomarker, since aberrant high expression of SSRP1 has been detected in numerous malignant tumors. However, the correlation between the expression level of SSRP1 and glioma remains unclear. The present study attempted to investigate the role of SSRP1 in the pathogenesis of glioma. In the present study, our data revealed that SSRP1 overexpression was detected in glioma tissues at both the mRNA and protein levels using quantitative real-time RT-PCR and immunohistochemical analysis. We also demonstrated that the upregulated expression of SSRP1 was correlated with the World Health Organization (WHO) grade of glioma. The knockdown of SSRP1 by siRNA not only resulted in the inhibition of cell proliferation, but also significantly inhibited glioma cell migration and invasion. Mechanistic analyses revealed that SSRP1 depletion suppressed the activity of the phosphorylation of the MAPK signaling pathway. In conclusion, the present study indicated that SSRP1 regulated the proliferation and metastasis of glioma cells via the MAPK signaling pathway.

Dynamic changes of mononuclear phagocytes in circulating, pulmonary alveolar and interstitial compartments in a mouse model of experimental silicosis.

CONTEXT: Silicosis is a devastating, irreversible lung fibrosis condition exposed to crystalline silica. The mononuclear phagocyte system plays an important role in the pathogenesis of silicosis. OBJECTIVE: The present study was aimed to explore the dynamic changes of mononuclear phagocytes in circulating, pulmonary alveolar and interstitial compartments in experimental silicosis model. MATERIALS AND METHODS: A mouse model of lung fibrosis was developed with crystalline silica particles (2 mg/40 µL via oropharyngeal instillation) using male C57BL/6 mice, and were killed on days 1, 3, 7, 14, and 28. The lung inflammation and fibrosis was investigated using hematoxylin-eosin staining and bronchoalveolar lavage fluid (BALF) analysis, Masson's trichrome staining, and immunofluorescence. Circulating monocyte subsets (Ly6C(hi) and Ly6C(lo)), polarization state of BALF-derived alveolar macrophages (AMϕ) and lung interstitial macrophages (IMϕ, derived from enzymatically digested lung tissue) were analyzed by flow cytometry. RESULTS: The percentage of Ly6C(hi) monocytes significantly increased on day 1 after silica exposure, which reached the peak level from day 7 till day 28. Moreover, M2 (alternative activation) AMϕ (PI - CD64 + CD206+) was dramatically and progressively increased from day 1 to day 28. A parallel increase in IMϕ with M2 polarization (PI-CD64 + CD11b + CD206+) was also observed from day 1 to day 28. CONCLUSION: Our data demonstrate a dynamic view of mononuclear phagocyte change in three compartments after silica challenge, which highlights the remodeling of mononuclear phagocyte system as a potential therapeutic target for silicosis.

Inflammatory monocyte/macrophage modulation by liposome-entrapped spironolactone ameliorates acute lung injury in mice.

AIM: To examine the therapeutic/preventive potential of liposome-encapsulated spironolactone (SP; Lipo-SP) for acute lung injury (ALI) and fibrosis. MATERIALS & METHODS: Lipo-SP was prepared by the film-ultrasonic method, and physicochemical and pharmacokinetic characterized for oral administration (10 and 20 mg/kg for SP-loaded liposome; 20 mg/kg for free SP) in a mouse model bleomycin-induced ALI. RESULTS: Lipo-SP enhanced bioavailability of SP with significant amelioration in lung pathology. Mechanistically, SP-mediated mineralocorticoid receptor antagonism contributes to inflammatory monocyte/macrophage modulation via an inhibitory effect on Ly6C(hi) monocytosis-directed M2 polarization of alveolar macrophages. Moreover, Lipo-SP at lower dose (10 mg/kg) exhibited more improvement in body weight gain. CONCLUSION: Our data highlight Lipo-SP as a promising approach with therapeutic/preventive potential for ALI and fibrosis.

Highly expressed MT-ND3 positively associated with histological severity of hepatic steatosis.

Hepatic steatosis is the accumulation of an excess amount of triglycerides and other fats inside liver cells resulting from abnormal hepatic lipid metabolism. Mitochondrial structural and molecular defects are involved in the progression of hepatic steatosis pathogenesis. Hepatic methylation and transcriptional activity of the mitochondrial-encoded NADH dehydrogenase (MT-ND) play a critical role in the progression of non-alcoholic fatty liver disease (NAFLD). However, the expression of MT-ND3 in hepatic steatosis has not been extensively studied. In this study, liver specimens were collected from different patients, and were subjected to immunohistochemistry. Primary hepatocytes were treated with oxidative stress, hypoxia, and lipotoxicity to investigate the respective roles of these factors on MT-ND3 expression and cell apoptosis by western blotting and flow cytometry, respectively. We found that increased MT-ND3 expression in human hepatic steatosis was positively associated with histological severity of hepatic steatosis. Hypoxia, H2O2 , and saturated fatty acid treatment induced cell apoptosis mediated by mitochondria. These three factors all had effects on MT-ND3 expression in cultured hepatocytes. Taken together, MT-ND3 may play important roles in hepatic steatosis progress. Hypoxia, oxidative stress, and lipotoxicity could all influence expression of MT-ND3 and thus may play a role in the progression of hepatic steatosis.

Simultaneous laparoscopic excision for rectal carcinoma and synchronous hepatic metastasis.

BACKGROUND: Rectal carcinoma patients are often accompanied by hepatic metastasis. The aim of this study was to evaluate the therapeutic efficacy of simultaneous laparoscopic excision for rectal carcinoma with synchronous hepatic metastasis. METHODS: A total of 41 patients with rectal carcinoma and synchronous hepatic metastasis detected by CT scan were included in this study. Among them, 23 patients underwent laparoscopic surgery and 18 patients underwent traditional open surgery to simultaneously remove the rectal tumor and hepatic metastasis lesions. All patients received postoperative adjuvant chemotherapy. All the patients were followed up from 36 to 72 months (mean 45.3 months). RESULTS: All the operations were performed successfully and no patient was turned to open surgery in laparoscopic group. The mean blood loss, the mean postoperative hospital stay, the mean blood transfusion and the mean intestinal functional recovery time showed a significant difference between the two groups (P < 0.05). The 1-, 3- and 5-year survival rates were 82.6%, 43.5% and 8.6% in the laparoscopic group, without significant difference compared with the open group (77.8%, 38.9% and 0) (P > 0.05). CONCLUSIONS: Simultaneous laparoscopic excision for rectal carcinoma and synchronous hepatic metastasis is safe and effective with similar survival achieved by the traditional open abdominal surgery.

[Applied anatomy of the inguinal region and laparoscopic inguinal hernia repair].

OBJECTIVE: To investigate the regional anatomy of the inguinal region and abdominal ring and provide accurate anatomic basis for the clinical application of total peritoneum intraperitoneal onlay mesh (TPIPOM). METHODS: The structures of the inguinal region and those surrounding the abdominal ring of 18 cadavers (11 males and 7 females, 36 sides) were dissected to measure the lengths from the nerves and vessels to the corresponding anatomical landmarks. RESULTS: The average distances from the point where the iliohypogastric nerve (IHN) ran through the obliquus internus abdominis to anterosuperior iliac spine and from the point where the IHN ran through the aponeurosis of the external oblique muscle of the abdomen to the superior margin of the symphysis pubica were 4.10±0.89 cm and 5.02±1.46 cm, respectively. The average distances from the point where the ilioinguinal nerve (IGN) ran through the obliquus internus abdominis to the anterosuperior iliac spine and from the point where IGN ran through the aponeurosis of the external oblique muscle of the abdomen to the superior surface of the tuberculum pubicum were 3.09±0.81 cm and 3.84±0.89 cm, respectively. We established the regional anatomy model of the structures surrounding the abdominal ring. CONCLUSION: The quantitative measurement of important structures of the inguinal region and establishment of the regional anatomy model of the surrounding structures of the abdominal ring can provide a valuable reference to reduce intraoperative and postoperative complications of TPIPOM.

[Effect of ROUX-en-Y anastomosis and Billroth-II anastomosis after subtotal gastrectomy on blood glucose in type 2 diabetic patients].

OBJECTIVE: To evaluate the effect of ROUX-en-Y anastomosis and Billroth-II anastomosis after subtotal gastrectomy on blood glucose in patients with type 2 diabetes. METHODS: From January 2006 to December 2009, 26 and 24 type 2 diabetic patients underwent subtotal gastrectomy for gastric cancer or gastric ulcer and received subsequent ROUX-en-Y anastomosis and Billroth-II anastomosis, respectively. Perioperative and postoperative blood glucose and glycosylated hemoglobin (HbA1c) were detected in these patients to identify the variations. RESULTS: In ROUX-en-Y group, the fasting blood glucose (FBG) of the patients decreased significantly in the first month after the operation (t=4.46, P<0.05), and the 2-hour postprandial glucose (2hPG) and HbA1c also underwent significant reductions in the first postoperative week and month, respectively (t=3.5, P<0.05; t=2.21, P<0.05). In Billroth-II group, the FBG decreased significantly till 6 months after the operation (t=2.0, P<0.05), and HbA1c reduction occurred 3 months after the operation (t=2.61, P<0.05). There were significant differences in FBG in the first postoperative month, 2hPG in the 6th month, and HbA1c in the 3rd month between the two groups (P<0.05). CONCLUSION: The ROUX-en-Y anastomosis and Billroth-II anastomosis after subtotal gastrectomy can both reduce blood glucose of type 2 diabetic patients, but the former approach has better effect.

[Signal transduction pathway in liver fibrosis regulated by human hepatocyte growth factor].

OBJECTIVE: To explore the changes in the gene expression profiles in HepG2 cells transfected by human hepatocyte growth factor (hHGF) and analyze the signal transduction pathway in liver fibrosis regulated by hHGF. METHOD: A 20,000 gene cDNA microarray (Affymetrix) was used to examine the gene expressions in the HepG2 cells transfected by hHGF. The differentially expressed genes were identified and some genes with possible contribution to hepatic fibrosis were subjected to real-time PCR analysis. RESULT: The differentially expressed genes were mostly transcription regulatory molecules, cytokines, signal transduction, glucose metabolism, lipid metabolism. The results of real-time PCR showed up-regulated STAT1 and MAPK1 expression in the cells as were consistent with genechip analysis results. CONCLUSION: hHGF gene transfection results in the gene expression profile changes in HepG2 cells. HGF may regulate liver fibrosis via the JAK/STAT and MAPK pathways.

[Immunological influence of iodine-125 implantation in patients with hepatocellular carcinoma resection].

OBJECTIVE: To investigate the effect of iodine-125 implantation on immune cell subsets and cytokine production in patients undergoing hepatocellular carcinoma (HCC) resection. METHODS: Sixty-eight patients with resectable HCC were randomly divided into intrahepatic iodine-125 embedding group and control group. The percentages of T lymphocyte phenotypes (CD3(+), CD4(+), CD8(+)), NK cells, and the plasma concentrations of IL-4, IL-10, IL-12 and IFN-gamma of the patients were determined with flow cytometry and ELISA, respectively. RESULTS: In the control group, the postoperative CD3(+) and CD4(+) immunocytes were (39.38-/+6.98)% and (24.34-/+3.18)%, significantly lower than the preoperative levels [(62.58-/+8.67)% and (30.63-/+4.19)%, respectively, P<0.05)]. The postoperative concentrations of IL-4 and IL-10 were (29.83-/+7.99) and (87.54-/+2.89) ng/L, significantly higher than the preoperative levels (10.35-/+8.76 and 64.25-/+2.54 ng/L, respectively, P<0.05). In the treatment group, the percentages of the immunocytes and cytokine concentrations underwent no significant changes after the operation, but postoperative IL-12 (89.46-/+11.43 ng/L) and IFN-gamma (47.78-/+5.45 ng/L) levels were significantly higher than the preoperative levels (36.13-/+9.16 and 7.14-/+2.17 ng/L, respectively, P<0.05). Significant differences were found between the two groups in the postoperative CD3(+) and CD4(+) immunocytes and IL-4, IL-10, IL-12 and IFN-gamma levels. CONCLUSION: Iodine-125 implantation can strongly stimulates the anti-tumor immune response in HCC patients by increasing CD3(+) and CD4(+) immunocytes and promoting Th2/Th1 deviation.

[Laparoscopy combined with endoscopic and digital subtraction angiography for treatment of severe acute pancreatitis].

OBJECTIVE: To study the effect of laparoscopy combined with endoscopic and digital subtraction angiography in the treatment of severe acute pancreatitis (SAP). METHODS: Nine-seven SAP patients were randomly divided into group A (n=32) with conventional treatment and group B (n=35) with combined treatment with laparoscopy, endoscopic and digital subtraction angiography in addition to the conventional treatment. The clinical indices and therapeutic effects in the 2 groups were compared. RESULTS: After treatment, the patients in group B had significantly lower APACHE score than those in group A (P<0.05), with also better hepatic, renal and lung functions (P<0.05). The serum TNF-alpha and IL-1beta levels was significantly lower, but IL-10 significantly higher in group B (P<0.05). The CT SPN was significantly lowered in group B as compared with that in group A (P<0.05). The patients in group B had significantly lower rate of organ failure (P<0.01) and higher successful rate in organ failure management (P<0.05), with also lowered inhospital mortality than those in group A (P<0.05). CONCLUSION: Laparoscopy combined with endoscopic pancreaticobiliary duct drainage and digital subtraction angiography in addition to conventional treatment significantly improves the outcome and decreases the mortality of SAP patients.

[Simultaneous laparoscopic excision for the treatment of rectal carcinoma and the synchronous hepatic metastasis].

OBJECTIVE: To evaluate the therapeutic efficacy of simultaneous laparoscopic excision for the treatment of rectal carcinoma and synchronous hepatic metastasis. METHODS: Totally 38 patients with rectal carcinoma and synchronous hepatic metastasis detected by CT scan were included in this study. Among them, 23 patients in the group A were treated with laparoscopic surgery, and the other 18 patients in the group B with traditional abdominal operation to resect the rectal tumor and hepatic metastasis simultaneously. All patients received postoperative chemotherapy. RESULTS: All the patients were treated successfully with no postoperative death in both groups. The mean operative time was 350 +/- 45 min in group A versus 342 +/- 38 min in group B (P > 0.05). The mean blood loss was 275 +/- 96 ml in group A versus 590 +/- 85 ml in group B (P < 0.01), and the average hospital stay was 12 +/- 1.5 days in group A versus 16 +/- 2.5 days in group B (P < 0.05). Only one patient in group A received blood transfusion of 200 ml during operation, while the average blood transfusion in group B was 500 +/- 100 ml (P < 0.01). The follow-up duration was from 36 to 72 months with an average duration of 45.3 months. The 1-, 3- and 5-year survival rates were 82.6%, 43.5% and 8.6% in the group A, versus 77.8%, 38.9% and 0% in group B, respectively (P > 0.05). CONCLUSION: Simultaneous laparoscopic excision of rectal carcinoma and synchronous hepatic metastasis is safe, effective and minimally invasive with a similar survival achieved by traditional open abdominal operation.

[Laparoscopic placement of total peritoneum intraperitoneal onlay mesh in patients with inguinal hernia].

OBJECTIVE: To study the efficacy of laparoscopic placement of total peritoneum intraperitoneal onlay mesh (TPIPOM) for treatment of inguinal hernia. METHODS: TPIPOM was placed laparoscopically in 125 cases of inguinal hernia, and the clinical outcomes of the patients were observed and compared with 64 patients receiving transabdominal preperitoneal laparoscopic mesh repair (TAPP) and 53 with total extraperitoneal laparoscopic hernioplasty (TEP). RESULTS: The laparoscopic operations were successfully performed in all the patients. In TPIPOM, TAPP and TEP groups, the operating time was 30.8-/+10.3 min, 68.4-/+22.4 min and 69.5-/+23.4 min (P<0.05), the mean hospital stay was 3.8-/+1.3 days, 4.3-/+1.5 days and 4.5-/+1.6 days (P<0.05), the average time to ambulation was 1.2-/+0.5 days, 1.8-/+0.7 days and 2.2-/+0.8 days (P<0.05), the duration of pain was 1.0-/+0.5 days, 1.6-/+0.9 days and 1.9-/+0.8 days (P<0.05), and the cost was 5000.8-/+800.5 yuan, 8000.5-/+950.6 yuan and 8900.2-/+750.3 yuan (P<0.05), respectively. No scrotum edema occurred in these patients. The patients were followed up for 59.9-/+6.5 months and recurrence was found. CONCLUSION: TPIPOM is safe and effective for management of inguinal hernia with such advantages as minimal invasion, simple procedures, shorter operation time, reduced relapse and quick recovery.

[Laparoscopy and digital subtraction angiography in the treatment of severe acute pancreatitis].

OBJECTIVE: To study the effect of laparoscopy and digital subtraction angiography in the treatment of severe acute pancreatitis (SAP). METHODS: Seventy-five SAP patients were randomly divided into tow groups: (1) Conventional treatment group (group A, n = 35); (2) Conventional treatment combined with laparoscopy and digital subtraction angiography treatment group (group B, n = 40). The clinical parameters and treatment results in the 2 groups were compared. RESULTS: After treatment, APACHE II score in group B was significantly lower than that in group A (P < 0.05). The functions of liver, renal and lung were recovered (P < 0.05, respectively), levels of serum TNF-alpha and IL-1 beta were significantly lower, but IL-10 significantly elevated (P < 0.05), the CT SPN was much lower (P < 0.05); rate of organ failure significantly decreased (P < 0.01), the successful rate of organ failure treatment was increased (P < 0.05); the in hospital mortality decreased (all P < 0.05). CONCLUSIONS: Laparoscopy and digital subtraction angiography in combination with conventional treatment for SAP significantly improves the outcome and decrease the mortality of SAP.

[Total colectomy and proctocolectomy under laparoscopic for familial adenomatous polyposis].

OBJECTIVE: To evaluate the efficacy and characteristics of treating familial adenomatous polyposis (FAP) by total colectomy and proctocolectomy under laparoscopy. METHODS: The perioperative data, including surgical outcomes, safety, and recovery of 8 FAP patients, 5 males and 3 females, aged 39 (28 approximately 65), who underwent laparoscopic total colectomy and proctocolectomy were analyzed retrospectively and follow-up of 46.8 months (32 approximately 58 months) between April 2001 and January 2003 were analyzed and compared with the data of 6 patients undergoing conventional open surgery before 2001. RESULTS: Laparoscopic total colectomy and proctocolectomy were performed successfully without severe complications on the 8 patients. The mean operation time of the laparoscopy group was 178 min, not significantly different from that of the conventional group (170 min, P>0.05). The mean intra-operative blood loss, anal exsufflation time, and hospital stay, and incision length of the laparoscopy group was 110 ml, 1.2 d, 12.5 d, and 0 cm, all significantly shorter than those of the conventional group (211 ml, 3.1 d, 17.4 d, and 22.3 cm, P<0.05 or P<0.01). Follow-up showed no local recurrence. The function of stool controlling was good 9 months after the operation. CONCLUSION: With less trauma and pain, rapid recovery, and shorter hospital stay, laparoscopic total colectomy and proctocolectomy is feasible and safe for FAP. It must be performed by skilled and experienced surgeons.

[Laparoscopic high ligation of hernia sac and median umbilical fold covering internal ring in treating pediatric indirect inguinal hernia].

OBJECTIVE: To investigate the effect and clinic practice of laparoscopic high ligation of hernia sac and median umbilicus fold covering internal ring in pediatric indirect inguinal hernia. METHODS: Five hundred and fifty-two children with indirect inguinal hernia were randomly divided into group A (control group) and group B (combination group) according to their check-in dates (odd or even). In group A, 275 children were treated with laparoscopic high ligation of hernia sac. In group B, 277 children were treated with laparoscopic high ligation of hernia sac and suturing the median umbilical fold to internal ring. RESULTS: The operation was successfully performed in all 552 patients. The operating time in group A and B were (12.3 +/- 5.5) min and (20.6 +/- 4.2) min (P<0.05) respectively; and the hospital stay were (2.2 +/- 1.5) d and (2.4 +/- 1.3) d (P>0.05); the day of restoring normal active were (1.2 +/- 0.5) d and (1.3 +/- 0.6) d (P>0.05); the recurrence rate were 2.2% (6/275) and 0 (0/277) (P<0.05). No complications, such as abdominal cavity infection and scrotum hematoma occurred during the follow-up of 22 months to 55 months. CONCLUSIONS: Laparoscopic high ligation of hernia sac and median umbilical fold covering internal ring is safe and effective in treating indirect inguinal hernia of the children.

[Intraoperative radiofrequency ablation and 125I therapy for preventing local recurrence in hepatocellular carcinoma after hepatectorny].

OBJECTIVE: To evaluate the efficacy of intraoperative radiofrequency ablation and 125I therapy for preventing local recurrence in hepatocellular carcinoma (HCC) after hepatectomy. METHODS: Seventy-eight HCC patients with a tumor close to the first or the second hepatic portal underwent hepatectomy with a resection margin less than 1 cm from 1999 to 2001. All patients were randomly divided into control group and combined treatment group according to their check-in date (odd or even). In the control group, 38 patients were treated with hepatectomy alone, whereas in the combined group, 40 patients were treated with hepatectomy plus radiofrequency ablation and 125I implantation on surgical margin. All patients were followed up regularly. RESULTS: the 1-, 3- and 5-year recurrent rate was 7.5%, 30.0% and 45.0% in the combined treatment group versus 18.4%, 60.5% and 86.8% in the control group, respectively, with a significant difference in the 3-year (chi2 = 7.340, P < 0.01) and 5-year recurrent rates (chi2 = 15.740, P < 0.01). The 1-, 3- and 5-year survival rate was 92.5%, 67.5% and 30.0% in the combined group versus 81.5%, 39.4% and 18.4%, respectively. CONCLUSION: Intraoperative radiofrequency ablation and 125I therapy on the resection margin is effective to prevent local recurrence in HCC patients after hepatectomy, and to prolong their postoperative tumor free survival.

[Endoscopic thyroidectomy: a comparison of the trans-axilloareolar approach and the trans-thoracoareolar approach].

OBJECTIVE: To evaluate the advantages and shortcomings of endoscopic thyroid surgery by trans-axilloareolar approach and trans-thoracoareolar approach. METHODS: Endoscopic thyroidectomy was performed in 238 cases from December 2003 to January 2006. The patients were randomly divided into two groups. One hundred and twenty-three patients received the trans-axilloareolar approach and 115 patients randomly received the trans-thoracoareolar approach procedure. RESULTS: All the operations were succeed. The operating duration of trans-axilloareolar approach group and trans-thoracoareolar approach group were (69 +/- 29) min and (70 +/- 25) min (P > 0.05), the blood lost were (38 +/- ll) ml and (40 +/- 13) ml (P > 0.05), the average hospitalized days were (4 +/- 1.3) d and (4.5 +/- 1.2) d (P > 0.05), the rate of satisfaction with the cosmetic effects of the procedures were 97.5% and 85.2% (P <0. 05). There were no conversions to open surgery or any complications. The drainage was removed at 24 h to 36 h after the operation. CONCLUSIONS: Endoscopic thyroidectomy through trans-axilloareolar approach and trans-thoracoareolar approach is feasible, safe and cosmetic. The cosmetic effects of the trans-axilloareolar approach is better than the trans-thoracoareolar approach. The procedure selection depends on both the patient request and the technology of the surgeons.