Laparoscopic radical gastrectomy versus traditional open surgery in elderly patients with gastric cancer: Benefits and complications.

This study was conducted to compare the therapeutic effect and complications of laparoscopic radical gastrectomy (LRG) with those of traditional open surgery in elderly patients with gastric cancer (GC). We conducted a retrospective comparison of therapeutic efficacy and complications between elderly patients with GC (defined as those aged ≥70 years) who received laparoscopic gastrectomy and those who underwent gastrectomy by open surgery. A total of 108 patients who either underwent laparoscopic surgery (n=54) or traditional open surgery (n=54) at the General Hospital of Lanzhou Military Region between June, 2008 and March, 2009 were analyzed. Compared to traditional open surgery, LRG exhibited several advantages, such as being less invasive, with less intraoperative blood loss, shorter bedbound time, less intubation time, low frequency of fever, less time to normal diet, shorter hospital stay and a low overall incidence of complications. No significant difference was observed between laparoscopic and open surgery in terms of operative time and number of lymph nodes dissected. The 3-year cancer recurrence and mortality rates were similar in the two groups. In conclusion, LRG is a safe and effective procedure for the management of GC in elderly patients and was found to be superior to traditional open surgery regarding the short-term curative effect. Therefore, LRG represents a feasible and safe surgical approach for elderly patients with GC.

Short-term efficacy of laparoscopy-assisted vs open radical gastrectomy in gastric cancer.

AIM: To investigate the short-term benefits of laparoscopic radical gastrectomy (LARG) and open radical gastrectomy (ORG) in patients with gastric cancer. METHODS: A total of 400 patients with gastric cancer aged ≤ 65 years who were treated at General Hospital of Lanzhou Military Region were enrolled. Among these, 200 patients underwent LARG between October 2008 and August 2012 (LARG group); and 200 patients underwent ORG between March 2000 and September 2008 (ORG group). The short-term therapeutic benefits between the two groups were analyzed. RESULTS: The LARG procedure offered significantly better benefits to the patients compared to the ORG procedure, including less intraoperative blood loss (103.1 ± 19.5 mL vs 163.0 ± 32.9 mL, P < 0.0001), shorter postoperative hospital stay (6.8 ± 1.2 d vs 9.5 ± 1.6 d, P < 0.0001), less frequent occurrence of postoperative complications (6.5% vs 13.5%, P = 0.02), shorter time to mobilization (1.0 ± 0.3 vs 3.3 ± 0.4 d, P < 0.0001), shorter time to bowel opening (3.3 ± 0.7 d vs 4.5 ± 0.7 d, P < 0.0001), and shorter time to normal diet (3.0 ± 0.4 vs d 3.8 ± 0.5 d, P < 0.0001). However, LARG required a longer time to complete than the ORG procedure (192.3 ± 20.9 min vs 180.0 ± 26.9 min, P < 0.0001). CONCLUSION: Compared to ORG, LARG is safer, more effective, and less invasive for treating gastric cancer, with better short-term efficacy.

Highly flexible and rapidly degradable papaverine-loaded electrospun fibrous membranes for preventing vasospasm and repairing vascular tissue.

Vasospasm is a common post-operative complication after vascular anastomosis. Currently, the main treatment is a local injection of antispasmodic drugs. However, this method has a high rate of relapse and is subject to a large degree of individual variation, and repeated injections cause additional pain for patients. In this study, we developed highly flexible and rapidly degradable papaverine-loaded electrospun fibrous membranes to be wrapped around vascular suturing to prevent vasospasm. Poly-l-lactic acid/polyethylene glycol (PLLA/PEG) electrospun fibers containing papaverine maintained a high degree of flexibility and could withstand any folding, and are therefore suitable for wrapping vascular suturing. A rapid release of papaverine, between 2 and 7 days, was achieved by adjusting the proportions of PEG and PLLA. PLLA electrospun fibers containing 40% PEG (PLLA-40%) could control drug release and polymer degradation most effectively during the first 2 weeks post-operation. Testing using an in vivo rabbit model showed that PLLA-40% fibrous membranes produced significant antispasmodic effect without observable inflammation or hyperplasia, and the fibrous membranes were ideally biodegradable, with no impact on regional blood flow, pressure, vessel diameter or surrounding tissue hyperplasia. Therefore, papaverine-loaded electrospun fibrous membranes show the potential to greatly reduce post-operative vasospasm and maintain regular vascular morphology during antispasmodic therapy.

Effect of celecoxib plus standard chemotherapy on serum levels of vascular endothelial growth factor and cyclooxygenase-2 in patients with gastric cancer.

Elevated serum levels of vascular endothelial growth factor (VEGF) and cyclooxygenase-2 (COX-2) are associated with poor prognosis in patients with gastric cancer. Little is known regarding the clinical benefits of combining celecoxib, a selective inhibitor of COX-2, with standard chemotherapy regimens for the treatment of gastric cancer patients. In this study, we investigated the effect of the combinatorial use of celecoxib with standard chemotherapy on the serum levels of VEGF and COX-2 in patients with gastric cancer. In our study, 80 patients with gastric cancer who underwent laparoscopic radical surgery were randomized into two groups, the combination [celecoxib plus standard oxaliplatin, leucovorin and 5-fluorouracil (FOLFOX4) chemotherapy, n=40] and the FOLFOX4 alone (n=40) groups. In the combination group, celecoxib was orally administered to the patients (400 mg, twice daily). The serum levels of VEGF and COX-2 were measured by ELISA prior to and following surgery. We detected no significant difference in the serum levels of VEGF and COX-2 between the combination and FOLFOX4 alone groups prior to chemotherapy (P>0.05). However, after 6 cycles of chemotherapy, there was a greater decrease in the serum levels of VEGF and COX-2 in the combination group compared to those in the FOLFOX4 group (P<0.01). In addition, the serum levels of VEGF and COX-2 were closely correlated in patients with gastric adenocarcinoma prior to treatment. Our data indicated that, when combined with standard chemotherapy, celecoxib may reduce the serum levels of VEGF and COX-2, suggesting that COX-2 inhibitors may be of therapeutic value through the inhibition of tumor angiogenesis and the prevention of recurrence or metastasis. Thus, celecoxib may be a useful adjuvant agent to standard chemotherapy in patients with advanced gastric cancer.

15-deoxy-Δ¹²,¹4-prostaglandin J2 ameliorates endotoxin-induced acute lung injury in rats.

BACKGROUND: A proinflammatory milieu emerging in the lung due to neutrophil accumulation and activation is a key in the pathogenesis of acute lung injury (ALI). 15-deoxy-Δ(12, 14)-prostaglandin J2 (15d-PGJ2), one of the terminal products of the cyclooxygenase-2 pathway, is known to be the endogenous ligand of peroxisome proliferator-activated receptor γ (PPAR-γ) with multiple physiological properties. Growing evidence indicates that 15d-PGJ2 has anti-inflammatory, antiproliferative, cytoprotective and pro-resolving effects. We investigated whether 15d-PGJ2 has a protective effect against endotoxin-induced acute lung injury in rats. METHODS: Twenty-four male Wistar rats were randomly assigned into four groups (n = 6 per group): sham+vehicle group, sham+15d-PGJ2 group, LPS+vehicle group, and LPS+15d-PGJ2 group. The rats were given either lipopolysaccharide (LPS, 6 mg/kg intravenously) or saline, and pretreated with 15d-PGJ2 (0.3 mg/kg intravenously) or its vehicle (dimethyl sulphoxide) 30 minutes before LPS. Histological alterations, wet/dry weight (W/D) ratio and myeloperoxidase (MPO) activity as well as tumor necrosis factor (TNF)-α and cytokine-induced neutrophil chemoattractant-1 (CINC-1) levels were determined in lung tissues four hours after LPS injection. Immunohistochemical analysis for intercellular adhesion molecule-1 (ICAM-1) expression and Western blotting analysis for nuclear factor (NF)-κB p65 translocation and IκBα protein levels were also studied. RESULTS: 15d-PGJ2 pretreatment significantly attenuated LPS-induced lung injury, and reduced the increased W/D ratio, MPO activity, TNF-α, CINC-1 levels, and ICAM-1 expression in the lung. 15d-PGJ2 also suppressed the nuclear NF-κB p65 translocation and increased cytosolic IκBα levels. CONCLUSIONS: 15d-PGJ2 protects against endotoxin-induced acute lung injury, most likely through the reduction of proinflammatory protein levels during endotoxemia subsequent to the inhibition of NF-κB activation.

Ibuprofen-loaded electrospun fibrous scaffold doped with sodium bicarbonate for responsively inhibiting inflammation and promoting muscle wound healing in vivo.

Infection or inflammation can cause the in vivo microenvironment to become acidic, and an inappropriately excessive inflammatory response can significantly delay the healing process. A feasible acid-responsive ibuprofen-loaded poly(l-lactide) (PLLA) fibrous scaffold with doped sodium bicarbonate has been designed to prevent an excessive inflammatory response and promote regeneration. The results of the in vitro drug release study show that the acid-responsive fibrous scaffold exhibited a quick drug releasing response at pH 5.0 and a slow drug releasing response at pH 7.4. The in vivo rat muscle wound model study shows that the acid-responsive ibuprofen-loaded PLLA fibrous scaffold caused slighter inflammation and an earlier reparation. The immunohistochemical staining and quantitative real-time polymerase chain reaction analysis further showed that the scaffold caused lower levels of inflammatory factors and a higher expression of repair factors during the whole observation. Taken together, through the muscle wound healing process, the results demonstrate that the acid-responsive ibuprofen-loaded PLLA fibrous scaffold shows a better performance in preventing excessive inflammation than scaffolds that do not contain ibuprofen or are not acid-responsive. Additionally, the acid-responsive ibuprofen-loaded PLLA fibrous scaffold also has a faster healing process than others.

Use of ginsenoside Rg3-loaded electrospun PLGA fibrous membranes as wound cover induces healing and inhibits hypertrophic scar formation of the skin.

Prevention of hypertrophic scar formation of the skin requires a complex treatment process, which mainly includes promoting skin regeneration in an early stage while inhibiting hypertrophic formation in a later stage. Electrospinning PLGA with the three-dimensional micro/nano-fibrous structure and as drugs carrier, could be used as an excellent skin repair scaffold. However, it is difficult to combine the advantage of nanofibrous membranes and drug carriers to achieve early and late treatment. In this study, Ginsenoside-Rg3 (Rg3) loaded hydrophilic poly(D,L-lactide-co-glycolide) (PLGA) electrospun fibrous membranes coated with chitosan (CS) were fabricated by combining electrospinning and pressure-driven permeation (PDP) technology. The PDP method was able to significantly improve the hydrophilicity of electrospun fibrous membranes through surface coating of the hydrophilic fibers with CS, while maintaining the Rg3 releasing rate of PLGA electrospun fibrous membranes. Experimental wounds of animal covered with PDP treated fibrous membranes completely re-epithelialized and healed 3-4 days earlier than the wounds in control groups. Scar elevation index (SEI) measurements and histologic characteristics revealed that Rg3 significantly inhibited scar formation 28 days post-surgery. Moreover, RT-PCR assays and western blot analysis revealed that at day 28 after wound induction the expression of VEGF, mRNA and Collagen Type I in the scars treated with Rg3 was decreased compared to control groups. Taken together PLGA-Rg3/CS electrospun fibrous membranes induced repair of tissue damage in the early stage and inhibited scar formation in the late stage of wound healing. These dual-functional membranes present a combined therapeutic approach for inhibiting hypertrophic scars of the skin.

Clinical importance of surgical treatment of low rectal carcinoma in anus-preserving procedure--an analysis of 86 cases.

We investigated the methods and experiences of an anus-preserving procedure in curative resection of low rectal carcinoma. Eighty-six patients with low rectal carcinoma underwent Dixon's procedure with device assistance. Patients were then observed for the effects of operation. The operation was successful in all patients. Pathologic examination of specimens revealed negative margins. Complications such as anastomotic leakage were found in 7 cases. All patients recovered well. Device assistance may contribute to the successful performance of anus-preserving procedure in low rectal carcinoma. Whether the anus can be preserved or not depends on the accurate measurement of the distal length of the rectum. A meticulous hemostasis and avoidance of tension on the stoma are key measures for avoiding anastomotic leakage.

[Clinical evaluation of radiofrequency ablation therapy in patients with hepatic cavernous hemangiomas].

OBJECTIVE: To evaluate the feasibility, safety and efficacy of radiofrequency ablation (RFA) therapy in patients with hepatic cavernous hemangioma (HCH) and investigate its optimal operative approach. METHODS: Between March 2001 and June 2004, a total of 68 patients, 18 males and 50 females, age 43.1 (30-64), with 104 HCHs 2.5-11 cm in diameter with the mean size of 5.6 cm, were treated by ultrasound-guided RFA, via percutaneous (n = 19), laparoscopic (n = 29), or open surgical (n = 20) approach. In 7 patients with hepatic lesions larger than 7 cm in diameter, Pringle maneuver was used to occlude the hepatic blood flow during the laparoscopic and open RFA therapy. All patients were followed up with helical computed tomographic (CT) scans and ultrasonography for 19 months (6-36 months). RESULTS: Additional intrahepatic lesions not detected preoperatively were found in 2 patients (with 2 new lesions) via laparoscopy and 3 patients (with 4 new lesions) via celiotomy. All patients were treated with RFA successfully. The mean blood loss in the Pringle group (90.0 ml +/- 22.4 ml) was significantly fewer than that in the non-Pringle group (249 ml +/- 56 ml) (P < 0.01). The mean RFA time per lesion in the Pringle group (29.0 min +/- 7.5 min) was shorter markedly compared to the non-Pringle group (55.4 min +/- 12.4 min) (P < 0.01). In the laparoscopic RFA group, laparoscopic cholecystectomy was performed simultaneously in 15 patients with chronic calculous cholecystitis and in another 2 patients because of tumors abutting the gallbladders, and laparoscopic fenestration with intraperitoneal drainage was performed in 3 patients with simple hepatic cysts. In the open RFA group, cholecystectomy was performed in 5 patients with gallbladder diseases, partial cystectomy was performed in one patient with a hepatic cyst, and choledochotomy was performed in 3 patients with common bile duct stones. Postoperative fever and abnormal serum transaminase (ALT and AST) levels were observed in 29 patients (42.6%). A transient hematuria occurred in one patient after open RFA. No specific complications developed during or after RFA. The follow-up showed a complete lesion necrosis rate of 99% (103/104). One patient showed an incomplete lesion necrosis in the margin of RFA site 6 months after percutaneous RFA therapy and obtained retreatment with percutaneous RFA. CONCLUSION: RFA therapy is a safe, feasible and effective treatment options for patients with HCHs. This procedure can be performed via percutaneous, laparoscopic, or open approach. To prevent the RFA-related complications and to increase the therapeutic efficacy of RFA, the choice of optimal operative approach should be based on the lesion size, number, and location and on the patient's clinical status. Hepatic inflow occlusion by Pringle maneuver during laparoscopic or open RFA therapy can reduce the blood loss and increase the therapeutic efficacy significantly.