Evaluation of uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculous empyema / 中华外科杂志

Objective: To examine the safety and efficacy of the uniportal video-assisted thoracoscopic decortication in treatment of drug-resistant tuberculosis empyema. Methods: From January 2018 to December 2020, 122 cases of tuberculous empyema treated by decortication in Department of Surgery, Wuhan Pulmonary Hospital were retrospectively analyzed, including 100 males and 22 females, aged(M(IQR)) 29.5(28.0) years (range: 13 to 70 years). According to the surgical approach and drug resistance, patients with drug-resistant tuberculosis who underwent uniportal video-assisted thoracoscopic decortication were included in group A (n=22), and those who underwent thoracotomy decortication were included in group B (n=28). Drug-sensitive patients who underwent uniportal video-assisted thoracoscopic decortication were included in group C (n=72). There was no statistical difference in the baseline data of the three groups (P>0.05). The operation, early postoperative recovery, and prognosis-related indicators were compared among three groups by Kruskal-Wallis test and χ2 test by Mann-Whitney U test and Bonferroni method between groups A and B, groups A and C. Results: The intraoperative blood loss of group A, group B, and group C was 200(475) ml, 300(200) ml, and 225(300) ml, respectively. There was no significant difference in intraoperative hemorrhage (H=2.74, P=0.254) and treatment outcome (χ2=4.76, P=0.575) among the three groups. Compared with group B, the operation time of group A (302.5(187.5) minutes vs. 200.0(60.0) minutes, U=171.0, P=0.007) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0 (2.2) months, U=146.5, P=0.032) were longer, and the postoperative drainage duration (9.5(7.8) days vs. 13.0(10.0) days, U=410.0, P=0.044), and the postoperative hospitalization time (12.0(7.8) days vs. 14.5(4.8) days, U=462.2, P=0.020) were shorter. There was no significant difference in complications between group A and group B (63.6%(14/22) vs. 71.4%(20/28), χ2=0.34, P=0.558). Compared with group C, the postoperative drainage duration of group A (9.5(7.8) days vs. 7.0(4.0) days, U=543.5, P=0.031), the postoperative hospitalization time (12.0(7.8) days vs. 9.0(4.0) days, U=533.0, P=0.031) and postoperative pulmonary reexpansion duration (4.5(3.0) months vs. 3.0(2.0) months, U=961.5, P=0.001) were longer. The operation time (302.5(187.5) minutes vs. 242.5(188.8) minutes, U=670.5, P=0.278), and complications (63.6%(14/22) vs. 40.3%(29/72), χ2=3.70, P=0.054) were not different between group A and group C. Conclusions: For drug-resistant tuberculous empyema, the uniportal video-assisted thoracoscopic decortication can achieve the same good therapeutic effect as drug-sensitive tuberculous empyema, and it is as safe as thoracotomy. At the same time, it has the advantage of minimally invasive and can accelerate the early postoperative recovery of patients.

The value of transanal multipoint full-layer puncture biopsy in determining the response degree of rectal cancer following neoadjuvant therapy: a prospective multicenter study / 中华外科杂志

Objective: To verify the feasibility and accuracy of the transanal multipoint full-layer puncture biopsy (TMFP) technique in determining the residual status of cancer foci after neoadjuvant therapy (nCRT) in rectal cancer. Methods: Between April 2020 and November 2022, a total of 78 patients from the Beijing Chaoyang Hospital of Capital Medical University, the Beijing Friendship Hospital of Capital Medical University, the Qilu Hospital of Shandong University, the Zhongnan Hospital of Wuhan University with advanced rectal cancer received TMFP after nCRT participated in this prospective multicenter trial. There were 53 males and 25 females, aged (M(IQR)) 61 (13) years (range: 35 to 77 years). The tumor distance from the anal verge was 5 (3) cm (range: 2 to 10 cm). The waiting time between nCRT and TMFP was 73 (26) days (range: 33 to 330 days). 13-point transanal puncture was performed with a 16 G tissue biopsy needle with the residual lesion as the center. The specimens were submitted for independent examination and the complications of the puncture were recorded. The consistency of TMFP and radical operation specimen was compared. The consistency of TMPF with clinical remission rates for the diagnosis of complete pathological remission was compared by sensitivity, specificity, negative predictive value, positive predictive value and accuracy. Statistical analysis between groups was performed using the χ2 analysis, and a paired χ2 test was used to compare diagnostic validity. Results: Before TMFP, clinical complete response (cCR) was evaluated in 27 cases. Thirty-six cases received in vivo puncture, the number of punctures in each patient was 13 (8) (range: 4 to 20), 24 cases of tumor residue were found in the puncture specimens. The sensitivity to judgment (100% vs. 60%, χ2=17.500, P<0.01) and accuracy (88.5% vs. 74.4%, χ2=5.125, P=0.024) of TMFP for the pathologic complete response (pCR) were significantly higher than those of cCR. Implement TMFP based on cCR judgment, the accuracy increased from 74.4% to 92.6% (χ2=4.026, P=0.045). The accuracy of the in vivo puncture was 94.4%, which was 83.3% of the in vitro puncture (χ2=1.382, P=0.240). Overall, the accuracy of TMFP improved gradually with an increasing number of cases (χ2=7.112, P=0.029). Conclusion: TMFP is safe and feasible, which improves the sensitivity and accuracy of rectal cancer pCR determination after nCRT, provides a pathological basis for cCR determination, and contributes to the safe development of the watch and wait policy.

Analysis of Significant Genes and Pathways in Esophageal Cancer Based on Gene Expression Omnibus Database / 中国医学科学杂志(英文版)

Objective To screen antigen targets for immunotherapy by analyzing over-expressed genes, and to identify significant pathways and molecular mechanisms in esophageal cancer by using bioinformatic methods such as enrichment analysis, protein-protein interaction (PPI) network, and survival analysis based on the Gene Expression Omnibus (GEO) database.Methods By screening with highly expressed genes, we mainly analyzed proteins MUC13 and EPCAM with transmembrane domain and antigen epitope from TMHMM and IEDB websites. Significant genes and pathways associated with the pathogenesis of esophageal cancer were identified using enrichment analysis, PPI network, and survival analysis. Several software and platforms including Prism 8, R language, Cytoscape, DAVID, STRING, and GEPIA platform were used in the search and/or figure creation.Results Genes MUC13 and EPCAM were over-expressed with several antigen epitopes in esophageal squamous cell carcinoma (ESCC) tissue. Enrichment analysis revealed that the process of keratinization was focused and a series of genes were related with the development of esophageal cancer. Four genes including ALDH3A1, C2, SLC6A1,and ZBTB7C were screened with significant P value of survival curve.Conclusions Genes MUC13 and EPCAM may be promising antigen targets or biomarkers for esophageal cancer. Keratinization may greatly impact the pathogenesis of esophageal cancer. Genes ALDH3A1, C2, SLC6A1,and ZBTB7C may play important roles in the development of esophageal cancer.

Effect of circhipk3 on polarization of microglial cells in nerve injury caused by heat radiation / 中华急诊医学杂志

Objective:To investigate the expression of circhipk3 in microglial cells in heat-induced neurological injury, and to preliminary analyze the effect of circhipk3 on microglial polarization in heat-induced neurological injury.Methods:Mice were randomly (random number) divided into a control group and a heat radiation disease 0.8 h group (HS 0.8), a heat radiation disease 8h group (HS 8), and a heat radiation disease 24 h group (HS 24). By establishing a mouse model of heat shock (HS), heat-damaged brain tissue was obtained, microglia were isolated and RNA was extracted. Quantitative PCR method was used to detect M1 and M2 marker molecules in microglia, and to evaluate the polarization direction and type of microglia. The expression level of circhipk3 was detected in microglial cells in heat-induced neurological injury, and the effect of circhipk3 on microglial polarization was further elucidated by intervening the expression of circhipk3 in microglial cells.Results:The expression of CD45 and CD11-b in the HS 8 group was significantly higher than that in the control group [(4.41±0.18) vs. (1±0.15), P=0.000], [(3.47±0.19) vs (1±0.15), P=0.000] , and the CD45 and CD11-b of the HS 24 group was significantly lower than that of the HS 8 group [(1.34±0.15) vs. (4.41±0.18), P=0.000], [(1.38±0.21) vs. (3.47±0.19), P= 0.001]. At the same time, the expression of CD206, FIZZ and Arg1 in the HS 8 group started to increase compared with the control group [(1.59±0.16) vs. (1±0.12), P=0.014], [(1.62±0.15) vs. (1±0.15), P=0.002 ], [(2.23±0.28) vs. (1±0.19), P=0.004], and CD206, FIZZ, and Arg1 in the HS 24 group were significantly higher than those in the control group [(2.67±0.20) vs. (1±0.12), P=0.002], [(2.19±0.15) vs. (1±0.15), P=0.000], [(3.04±0.18) vs. (1±0.19), P=0.001]; circhipk3 mimicis significantly increased the expression of Arg1 [(7.26± 0.06) vs. (3.86±0.06), P=0.000]; at the same time, circhipk3 inhibitor promoted the expression of CD45 and HO-1 [(2.96±0.03) vs. (1.63±0.09), P=0.000], [(2.52±0.10) vs. ( 1.30±0.02), P=0.000]. Conclusions:Microglial cells are predominantly M1-type in early neurological injury of heat radiation disease. HO-1 may be one of the microglial M1-type markers. The high expression of circhipk3 in microglial cells mainly promotes its transformation to M2 type.

Advance in Point-of-care Ultrasound for Pulmonary Rehabilitation in Critically Ill Patients (review) / 中国康复理论与实践

In addition to primary diseases, critically ill patients often suffered from multiple functional disorders, including pulmonary dysfunction. Pulmonary rehabilitation can effectively improve the lung and overall function of patients, which need assistance of relevant examinations. Point-of-care ultrasound (POCUS) can not only help to diagnose, evaluate, monitor and treat the disease faster, more accurate and safer, but also reduce the adverse events resulting from handling, activities and radiation, which is applied more extensively in critical patients accepting pulmonary rehabilitation.

The near-infrared dye IR-61 restores erectile function in a streptozotocin-induced diabetes model via mitochondrial protection / 亚洲男科学杂志(英文版)

This study aimed to evaluate the therapeutic effect of IR-61, a novel mitochondrial heptamethine cyanine dye with antioxidant effects, on diabetes mellitus-induced erectile dysfunction (DMED). Eight-week-old male Sprague-Dawley rats were intraperitoneally injected with streptozotocin (STZ) to induce type 1 diabetes. Eight weeks after STZ injection, all rats were divided into three groups: the control group, DM group, and DM + IR-61 group. In the DM + IR-61 group, the rats were administered IR-61 (1.6 mg kg

Some Advice on Respiratory Rehabilitation for Coronavirus Disease 2019 / 中国康复理论与实践

At the end of 2019, coronavirus disease 2019 (COVID-19) caused by a new coronavirus SARS-CoV-2 spread rapidly. There is still no specific medicine for it. It is important to consider the functional improvement and rehabilitation. This article discussed on respiratory rehabilitation in management of patients with COVID-19.

Application of metabolomics in screening potential biomarkers for kidney transplantation / 医学研究生学报

Metabolomics, which inherits the ideas of genomics and proteomics, has been widely applied in clinical medical research. In the field of kidney transplantation, changes, which occur in the concentration of small molecule metabolites in blood or urine, can be used to identify organs at risk of acute rejection, locate organ damage, and monitor graft function. This article reviews the problems in the field of kidney transplantation, the concepts, characteristics and research methods of metabolomics, as well as the progress in the application of kidney transplantation and the biomarkers that have been discovered.

Analysis for 6-methyladenine modification of DNA in chorionic tissue from aborted fetuses with monosomy 21 / 中华医学遗传学杂志

OBJECTIVE@#To study the correlation of genome-wide distribution of 6-methyladenine (6mA) of DNA in chorionic tissues from abortuses with monosomy 21.@*METHODS@#Genomic DNA was extracted from chorionic samples from four abortuses with monosomy 21 and four without. After quality and purity test, partial DNA was subjected to chromatin immunoprecipitation with anti-6mA antibody, and then identified by sequencing. The sequencing data was analyzed by using bioinformatic software for the difference in 6mA between the two groups.@*RESULTS@#Analysis of read peaks suggested that the control group have much more 6mA genes (n=4607) compared with the experiment group (n=1059). For chromosome 21, this difference is even more pronounced (8032 vs. 1769). Above results suggested that the level of 6mA modification in monosomy 21 is low. Gene ontology enrichment analysis and KEGG pathway enrichment analysis indicated that the absence of 6mA genes in monosomy 21 is closely related to the growth and development of embryo.@*CONCLUSION@#The 6mA modification of human genes may play a similar role to 5-methylcytosine (5mC) modification during the growth and development of embryos.

Higher Expression of Linc00152 Promotes Bladder Cancer Proliferation and Metastasis by Activating the Wnt/ß-Catenin Signaling Pathway.

BACKGROUND Recent studies have demonstrated that Linc00152 is highly expressed in multiple cancer types and its genes show tumor-promoting characteristics. However, the efficacy and biological mechanism of Linc00152 in bladder cancer remains unclear. MATERIAL AND METHODS We study investigated the relative expression and promoter methylation of Linc00152 in 126 cases of bladder cancer tissues by qRT-PCR and Bisulfite sequencing PCR. qRT-PCR was used to assess the relative expression of Linc00152 in 4 human bladder cancer cell lines. To explore the biological properties of Linc00152, we performed cell growth and soft-agar colony-formation assays, flow cytometry analyses, wound-healing assay, and Transwell assay. Western blot analysis was used to detect the underlying mechanisms of Linc00152 in bladder cancer. RESULTS We found that Linc00152 was highly expressed in 126 cases of bladder carcinoma tissues (p<0.001) and 4 cell lines (p<0.01), and Linc00152 is more commonly expressed in patients with advanced-stage cancer (p=0.021). Knockdown of Linc00152 by using siRNAs in bladder cancer cell lines (T24 and HT-1197) suppressed cell viability and growth by causing cell cycle arrest and apoptosis (p<0.001), as well as inhibiting cell migration and invasion (p<0.001). In addition, the quantitative RT-PCR and Western blot results suggest that knockdown of Linc00152 reduced Wnt/ß-Catenin signaling (p<0.001). CONCLUSIONS This research shows that Linc00152 is highly expressed in patients with bladder cancer and the possible carcinogenic effect of Linc00152 in bladder cancer occurs through activating the Wnt/ß-Catenin signaling pathway, and could be a new biomarker for diagnosis and prevention of this cancer.

Detection of ketamine, MDMA and their main metabolites in urine samples by SPME-HPLC-MS / 中国药科大学学报

@#To establish a method for the determination of ketamine and MDA and their main metabolites in urine by solid phase microextraction-liquid chromatography-mass spectrometry. In a urine sample supplemented with quantitative ketamine, norketamine, MDMA and MDA control. The solution was adjusted pH 11, added solid Na2CO3, heated and stirred at 60 °C. Then, the sample was extracted by SPME with 60 μm polydimethylsiloxane-vinylbenzene copolymer(PDMS/DVB ), a middle-polar coated fiber for 15 minutes and then analyzed by HPLC-MS. The result showed good linearity in the range of 0. 03-1. 0 μg/mL, r≥0. 999 2, and LOD was 0. 01 μg/mL, the value of the average recovery rate was varying from 97. 19%-105. 44%, and RSD was within 10%. The method is simple, safe and accurate, and can be used to determine ketamine, MDMA and their main metabolites in urine.

Effect of p38 mitogen-activated protein kinase inhibitor on liver function and tissue in rats with hepatic hydatidosis / 中华肝胆外科杂志

Objective@#To investigate the effect of p38 mitogen-activated protein kinase (p38 MAPK) inhibitor on liver function and tissue in rats with hepatic hydatidosis.@*Methods@#A model of liver echinococcosis was established in 100 female Wistar rats, 60 of 100 were, randomly divided into three groups, Control group (0.3 ml normal saline), Low dose group (50 μmol/L p38MAPK inhibitor SB-202190), High dose group (100 μmol/L SB-202190B). The reagents were given via the hepatic artery 1, 3, 7, 14 and 42 days after the rat model was generated. Rats were sacrificed 42 days after the intervention, liver tissue and blood samples were collected for liver function study.@*Results@#Alanine aminotransferase levels were (49.58±2.38) U/L, (38.35±1.34) U/L and (30.93±1.51) U/L and aspartic aminotransferase levels were (67.45±5.14) U/L, (54.86±1.09) U/L and (45.76±1.04) U/L in the Control group, the Low-dose group and High-dose group, showing a decreasing trend, with statistically significant differences (all P<0.05). Triglycerides in the Low-dose group were higher than those in Control group and the High-dose group, with statistically significant differences (all P<0.05). In the Control group, the hepatocytes were severely injured, with almost no normal hepatocytes left, and the normal hepatocyte boundaries were also disrupted, he normal hepatic lobule was replaced by the pseudolobules. In the Low-dose group, there were more inflammatory cells, and less replacement of normal liver cells by pseudolobules. High dose group of a small amount of inflammatory cells infiltration, roughly normal liver cells, normal liver cell line is clear, visible central vein of liver cells.@*Conclusion@#p38MAPK inhibitor SB-202190 improved liver function and reduced liver tissue damage in rats with hepatic hydatidosis.

Effect of p38 mitogen-activated protein kinase inhibitor on liver function and tissue in rats with hepatic hydatidosis / 中华肝胆外科杂志

Objective To investigate the effect of p38 mitogen-activated protein kinase(p38 MAPK)inhibitor on liver function and tissue in rats with hepatic hydatidosis.Methods A model of liver echinococcosis was established in 100 female Wistar rats,60 of 100 were,randomly divided into three groups,Control group(0.3 ml normal saline),Low dose group(50 p,mol/L p38MAPK inhibitor SB-202190),High dose group(100 μmol/L SB-202190B).The reagents were given via the hepatic artery 1,3,7,14 and 42 days after the rat model was generated.Rats were sacrificed 42 days after the interven-tion,liver tissue and blood samples were collected for liver function study.Results Alanine aminotrans-ferase levels were(49.58±2.38)U/L,(38.35±1.34)U/L and(30.93±1.51)U/L and aspartic ami-notransferase levels were(67.45±5.14)U/L,(54.86±1.09)U/L and(45.76±1.04)U/L in the Control group,the Low-dose group and High-dose group,showing a decreasing trend,with statistically sig-nificant differences(all P＜0.05).Triglycerides in the Low-dose group were higher than those in Control group and the High-dose group,with statistically significant differences(all P＜0.05).In the Control group,the hepatocytes were severely injured,with almost no normal hepatocytes left,and the normal hepato-cyte boundaries were also disrupted,he normal hepatic lobule was replaced by the pseudolobules.In the Low-dose group,there were more inflammatory cells,and less replacement of normal liver cells by pseud-olobules.High dose group of a small amount of inflammatory cells infiltration,roughly normal liver cells,normal liver cell line is clear,visible central vein of liver cells.Conclusionp38MAPK inhibitor SB-202 190 improved liver function and reduced liver tissue damage in rats with hepatic hydatidosis.

miR-320 mediates diabetes amelioration after duodenal-jejunal bypass via targeting adipoR1.

BACKGROUND: Duodenal-jejunal bypass (DJB) surgery can improve type 2 diabetes (T2D) dramatically. Accumulating evidence implicates deficiency of hepatic adiponectin signaling as a contributor to gluconeogenesis disorders, and some microRNAs (miRNAs) regulate adiponectin receptors (AdipoR1, AdipoR2). We investigated the effects of DJB on hepatic gluconeogenesis, lipid metabolism, and inflammation as well as the effects of miRNA-320 (AdipoR1-targeting miRNA) on DJB-induced T2D amelioration. OBJECTIVES: To investigate the essential role of miRNAs in regulation of adiponectin signaling by targeting AdipoR1 in DJB and the underlying mechanisms. SETTING: University Hospital, China. METHODS: We studied hepatic adiponectin signaling changes and hepatic miRNAs involved in a rat model of DJB. We investigated the effects of miR-320 on AdipoR1 signaling in buffalo rat liver cell lines. Liver tissues and glucose tolerance tests were analyzed in DJB rats injected with lentivirus encoding a miR-320 mimic. RESULTS: Transfection with a miR-320 mimic reduced AdipoR1 protein levels and inhibited downstream adiponectin signaling; transfection with a miR-320 inhibitor elicited the opposite effects. A luciferase assay confirmed that miR-320 binds to the 3'-untranslated regions of AdipoR1. Global upregulation of miR-320 expression in DJB rats showed impaired gluconeogenesis, lipid metabolism, and relatively higher expression of inflammation markers. CONCLUSION: miR-320 regulates the adipoR1-mediated amelioration of T2D in DJB and should be explored as a potential target for T2D treatment.

MiR-199a-3p affects the multi-chemoresistance of osteosarcoma through targeting AK4.

BACKGROUND: MicroRNAs (miRNAs) play vital roles in regulating various biological processes. The dysregulations of miRNAs may result in severe human diseases, including cancer. METHODS: We performed the qRT-PCR, western blot and the luciferase reporter assays to test whether Adenylate Kinase 4 (AK4) is the target of miR-199a-3p. Up- or down-regulation of miR-199a-3p and/or the AK4 gene was done to detect their roles in OS multi-drug resistance using drug resistance profiling assays. We further predicted the putative signal pathway involved in the miR-199a-3p-mediated OS drug-resistance. RESULTS: The AK4 gene is one of the targets of miR-199a-3p and negatively correlates with the effect of miR-199a-3p on OS drug-resistance. In addition, the activity of the NF-кB signaling pathway was drastically altered by the forced changes of the miR-199a-3p level in OS cells. CONCLUSIONS: Our data revealed that both miR-199a-3p and its target gene AK4 are reversely correlated with the OS drug resistance.

Application of extracorporeal membrane oxygenation in neonate diseases / 中华实用儿科临床杂志

Neonates occupied a large numbers in extracorporeal membrane oxygenation (ECMO) group.Cases of ECMO for neonate diseases increased year by year and the survival rate of patients improved apparently all over the world.But in China,ECMO in newborn diseases is still at the starting stage.ECMO is a feasible resolution for neonates with circulation or respiratory crisis who had no response to all medical treatment except ECMO.But ECMO still has invasive problem,difficulties in anti-coagulation management,high ratio of complication,expensive cost and unsatisfactory survival rates of newborns with some disease.Now,the application of ECMO for neonate diseases at home and abroad was summarized.

Application of whole exome sequencing technique for the pathogenic gene screening of rare osteopetrosis / 国际检验医学杂志

Objective To screen the pathogenic gene of osteopetrosis to provide reference for its genetic di-agnosis and prognosis .Methods The clinical data and peripheral blood samples were collected from the pa-tients with osteopetrosis ,DNA was extracted ,the whole exome sequencing library was built ,then the high throughput detection was performed and the pathogenic gene was screened by combining with the bioinformat-ics technology .Results The whole exomes in 2 cases of osteopetrosis were analyzed ,the average sequencing depth of the two samples were 169 .38X and 231 .06X respectively ,in which the case 1 carried rare mutation TCIRG1(c .1305+2T>C) ,TCIRG1(c .2008C> T ) and CLCN7(c .1116C> T );the case 2 carried a rare muta-tion CLCN7(c .857G>A ) .T he bioinformatics analysis indicated that the rare mutations carried by these cases all had different degrees of influence on the structure and function of gene products .Conclusion The whole exome sequencing can once screen the know n pathogenic mutations of osteopetrosis ,is an effective tool for pathogenic mutation screening of osteopetrosis ,the clinical disease in 2 cases of osteopetrosis may be closely related with the patient′s carrying TCIRG1 and CLCN7 mutation .

Research update of Klotho in kidney injury and repair / 生理学报

Klotho is highly expressed in the kidney, while soluble Klotho is detectable in the blood, urine, and cerebrospinal fluid, and has multiple hormone-like functions. The role of Klotho in kidney injury has attracted more and more attentions from researchers. Emerging evidence revealed that the transient deficiency of Klotho is an early event of acute kidney injury (AKI), whereas, in chronic kidney disease, this deficiency is sustained not only in the kidney, but also in other organ systems. Therefore, Klotho could be a potential biomarker for early diagnosis of AKI, as well as for its progression to chronic kidney disease. Moreover, Klotho might have therapeutic value to renal injury. Nevertheless, there are only few studies on the involvement of Klotho in post AKI repair. This review focused on the role of Klotho in not only kidney injury, but also its repair, in particular the relationship between Klotho and cell fate (autophagy/apoptosis/necrosis), repair/regeneration, Wnt/β-catenin and erythropoietin receptor, one of the Klotho effectors.

Preliminary report on prospective, multicenter, open research of selective surgery after expandable stent combined with neoadjuvant chemotherapy in the treatment of obstructive left hemicolon cancer / 中华胃肠外科杂志

OBJECTIVE@#To evaluate the safety and feasibility of neoadjuvant chemotherapy prior elective surgery following self-expanding metallic stents (SEMS) for complete obstructive left hemicolon cancer.@*METHODS@#This prospective, multicenter, open-labelled trial was approved by the Ethics Committee of Beijing Chaoyang Hospital, Capital Medical University(2016-ke-161-1) and registered in Clinicaltrials.gov (NCT02972541).@*INCLUSION CRITERIA@#(1)age between 18 and 75 years old;(2) adenocarcinoma confirmed by pathology;(3) left hemicolon cancer confirmed by clinical manifestations and imaging examinations with the distance to anal verge > 15 cm; (4) resectable cancer evaluated by imaging examination without distant metastasis; (5) Eastern Cooperative Oncology Group (ECOG) score ≤ 1 or Karnofsky Performance Scale (KPS) > 70, indicating tolerance of neoadjuvant chemotherapy and operation; (6) absence of chemotherapy or radiotherapy within past six months; (7) bone marrow system and hepatorenal function: hemoglobin ≥ 90 g/L, neutrophil ≥ 1.5×10/L, platelet ≥ 80×10/L, total bilirubin ≤ 1.5×ULN(upper limits of normal), serum transaminase ≤ 2.5×ULN, serum creatinine ≤ 1.0×ULN, endogenous creatinine clearance rate > 50 ml/min; (8) sign for informed consent.@*EXCLUSION CRITERIA@#(1) multiple primary colorectal cancer; (2) rejection of operation;(3) presenting peritonitis or bowel perforation before SEMS; (4) unqualified conditions proved by inspector from registration data. According to inclusion criteria, 62 consecutive patients receiving neoadjuvant chemotherapy prior to elective surgery following SEMS for complete obstructive left hemicolon cancer from Beijing Chaoyang Hospital of Capital Medical University (n=31), Qilu Hospital of Shandong University (n=14), the Third Xiangya Hospital of Central South University (n=13), Zhongnan Hospital of Wuhan University (n=2), the Fourth Hospital of Hebei Medical University (n=2) between December 2015 and December 2017 were prospectively enrolled in this study. Patients were divided into neoadjuvant chemotherapy group and elective surgery group according to the investigator's clinical experience and patient's preference. Patients in the elective surgery group received surgery within one to two weeks after SEMS placement without neoadjuvant chemotherapy. Those in the neoadjuvant chemotherapy group received 2 cycles of CapeOX or 3 cycles of mFOLFOX6 neoadjuvant chemotherapy within one to two weeks after SEMS placement, and then underwent surgery within 3 weeks after finishing neoadjuvant chemotherapy. Data between groups were compared using Student t-test, chi-square analysis or Fisher exact test analysis, including basic clinical informations, operational conditions and postoperative complications. The adverse reactions during the neoadjuvant chemotherapy were recorded. Surgical difficulty was assessed using visual analog scales ranging from 1 to 10, where 1 represented the lowest and 10 the highest degree of surgical difficulty, as judged by the surgeon.@*RESULTS@#The study included 38 males and 24 females with mean age of (64.8±8.8) years. The clinical baseline data between 2 groups were not significantly different (all P>0.05) except the average time interval between SEMS and surgery was significantly longer in neoadjuvant chemotherapy group [(61.6±13.5) days vs. (10.4±5.2) days, t=16.679, P0.05).@*CONCLUSION@#Neoadjuvant chemotherapy prior elective surgery following SEMS is a relatively safe and feasible approach in the treatment for obstructive left hemicolon cancer, and is associated with less stoma, more laparoscopic surgery, shorter operative time, less blood loss, lower surgical difficulty, and faster postoperative recovery as compared with conventional elective surgery.

Analysis of gastric gastrointestinal stromal tumors in Shandong Province: a midterm report of multicenter GISSG1201 study / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To summarize the treatment status of gastric gastrointestinal stromal tumor (GIST) in Shandong province,by analyzing the clinicopathological features and prognostic factors.</p><p><b>METHODS</b>Clinicopathological and follow-up data of 1 165 patients with gastric GIST between January 2000 and December 2013 from 23 tertiary referral hospitals in Shandong Province were collected to establish a database. The risk stratification of all cases was performed according to the National Institutes of Health(NIH) criteria proposed in 2008. Kaplan-Meier method was used to calculate the survival rate. Log-rank test and Cox regression model were used for univariate and multivariate prognostic analyses.</p><p><b>RESULTS</b>Among 1 165 cases of gastric GIST, 557 were male and 608 were female. The median age of onset was 60 (range 15-89) years. Primary tumors were located in the gastric fundus and cardia in 623 cases(53.5%), gastric body in 346 cases(29.7%), gastric antrum in 196 cases(16.8%). All the cases underwent resection of tumors, including endoscopic resection (n=106), local resection (n=589), subtotal gastrectomy(n=399), and total gastrectomy(n=72). Based on the NIH risk stratification, there were 256 cases (22.0%) at very low risk, 435 (37.3%) at low risk, 251 cases (21.5%) at intermediate risk, and 223 cases (19.1%) at high risk. A total of 1 116 cases(95.8%) were followed up and the median follow-up period was 40 (range, 1-60) months. During the period, 337 patients relapsed and the median time to recurrence was 34 (range 1-60) months. The 1-, 3-, and 5-year survival rates were 98.6%, 86.1% and 73.4%, respectively. The 5-year survival rates of patients at very low, low, intermediate, and high risk were 93.1%, 85.8%, 63.0% and 42.3% respectively, with a statistically significant difference (P=0.000). Multivariate analysis showed that primary tumor site (RR=0.580, 95%CI:0.402-0.835), tumor size (RR=0.450, 95%CI:0.266-0.760), intraoperative tumor rupture(RR=0.557, 95%CI:0.336-0.924), risk classification (RR=0.309, 95%CI:0.164-0.580) and the use of imatinib after surgery (RR=1.993, 95%CI:1.350-2.922) were independent prognostic factors.</p><p><b>CONCLUSIONS</b>The choice of surgical procedure for gastric GIST patients should be based on tumor size. All the routine procedures including endoscopic resection, local excision, subtotal gastrectomy and total gastrectomy can obtain satisfactory curative outcomes. NIH classification has a high value for the prediction of prognosis. Primary tumor site, tumor size, intraoperative tumor rupture, risk stratification and postoperative use of imatinib are independent prognostic factors in gastric GIST patients.</p>