Imaging diagnostic value of lateral lymph node metastasis in middle and low rectal cancer / 中华普通外科杂志

Objective:To evaluate CT and or MRI imaging in the diagnosis of lateral lymph node metastasis in patients of middle and low rectal cancer.Methods:In this study, 112 lateral lymph nodes were harvested in 79 patients with middle and low rectal cancer. The relationship between the preoperative imaging features of the lateral lymph nodes and the postoperative pathology was evaluated.Result:Thirty-eight cases (48%) were pathologically confirmed to have lateral lymph node metastasis. The diameter of metastasis-positive lateral lymph nodes was significantly larger than that of metastasis-negative lateral lymph nodes ( P<0.01). Multivariate analysis of clinical features and imaging features found that, tumors poorly differentiated, mucinous adenocarcinoma, signet ring cell carcinoma ( P=0.006), and the largest short diameter of the lateral lymph node ≥7 mm ( P=0.024), uneven density or signal ( P=0.022) were independent risk factors for lateral lymph node metastasis. Conclusion:Poor tumor differentiation, lateral lymph node maximum short diameter ≥7 mm, density or signal unevenness are independent risk factors for lateral lymph node metastasis in middle and low rectal carcinoma.

Thirty years' changes of the strategy of lateral lymph node dissection in low rectal cancer: treatment experience and prognostic analysis of 289 cases in one single center / 中华胃肠外科杂志

Objective: The surgical indications, resection extent and management principle of lateral lymph node dissection (LLND) in lower rectal cancer have been controversial between Eastern and Western countries. This study aims to provide a theoretical basis for the rational implementation of LLND by reviewing the changes of LLND strategy over the past 30 years in a single-center, and analyzing prognostic factors for the survival outcomes of patients with lateral lymph node metastasis (LLNM). Methods: A retrospective observational study was performed. Clinical data of 289 patients with rectal cancer who received LLND at the Department of General Surgery of Peking University First Hospital from 1990 to 2019 were collected. Patients were divided into three groups based on decades. There were 89 cases in 1990-1999 group, 92 cases in the 2000-2009 group, and 108 cases in the 2010-2019 group. Data analyzed: (1) patient baseline data; (2) surgery and postoperative recovery; (3) lateral lymph node dissection; (4) postoperative survival and prognosis of patients with positive lateral lymph nodes. The surgical methods and pathological results of LLND were compared between groups, and the prognostic risk factors of patients with LLNM were analyzed. Results: A total of 289 patients underwent radical resection with LLND' accounting for 6.3% of the 4542 patients with rectal cancer during the same period in our hospital. Except decade-by-decade increase in tumors with distance from anal verge ≤ 7 cm, the proportion of ulcerated tumors, and the proportion of neoadjuvant radiochemotherapy, the differences in other baseline data were not statistically significant among 3 decade groups (all P>0.05). The proportion of LLND in the 3 groups decreased decade by decade [9.9% (89/898) vs. 8.0% (92/1154) vs. 4.3% (108/2490), χ(2)=40.159, P<0.001]. The proportion of laparoscopic surgery and unilateral LLND increased, while the mean operative time, intraoperative blood loss, surgical complications above grade III and postoperative hospital stay decreased decade by decade. These 289 patients completed a total of 483 lateral dissections, including 95 cases of the unilateral dissection and 194 cases of the bilateral dissection. The proportion of LLND in the 3 groups decreased decade by decade [9.9% (89/898) vs. 8.0% (92/1154) vs. 4.3% (108/2510), P<0.001]. The median number of dissected lymph nodes in the internal iliac artery and obturator regions increased (2 vs. 3 vs. 3, P<0.001), but those in the common iliac and external iliac regions decreased significantly (4 vs. 3 vs. 2, P=0.014). A total of 71 patients with LLNM were identified. The rate of LLNM in the 2010-2019 group was significantly higher than that in the previous two groups [37.0% (40/108) vs. 16.9% (15/89) vs. 17.4% (16/92), P=0.001]. The patients with LLNM showed a poorer overall survival (OS) and disease-free survival (DFS) compared with negative lateral lymph nodes (P<0.001). There were statistically significant differences in 5-year OS rate (30.9% vs. 27.2% vs. 0, P=0.028) and 5-year DFS rate (28.3% vs. 16.0% vs. 0, P=0.038) among patients with only internal iliac lymph node metastasis, patients with only obturator lymph node metastasis, and patients with external iliac or common iliac lymph node metastasis. Multivariate analysis of prognostic factors showed that external iliac or common iliac lymph node metastasis was an independent risk factor for OS (HR=1.649, 95%CI: 1.087-2.501) and DFS (HR=1.714, 95%CI: 1.173-2.504) in patients with LLNM (all P<0.05) . The OS and DFS were not significant different in patients with LLNM among 3 decade groups. Conclusions: In the past decade, the proportion of LLND in rectal cancer has decreased significantly. However, LLNM rate has been significantly increased due to preoperative imaging assessments focusing on suspicious LLNM without compromising the survival. Internal iliac artery and obturator lymph nodes can be regarded as regional lymph nodes with a satisfactory prognosis after LLND. For suspected external iliac or common iliac lymph node metastasis, the significance of LLND remains to be further evaluated.

Clinical analysis of 554 patients with colorectal diverticulosis / 中华胃肠外科杂志

Objective: Most patients with asymptomatic colorectal diverticulosis are easily overlooked. However, some of diverticulosis become diverticulitis, bleeding and even perforation, which cause extensive harm to patients. The purpose of this study is to analyze the incidence, clinical features, diagnosis and treatment of colorectal diverticulosis in order to improve the clinical understanding of diverticulosis and its related complications. Methods: A descriptive cohort study was carried out. Clinical data of 554 patients with colorectal diverticulosis confirmed by CT, colonoscopy, digestive tract radiography or operation in Peking University First Hospital from January 2009 to June 2019 were retrospectively analyzed. Patients with malignant tumors, autoimmune diseases, long term use of immunosuppressive drugs, chronic liver diseases and renal diseases, and mental disorders were excluded. The analysis parameters included gender, onset age, clinical symptoms, location of diverticulitis, treatment and prognosis. According to the criteria established by the World Society of Emergency Surgery (WSES), acute diverticulitis was divided into 5 stages based on the extension of the infectious process. Stage 0 was simple diverticulitis and stage 1-4 was complicated diverticulitis. Results: Among the 554 patients with colorectal diverticulosis, 358 (64.6%) were males, the median onset age was 63 years; 191 patients (34.5%) had various digestive symptoms, of whom 113 (20.4%) had chronic constipation and abdominal distension, 78 (14.1%) had chronic diarrhea and abdominal pain; the other 363 patients had no obvious abdominal symptoms. Four hundred and six patients were found by colonoscopy and 465 patients were found by CT. Twenty-five patients were diagnosed by lower gastrointestinal tract radiography and 3 were confirmed during operation. There were 339 patients with multiple diverticula (61.2%) and 215 patients with single diverticulum (38.8%). 76.5% (424/554) of diverticula were located in colon, 37.0% (205/554) in ascending colon, 21.3% (118/554) in multiple sites, and 2.2% (12/554) in rectum. The median diameter of diverticulum was 7 mm, and 78 cases (14.1%) was ≥30 mm. Forty-nine patients (8.8%) developed acute diverticulitis, including 13 patients with simple diverticulitis and 36 patients with complicated diverticulitis. Among 36 patients with complicated diverticulitis, 29 (80.6%) were males, 27 (75.0%) had recurrent abdominal pain and fever before onset; diverticula of 25 cases were located in sigmoid colon; 11 cases in ascending colon. Nine cases developed sigmoid colon perforation and 8 cases developed vesicocolonic fistula, and these 17 patients underwent surgical treatment. The other 19 cases with complicated diverticulitis developed gastrointestinal bleeding, of whom 18 cases were male, 11 cases were located in ascending colon; 13 cases were healed after conservative treatment, 4 cases received endoscopic hemostatic intervention, and 2 cases underwent surgery. Conclusions: Colorectal diverticulosis is more common in male patients, and CT and colonoscopy are main diagnostic methods. The symptoms of complicated colonic diverticulitis are related to the location of diverticulum. In addition to symptomatic treatment, surgical procedures are the most important treatments.

Puerarin Inhibits Inductible Nitric Oxide Synthase expression in Lipopolysaccharide -induced RAW264.7 Macrophage Cells / 中国康复理论与实践

@#ObjectiveTo investigate the effect of Puerarin on expression of inductible nitric oxide synthase (iNOS) in RAW264.7 macrophage cells induced by lipopolysaccharide （LPS）. MethodsThe protein and mRNA levels of lipopolysaccharide (LPS)-induced iNOS was determined in RAW264.7 macrophage cells using Western blotting and RT-PCR respectively. ResultsPuerarin inhibited expression of iNOS concentration dependently (P<0.01). ConclusionPuerarin may reduce iNOS level, result in prevention of inflammation.

Relationship between Serum Pregnancy-Associated Plasma Protein-A and Plaque Stability of Coronary Lesion / 中国康复理论与实践

@#Objective To study the relationship between serum pregnancy-associated plasma protein-A(PAPP-A)and plaque stability of coronary lesion.Methods Levels of serum PAPP-A were measured among 230 patients seemed as coronary heart disease(CHD)including 50 cases with acute myocardial infraction(AMI),110 cases with unstable angina pectoris(UAP),40 cases with stable angina pectoris(SAP)and 30 cases without CHD as control by enzyme-linked immunoassay(ELISA).Anginographic morphology of the coronary lesion was assessed in patients with CHD.Then,the serum PAPP-A levels were compared among different types of CHD and plaque.Results Serum PAPP-A levels were significantly higher in the AMI group(26.13±4.65)mIU/L and UAP group(20.37±5.78)mIU/L than in the SAP group(12.82±3.94)mIU/L and without CHD group(10.70±2.86)mIU/L(P<0.01,UAP group vs AMI group,P<0.05).Serum PAPP-A levels were significantly higher in the type Ⅱ lesions(24.52±4.82)mIU/L than in the other type lesions group(16.82±5.37)mIU/L and in the control group(10.70±2.86)mIU/L(P<0.01).Conclusion Serum PAPP-A level was closely associated with plaque stability of coronary lesion.

Effect of Puerarin on Expression of C-reactive Protein in Iliac Artery of Atherosclerotic Rabbit / 中国康复理论与实践

@#Objective To investigate the effect of Puerarin on expression of C-reactive protein(CRP)in iliac artery of atherosclerotic rabbits.Methods Twenty male New Zealand white rabbits were divided into the normal control group(n=6,fed on a normal diet),basic control group(n=8,fed on a cholesterol diet)and Puerarin group(n=8,fed on a cholesterol diet).The balloon injury of iliac arteries was performed in animals of the basic control group and Puerarin group,and the animals of the Puerarin group were injected with Puerarin(25 mg/kg/d per rabbit)after injury.Four weeks after balloon injury,untreated and balloon injury iliac arteries were harvested for immunocytochemical staining.The mRNA and protein expression of CRP were tested by RT-PCR and immunucytochemistry.Results The mRNA and expression of CRP in atheroseclerotic plaque of iliac artery in the Puerarin group was significantly lower than that in the basic control group(P<0.01).Conclusion Puerarin can make atheroseclerotic plaque stable by regulating of the expression of CRP in iliac artery of atherosclerotic rabbit.

Effect of Shenmai Injection on neuroendocrine factors and cytokines in patients with chronic heart failure / 中国康复理论与实践

@#ObjectiveTo investigate the effects of Shenmai Injection(SI) on chronic systolic heart failure patients.Methods120 chronic heart failure patients were randomly divided into routine treatment and the routine treatment and SI group. The changes of angiotension Ⅱ(Ang Ⅱ), aldosterone(Ald), endothelin-1 (ET-1), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), plasm rennin activity (PRA), cardionatrin(ANP), brain natriuretic peptide (BNP), cardiac function were observed.ResultsAfter treatment, LVEF,stage of NYHA increased in two groups,LVDs, LVDd and the level of Ang Ⅱ,Ald, ET-1, IL-6, TNF-α,PRA, ANP and BNP decreased in both groups(P<0.05). LVEF, stage of NYHA in the routine treatment and SI group incresed more significantly than those in routine treatment group(P<0.05). LVEDs, LVEDd and the level of Ang Ⅱ,Ald, ET-1, IL-6, TNF-α,PRA, ANP and BNP in the routine treatment and SI group were decreased more significantly than those in routine treatment group (P<0.05).ConclusionSI can improve not only the disturbed endocrine function and cytokines, but also left ventricular function.