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Ribosome assembly factor URB1 is essential for ribosome biogenesis. However, its latent role in cancer remains unclear. Analysis of The Cancer Genome Atlas database and clinical tissue microarray staining showed that URB1 expression was upregulated in colorectal cancer (CRC) and prominently related to clinicopathological characteristics. Silencing of URB1 hampered human CRC cell proliferation and growth in vitro and in vivo. Microarray screening, ingenuity pathway analysis, and JASPAR assessment indicated that activating transcription factor 4 (ATF4) and X-box binding protein 1 (XBP1) are potential downstream targets of URB1 and could transcriptionally interact through direct binding. Silencing of URB1 significantly decreased ATF4 and cyclin A2 (CCNA2) expression in vivo and in vitro. Restoration of ATF4 effectively reversed the malignant proliferation phenotype of URB1-silenced CRC cells. Dual-luciferase reporter and ChIP assays indicated that XBP1 transcriptionally activated ATF4 by binding with its promoter region. X-box binding protein 1 colocalized with ATF4 in the nuclei of RKO cells, and ATF4 mRNA expression was positively regulated by XBP1. This study shows that URB1 contributes to oncogenesis and CRC growth through XBP1-mediated transcriptional activation of ATF4. Therefore, URB1 could be a potential therapeutic target for CRC.
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Fator 4 Ativador da Transcrição/genética , Proliferação de Células/genética , Neoplasias Colorretais/genética , Proteínas Nucleares/genética , Ribossomos/genética , Ativação Transcricional/genética , Linhagem Celular Tumoral , Transformação Celular Neoplásica/genética , Neoplasias Colorretais/patologia , Feminino , Regulação Neoplásica da Expressão Gênica/genética , Células HCT116 , Humanos , Masculino , Pessoa de Meia-Idade , Transdução de Sinais/genética , Regulação para Cima/genética , Proteína 1 de Ligação a X-Box/genéticaRESUMO
BACKGROUND: Despite the fact that thyroid surgery has evolved towards minimal incisions and endoscopic approaches, the role of total endoscopic thyroidectomy (TET) in thyroid cancer has been highly disputed. We performed a systematic review and meta-analyses of peer reviewed studies in order to evaluate the safety and effectiveness of TET compared with conventional open thyroidectomy (COT) in papillary thyroid cancer (PTC). METHOD: Medical literature databases such as PubMed, Embase, the Cochrane Library, and Web of science were systematically searched for articles that compared TET and COT in PTC treatment from database inception until March 2019. The quality of the studies included in the review was evaluated using the Downs and Black scale using Review Manager software Stata V.13.0 for the meta-analysis. RESULTS: The systematic review and meta-analysis were based on 5664 cases selected from twenty publications. Criteria used to determine surgical completeness included postoperative thyroglobulin (TG) levels, recurrence of the tumor after long-term follow-up. Adverse event and complication rate scores included transient recurrent laryngeal nerve (RLN) palsy, permanent RLN palsy, transient hypocalcaemia, permanent hypocalcaemia, operative time, number of removed lymph nodes, length of hospital stay and patient cosmetic satisfaction. TET was found to be generally equivalent to COT in terms of surgical completeness and adverse event rate, although TET resulted in lower levels of transient hypocalcemia (OR 1.66; p < 0.05), a smaller number of the retrieved lymph nodes (WMD 0.46; p < 0.05), and better cosmetic satisfaction (WMD 1.73; p < 0.05). COT was associated with a shorter operation time (WMD - 50.28; p < 0.05) and lower rates of transient RLN palsy (OR 0.41; p < 0.05). CONCLUSIONS: The results show that in terms of safety and efficacy, TET was similar to COT for the treatment of thyroid cancer. Indeed, the tumor recurrence rates and the level of surgical completeness in TET are similar to those obtained for COT. TET was associated with significantly lower levels of transient hypocalcemia and better cosmetic satisfaction, and thus is the better option for patients with cosmetic concerns. Overall, randomized clinical trials and studies with larger patient cohorts and long-term follow-up data are required to further demonstrate the value of the TET.
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Endoscopia/métodos , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: The aim of this meta-analysis was to compare high inferior mesenteric artery (IMA) ligation (HL) with low IMA ligation (LL) for the treatment of colorectal cancer and to evaluate the lymph node yield, survival benefit, and safety of these surgeries. METHODS: PubMed, Embase, Cochrane Library, Web of Science, and China Biomedical Literature Database (CBM) were systematically searched for relevant articles that compared HL and LL for sigmoid or rectal cancer. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) for dichotomous outcomes and the weighted mean difference (WMD) for continuous outcomes. RESULTS: In total, 30 studies were included in this analysis. There were significantly higher odds of anastomotic leakage and urethral dysfunction in patients treated with HL compared to those treated with LL (OR = 1.29; 95% CI = 1.08 to 1.55; OR = 2.45; 95% CI = 1.39 to 4.33, respectively). There were no significant differences between the groups in terms of the total number of harvested lymph nodes, the number of harvested lymph nodes around root of the IMA, local recurrence rate, and operation time. Further, no statistically significant group differences in 5-year overall survival rates and 5-year disease-free survival rates were detected among all patients nor among subgroups of stage II patients and stage III patients, respectively. CONCLUSIONS: LL can achieve equivalent lymph node yield to HL, and both procedures have similar survival benefits. However, LL is associated with a lower incidence of leakage and urethral dysfunction. Thus, LL is recommended for colorectal cancer surgery.
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Neoplasias Colorretais/cirurgia , Cirurgia Colorretal , Linfonodos/patologia , Artéria Mesentérica Inferior/cirurgia , Fístula Anastomótica/etiologia , Cirurgia Colorretal/efeitos adversos , Intervalo Livre de Doença , Humanos , Ligadura , Recidiva Local de Neoplasia/patologia , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Análise de SobrevidaRESUMO
BACKGROUND: The aim of this study was to compare radiofrequency ablation (RFA) with minimally invasive liver surgery (MIS) in the treatment of small hepatocellular carcinoma (SHCC) and to assess short-term and long-term clinical outcomes. METHODS: PubMed, Embase, Cochrane Library, Web of science, and CBM were systematically searched for articles from inception to July 2018, comparing RFA and MIS in SHCC treatment. We evaluated overall survival (OS), disease-free survival (DFS), local recurrence, and complication rates, as well as hospitalization duration and operation times. RESULTS: Six retrospective studies were analyzed, including a total of 597 patients, 313 treated with RFA and 284 treated with MIS. OS rates were significantly higher in patients treated with MIS at 3 years, when compared to RFA (OR 0.55; 95% CI 0.36 to 0.84). The 3-year DFS MIS rates were also superior to RFA (OR 0.63; 95% CI 0.41 to 0.98). In contrast, when compared to MIS, RFA demonstrated a significantly higher rate of local intrahepatic recurrences, (OR 2.24; 95% CI 1.47 to 3.42), and a lower incidence of postoperative complications (OR 0.34; 95% CI 0.22 to 0.53), as well as shorter operation times (OR - 145.31, 95% CI - 200.24 to - 90.38) and hospitalization duration (OR - 4.02,95% CI - 4.94 to - 3.10). CONCLUSIONS: We found that MIS led to higher OS, DFS, and lower local recurrences in SHCC patients. Meanwhile, RFA treatments led to significantly lower complication rates, shorter operation times, and hospitalization duration. Considering long-term outcomes, MIS was found to be superior to RFA. However, RFA may be an alternative treatment for patients presenting a single SHCC nodule (≤ 3 cm), given its minimally invasive nature and its comparable long-term efficacy with MIS. Nevertheless, our findings should be explained with caution due to the low level of evidence obtained.
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Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/mortalidade , Intervalo Livre de Doença , Saúde Global , Hepatectomia/efeitos adversos , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/mortalidade , Duração da Cirurgia , Taxa de Sobrevida/tendênciasRESUMO
AIM: The robotic technique has been established as an alternative approach to laparoscopy in colorectal surgery. The aim of this study was to compare short-term outcomes of robot-assisted and laparoscopic surgery in colorectal cancer. METHODS: The cases of robot-assisted or laparoscopic colorectal resection were collected retrospectively between July 2015 and October 2017. We evaluated patient demographics, perioperative characteristics, and pathologic examination. A multivariable linear regression model was used to assess short-term outcomes between robot-assisted and laparoscopic surgery. Short-term outcomes included time to passage of flatus and postoperative hospital stay. RESULTS: A total of 284 patients were included in the study. There were 104 patients in the robotic colorectal surgery (RCS) group and 180 in the laparoscopic colorectal surgery (LCS) group. The mean age was 60.5 ± 10.8 years, and 62.0% of the patients were male. We controlled for confounding factors, and then the multiple linear model regression indicated that the time to passage of flatus in the RCS group was 3.45 days shorter than the LCS group (coefficient = -3.45, 95% confidence interval [CI] = -5.19 to -1.71; P < .001). Additionally, the drainage of tube duration (coefficient = 0.59, 95% CI = 0.3 to 0.87; P < .001) and transfers to the intensive care unit (coefficient = 7.34, 95% CI = 3.17 to 11.5; P = .001) influenced the postoperative hospital stay. The total costs increased by 15501.48 CNY in the RCS group compared with the LCS group ( P = .008). CONCLUSIONS: The present study suggests that colorectal cancer robotic surgery was more beneficial to patients because of shorter postoperative recovery time of bowel function and shorter hospital stays.
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Neoplasias Colorretais/cirurgia , Cirurgia Colorretal/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Perda Sanguínea Cirúrgica , China , Estudos de Coortes , Neoplasias Colorretais/patologia , Cirurgia Colorretal/efeitos adversos , Feminino , Seguimentos , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Duração da Cirurgia , Seleção de Pacientes , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Pressure ulcers are common in clinical practice and pose a significant health problem worldwide. Apart from causing suffering to patients, they also result in longer hospital stays and increase the cost of health care. A variety of methods are used for treating pressure ulcers, including pressure relief, patient repositioning, biophysical strategies, nutritional supplementation, debridement, topical negative pressure, and local treatments including dressings, ointments and creams such as bacitracin, silver sulphadiazine, neomycin, and phenytoin. Phenytoin is a drug more commonly used in the treatment of epilepsy, but may play an important role in accelerating ulcer healing. OBJECTIVES: To assess the effects of topical phenytoin on the rate of healing of pressure ulcers of any grade, in any care setting. SEARCH METHODS: In September 2016, we searched the following electronic databases to identify relevant randomized clinical trials: the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library); Ovid MEDLINE; Ovid Embase; and EBSCO CINAHL Plus. We handsearched conference proceedings from the European Pressure Ulcer Advisory Panel, European Wound Management Association and the Tissue Viability Society for all available years. We searched the references of the retrieved trials to identify further relevant trials. We also searched clinical trials registries to identify ongoing and unpublished studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included all randomized controlled trials (RCTs) addressing the effects (both benefits and harms) of topical phenytoin on the healing of pressure ulcers of any grade compared with placebo or alternative treatments or no therapy, irrespective of blinding, language, and publication status. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted information on participants, interventions, methods and results and assessed risk of bias using Cochrane methodological procedures. For dichotomous variables, we calculated the risk ratio (RR) with 95% confidence interval (CI). For continuous variables, we calculated the mean difference with 95% CI. We rated the quality of the evidence by using Grading of Recommendations, Assessment, Development and Evaluation approach (GRADE). MAIN RESULTS: Three small RCTs met our inclusion criteria and included a total of 148 participants. These compared three treatments with topical phenytoin: hydrocolloid dressings, triple antibiotic ointment and simple dressings. In the three RCTs, 79% of participants had grade II ulcers, and 21% of participants had grade I ulcers; no participants had grade III or IV ulcers. Two RCTs had a high risk of bias overall and the other RCT was at unclear risk of bias due to poor reporting. Two RCTs had three intervention arms and the other had two intervention arms.Two studies compared topical phenytoin with hydrocolloid dressing (84 participants analysed). The available data suggest that hydrocolloid dressings may improve ulcer healing compared to topical phenytoin (39.3% ulcers healed for phenytoin versus 71.4% ulcers healed for hydrocolloid dressings (RR 0.55, 95% CI 0.33 to 0.92; 56 participants, 1 study; low quality evidence). We downgraded the evidence twice: once due to serious limitations (high risk of bias) and once due to the small sample size and small number of events. Two studies compared topical phenytoin with simple dressings (81 participants analysed). From the available data, we are uncertain whether topical phenytoin improves ulcer healing compared to simple dressings (39.3% ulcers healed for phenytoin versus 29.6% ulcers healed for the simple dressing (RR 1.33, 95% CI 0.63 to 2.78; 55 participants, 1 study; very low quality evidence). This evidence was downgraded once due to serious limitations (high risk of bias) and twice due to the low number of outcome events and resulting wide CI which included the possibility of both increased healing and reduced healing. We therefore considered it to be insufficient to determine the effect of topical phenytoin on ulcer healing. One study compared topical phenytoin with triple antibiotic ointment, however, none of the outcomes of interest to this review were reported. No adverse drug reactions or interactions were detected in any of the three RCTs. Minimal pain was reported in all groups in one trial that compared topical phenytoin with hydrocolloid dressings and triple antibiotic ointment. AUTHORS' CONCLUSIONS: This review has considered the available evidence and the result shows that it is uncertain whether topical phenytoin improves ulcer healing for patients with grade I and II pressure ulcers. No adverse events were reported from three small trials and minimal pain was reported in one trial. Therefore, further rigorous, adequately powered RCTs examining the effects of topical phenytoin for treating pressure ulcers, and to report on adverse events, quality of life and costs are necessary.
Assuntos
Bandagens , Fármacos Dermatológicos/administração & dosagem , Fenitoína/administração & dosagem , Úlcera por Pressão/tratamento farmacológico , Administração Tópica , Antibacterianos/administração & dosagem , Curativos Hidrocoloides , Humanos , Pomadas , Úlcera por Pressão/classificação , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Cold colorectal tumors are not likely to trigger a robust immune response and tend to suppress the immune response. There may be three reasons. First, the complex tumor microenvironment of cold colorectal cancer (CRC) leads to tolerance and clearance of immunotherapy. Second, the modification and concealment of tumor-specific targets in cold CRC cause immune escape and immune response interruption. Finally, the difference in number and function of immune cell subsets in patients with cold CRC makes them respond poorly to immunotherapy. Therefore, we can only overcome the challenges in immunotherapy of cold CRC through in-depth research and understanding the changes and mechanisms in the above three aspects of cold CRC.
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PURPOSE: To build a novel predictive model for hepatocellular carcinoma (HCC) patients based on DNA methylation data. METHODS: Four independent DNA methylation datasets for HCC were used to screen for common differentially methylated genes (CDMGs). Gene Ontology (GO) enrichment, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were used to explore the biological roles of CDMGs in HCC. Univariate Cox analysis and least absolute shrinkage and selection operator (LASSO) Cox analysis were performed to identify survival-related CDMGs (SR-CDMGs) and to build a predictive model. The importance of this model was assessed using Cox regression analysis, propensity score-matched (PSM) analysis and stratification analysis. A validation group from the Cancer Genome Atlas (TCGA) was constructed to further validate the model. RESULTS: Four SR-CDMGs were identified and used to build the predictive model. The risk score of this model was calculated as follows: risk score = (0.01489826 × methylation level of WDR69) + (0.15868618 × methylation level of HOXB4) + (0.16674959 × methylation level of CDKL2) + (0.16689301 × methylation level of HOXA10). Kaplan-Meier analysis demonstrated that patients in the low-risk group had a significantly longer overall survival (OS; log-rank P-value =0.00071). The Cox model multivariate analysis and PSM analysis identified the risk score as an independent prognostic factor (P<0.05). Stratified analysis results further confirmed this model performed well. By analyzing the validation group, the results of receiver operating characteristic (ROC) curve analysis and survival analysis further validated this model. CONCLUSION: Our DNA methylation-based prognosis predictive model is effective and reliable in predicting prognosis for patients with HCC.
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Biomarcadores Tumorais/genética , Carcinoma Hepatocelular/genética , Metilação de DNA , Neoplasias Hepáticas/genética , Carcinoma Hepatocelular/patologia , Biologia Computacional , Quinases Ciclina-Dependentes/genética , Feminino , Proteínas Homeobox A10/genética , Proteínas de Homeodomínio/genética , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Fatores de Transcrição/genéticaRESUMO
Minimally invasive surgery includes traditional laparoscopic and robot-assisted surgery. Although many studies related to robotic surgery and laparoscopic surgery have been published, when doing our search, scientometric studies that focus on related robotic surgery versus laparoscopic surgery were limited. In this study, we aimed to analyze and review the research hots and research status of robotic surgery versus laparoscopic surgery. We searched publications that involved robotic surgery versus laparoscopic surgery in the Web of Science database from 1980 to May 23, 2020. The top 100 publications were published in 2012 with the number of 17 and citations ranged from 618 to 64. Published across 34 different journals, namely European urology (n = 17) and others, the greatest contribution among 36 institutes was made by the Cleveland Clinic (n = 11). Of the top 100 publications, a total of 429 unique words were identiï¬ed and the most frequently occurring keyword was laparoscopy (n = 33). The co-occurrence of keywords in the top 100 publications indicated that the study of diseases mainly focused on prostatectomy, complications, prostate cancer, retropubic prostatectomy, nephron-sparing surgery, lymph-node dissection, total mesenteric excision, sexual function, rectal cancer, and assisted distal gastrectomy. In recent years, comparative research on robot and laparoscopic surgery has decreased and most studies focus on cancer.
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Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Excisão de Linfonodo , Masculino , Prostatectomia , Resultado do TratamentoRESUMO
Mammalian target of rapamycin complex 1 (mTORC1) is evolutionally conserved and frequently activated in various tumors, including colorectal cancer (CRC). It has been reported that the ribosome assembly factor Urb1 acts downstream of mTORC1/raptor signaling and contributes to digestive organ development in zebrafish. Previously, we highlighted that URB1 was overexpressed in CRC. Here, we assessed the mTORC1/regulatory associated protein with mTOR (RAPTOR)-URB1 axis in CRC tumorigenesis. We found that RAPTOR was overexpressed in CRC tissues and cell lines, was a favorable predictor in patients with CRC, and positively correlated with URB1. Silencing of RAPTOR suppressed CRC cell proliferation and migration and induced cell cycle arrest and apoptosis in vitro and inhibited xenograft growth in vivo. Moreover, ectopic overexpression of RAPTOR exerted an inverse biological phenotype. Knockdown of RAPTOR quenched mTORC1 activity and reduced the expression of URB1 and cyclinA2 (CCNA2). In contrast, overexpression of RAPTOR activated mTORC1 and upregulated URB1 and CCNA2. Furthermore, URB1 and CCNA2 expression were also impeded by rapamycin, which is a specific inhibitor of mTORC1. Thus, RAPTOR promoted CRC proliferation, migration, and cell cycle progression by inducing mTORC1 signaling and transcriptional activation of both URB1 and CCNA2. Taken together, we concluded that RAPTOR has the potential to serve as a novel biomarker and therapeutic target for CRC.
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Biomarcadores Tumorais/metabolismo , Neoplasias Colorretais/genética , Alvo Mecanístico do Complexo 1 de Rapamicina/metabolismo , Proteínas Nucleares/genética , Proteína Regulatória Associada a mTOR/metabolismo , Animais , Apoptose/efeitos dos fármacos , Apoptose/genética , Biomarcadores Tumorais/genética , Carcinogênese/efeitos dos fármacos , Carcinogênese/genética , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Proliferação de Células/genética , Colo/patologia , Colo/cirurgia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Ciclina A2/genética , Feminino , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Técnicas de Silenciamento de Genes , Humanos , Estimativa de Kaplan-Meier , Masculino , Alvo Mecanístico do Complexo 1 de Rapamicina/antagonistas & inibidores , Camundongos , Pessoa de Meia-Idade , Reto/patologia , Reto/cirurgia , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Sirolimo/farmacologia , Regulação para Cima/efeitos dos fármacos , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
OBJECTIVE: To compare robot-assisted surgery and conventional laparoscopy for gynecologic oncology regarding intra- and post-operative outcomes. METHODS: A retrospective study was performed on consecutive patients with gynecologic oncology from February 2014 to October 2017 at Gansu Provincial Hospital, China. Multivariable linear and logistic regression models were performed to explore the difference between two surgeries in the surgical outcomes after adjusting for potential confounders. RESULTS: 276 women were included in this study: 153 robot-assisted surgeries and 123 conventional laparoscopies. The multivariable linear regression model showed that robot-assisted surgery was longer operative time [coefficient (coef), 33.76; 95% CI, 12.47, 55.05; P = 0.002) ], higher lymph node yield (coef, 10.41; 95% CI, 7.47, 13.35; P < 0.001), shorter time to early post-operative feeding (coef, -1.09; 95% CI, -1.33, -0.84; P < 0.001) and less post-operative drainage volume (coef, -368.77; 95% CI, -542.46, -195.09; P < 0.001) than conventional laparoscopy. However, no difference was observed between the two surgeries regarding the estimated blood loss (P > 0.05). The multivariable logistic regression model showed that post-operative complications were similar between robot-assisted surgery and conventional laparoscopy (P > 0.05). CONCLUSION: Robot-assisted surgery was superior to conventional laparoscopy regarding intra- and post-operative outcomes for gynecologic oncology.
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Neoplasias dos Genitais Femininos/cirurgia , Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Feminino , Humanos , Período Intraoperatório , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Resultado do TratamentoRESUMO
The aim of this study was to evaluate and compare the intestinal function recovery time and other short-term outcomes between robotic-assisted total mesorectal excision (R-TME) and laparoscopic total mesorectal excision (L-TME) for rectal cancer. This is a retrospective study using a prospectively collected database. Patients' records were obtained from Gansu Provincial Hospital between July 2015 and October 2017. Eighty patients underwent R-TME, and 116 with the same histopathological stage of the tumor underwent an L-TME. Both operations were performed by the same surgeon, comparing intra- and postoperative outcomes intergroups. The time to the first passage of flatus (P < 0.001), the time to the first postoperative oral fluid intake (P < 0.001), and the length of hospital stay (P < 0.01) of the R-TME group were about three days faster than those in the L-TME group. The rate of conversion to open laparotomy (P = 0.038) and postoperative urinary retention (P = 0.016) were significantly lower in the R-TME group than in the L-TME group. Intraoperative blood loss of the R-TME group was more than that of the L-TME group (P < 0.01).The operation time, number of lymph nodes harvested, and rate of positive circumferential resection margin were similar intergroup. The total cost of the R-TME group was higher than that of the L-TME group, but with a lack of statistical significance (85,623.91 ± 13,310.50 vs 67,356.79 ± 17,107.68 CNY, P = 0.084). The R-TME is safe and effective and has better postoperative short-term outcomes and faster intestinal function recovery time, contrasting with the L-TME. The large, multicenter, prospective studies were needed to validate the advantages of robotic surgery system used in rectal cancer.
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Adenocarcinoma/cirurgia , Laparoscopia , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Duração da Cirurgia , Recuperação de Função Fisiológica , Neoplasias Retais/patologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
The aim of this study was to assess the quality of clinical practice guidelines of traumatic brain injury (TBI) and investigate the evidence grading systems.A systematic search of relevant guideline websites and literature databases (including PubMed, NGC, SIGN, NICE, GIN, and Google) was undertaken from inception to May 2018 to identify and select TBI guidelines. Four independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. The degree of agreement was evaluated with intraclass correlation coefficient (ICC).From 1802 records retrieved, 12 TBI guidelines were included. The mean scores for each AGREE II domain were as follows: scope and purpose (mean ± SD= 74.2â±â9.09); stakeholder involvement (mean± SD= 54.6â±â11.6); rigor of development (mean ± SD=70.1â±â13.6); clarity and presentation (mean ± SD=78.4â±â11.5); applicability (mean ± SD= 60.5â±â13.6); and editorial independence (mean ± SD=61.7â±â14.8). Ten guidelines were rated as "recommended." The ICC values ranged from 0.73 to 0.95. Seven grading systems were used by TBI guidelines to rate the level of evidence and the strength of recommendation.Most TBI guidelines got a high-quality rating, whereas a standardized grading system should be adopted to provide clear information about the level of evidence and strength of recommendation in TBI guidelines.
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Lesões Encefálicas Traumáticas , Medicina Baseada em Evidências/normas , Guias de Prática Clínica como Assunto , HumanosRESUMO
This meta-analysis aimed to compare the effectiveness of the suprapubic drainage and urethral catheterization after robot-assisted radical prostatectomy (RARP). PubMed, EMBASE, Cochrane Library and China Biology Medicine disc were systematically researched from their inception to December 2017. We selected randomized controlled trials, cohort studies comparing suprapubic tube with urethral catheter drainage in RARP patients. A meta-analysis was performed using R software, and a random-effects model was used to pool the effect size. Ten studies met eligibility criteria (N = 1248), including 3 RCTs, 3 prospective studies and 4 retrospective studies. Suprapubic drainage was associated with a reduction in the penile pain (39.64% [44 of 111]) compared with the UC group (62% [106 of 171]) (pooled RR 0.57, 95% CI 0.31 to 1.02, P = 0.05). However, two groups showed similarity in the overall pain (Postoperative days 1-3: pooled MD -0.26, 95% CI 1.34 to 0.83, P = 0.64; Postoperative days 6-7: pooled MD -0.50, 95% CI -1.54 to 0.54, P = 0.34), urinary incontinence (pooled RR 0.80, 95% CI 0.56 to 1.15, P = 0.23), bladder neck contracture (pooled RR 0.77, 95% CI 0.39 to 1.53, P = 0.45), urinary retention (pooled RR 0.88, 95% CI 0.29 to 2.70, P = 0.82), anastomotic stricture (P = 0.15), urethral stricture (P = 0.84) and bacteriuria (P = 0.40). The present meta-analysis showed that suprapubic drainage may be associated with less penile pain, but there was no conclusive evidence that suprapubic drainage was advantaged in other outcomes. Due to the low quality and small quantity of the available comparative studies, more high-quality randomized trials are needed to provide stronger evidence of the benefits of the two routes.
Assuntos
Drenagem/instrumentação , Drenagem/métodos , Intubação/instrumentação , Intubação/métodos , Dor Pós-Operatória/prevenção & controle , Prostatectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Cateteres Urinários , Bases de Dados Bibliográficas , Humanos , Masculino , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Software , Fatores de TempoRESUMO
BACKGROUND: Recent observations have suggested that overexpression of cyclooxygenase-2 (COX-2) promotes tumor lymphangiogenesis through an upregulation of vascular endothelial growth factor-C (VEGF-C) expression. It is unclear whether this mechanism also acts in gastric cancer. The aim of this study was to determine the relationship between COX-2 and VEGF-C expression in human gastric cancer, as well as to correlate with lymph node involvement, prognosis, and other clinicopathologic parameters. METHODS: Sixty-eight primary gastric cancers were immunohistochemically examined for COX-2, VEGF-C, vascular endothelial growth factor receptor-3 (VEGFR-3, also known as Flt-4), and CD34 expressions. Assessment of Flt-4-positive vessel density (FVD) and microvessel density (MVD) was performed. Then we analyzed their relationships and correlations with clinicopathologic findings and patients' survival time. RESULTS: The positivity rate of COX-2 and VEGF-C in the primary tumor was 67.7 and 54.4 percent, respectively. A significant correlation was found between the expression of VEGF-C and COX-2, and both were also correlated to MVD, FVD, lymphatic invasion, and TNM stage (p<0.05). COX-2 immunoreactivity was also associated with lymph node metastasis and serosa invasion. Increased MVD was significantly associated with lymph node metastasis and TNM stage. Both COX-2 and VEGF-C expression significantly correlated with poorer prognosis. CONCLUSIONS: Our data suggest that the expression of COX-2 correlates with VEGF-C expression and both of them correlate with the presence of lymphatic invasion and prognosis in gastric cancer. COX-2-mediated VEGF-C overexpression might promote lymphatic invasion via lymphangiogenesis pathway in patients with gastric cancer.
Assuntos
Biomarcadores Tumorais/metabolismo , Ciclo-Oxigenase 2/metabolismo , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Fator C de Crescimento do Endotélio Vascular/metabolismo , Adulto , Idoso , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Ciclo-Oxigenase 2/análise , Ciclo-Oxigenase 2/genética , Feminino , Humanos , Imuno-Histoquímica , Linfangiogênese , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Fator C de Crescimento do Endotélio Vascular/análise , Fator C de Crescimento do Endotélio Vascular/genéticaRESUMO
AIM: To investigate the synergistic effects of 3'-azido-3'-deoxythymidine (AZT) and FA-2-b-beta extracted from Ling Jin mushroom on apoptosis of gastric cancer cells MKN45 in vitro. METHODS: MTT analysis was made to examine the inhibition rate of MKN45 cells treated with AZT (2.5, 5, 10 and 20 mg/L) and FA-2-b-beta (5, 10, 20 and 40 mg/L) singly and combinatively for 24, 48 and 72 h. Apoptotic effects were evaluated by morphological methods, DNA agarose gel electrophoresis and flow cytometry, respectively. Telomerase activity was estimated by TRAP-ELISA. The mRNA expression of caspase-3 and Bcl-2 were detected by RT-PCR. RESULTS: AZT and FA-2-b-beta could significantly inhibit MKN45 cell proliferation and induce its apoptosis. MKN45 cells were inhibited in dose- and time- dependent manner. The inhibition effect of AZT combined with FA-2-b-beta was obviously better than that used singly (0.469 +/- 0.022 vs 1.075 +/- 0.055, P < 0.05, 0.325 +/- 0.029 vs 0.469 +/- 0.022 P < 0.01). AZT used singly and combination of FA-2-b-beta could decrease the activity of tumor cell telomerase, and AZT has synergistic function with FA-2-b-beta. A certain concentration of AZT could up-regulate the expression of caspase-3 mRNA (r = 0.9969, P < 0.01), which was positively related to apoptosis rate, and could down-regulate the expression of Bcl-2 mRNA, which was negatively related to apoptosis rate (r = 0.926, P < 0.01). Furthermore, the effect of AZT combined with FA-2-b-beta was significantly higher than that used singly. CONCLUSION: Combination of AZT and FA-2-b-beta has an obviously synergetic effect in the gastric cancer cells MKN45, which has provided a new approach to the treatment of gastric cancer clinically.
Assuntos
Agaricales , Apoptose/efeitos dos fármacos , Medicamentos de Ervas Chinesas/farmacologia , Proteínas de Plantas/farmacologia , Neoplasias Gástricas/patologia , Zidovudina/farmacologia , Caspase 3/genética , Caspase 3/metabolismo , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Quimioterapia Combinada , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Humanos , Fitoterapia , Proteínas Proto-Oncogênicas c-bcl-2/genética , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismoRESUMO
AIM: To evaluate the efficacy of telomerase activity assay and peritoneal lavage cytology (PLC) examination in peritoneal lavage fluid for the prediction of peritoneal metastasis in gastric cancer patients, and to explore the relationship between telomerase activity and proliferating cell nuclear antigen expression. METHODS: Telomeric repeated amplification protocol (TRAP)-enzyme-linked immunosorbent assay (ELISA) was performed to measure the telomerase activity in 60 patients with gastric cancer and 50 with peptic ulcer. PLC analysis of the 60 patients with gastric cancer was used for comparison. The proliferating cell nuclear antigen (PCNA) in gastric carcinoma was immunohistochemically examined. RESULTS: The telomerase activity and PLC positive rate in peritoneal lavage fluid from patients with gastric cancer was 41.7% (25/60), and 25.0% (15/60), respectively. The positive rate of telomerase activity was significantly higher than that of PLC in the group of pT(4) (15/16 vs 9/16, P < 0.05), P(1-3) (13/13 vs 9/13, P < 0.05) and diffuse type (22/42 vs 13/42, P < 0.05). The patients with positive telomerase activity, peritoneal metastasis, and serosal invasion had significantly higher levels of average PCNA proliferation index (PI), (55.00 +/- 6.59 vs 27.43 +/- 7.72, 57.26 +/- 10.18 vs 29.15 +/- 8.31, and 49.82 +/- 6.74 vs 24.65 +/- 7.33, respectively, P < 0.05). CONCLUSION: The TRAP assay for telomerase activity is a useful adjunct for cytologic method in the diagnosis of peritoneal micrometastasis and well related to higher proliferating activity of gastric cancer. The results of this study also suggest a promising future therapeutic strategy for treating peritoneal dissemination based on telomerase inhibition.
Assuntos
Adenocarcinoma/diagnóstico , Proliferação de Células , Neoplasias Peritoneais/diagnóstico , Neoplasias Gástricas/patologia , Telomerase/metabolismo , Adenocarcinoma/enzimologia , Adenocarcinoma/secundário , Adulto , Idoso , Líquido Ascítico/enzimologia , Biomarcadores Tumorais/metabolismo , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Técnicas de Amplificação de Ácido Nucleico , Úlcera Péptica/enzimologia , Lavagem Peritoneal/métodos , Neoplasias Peritoneais/enzimologia , Neoplasias Peritoneais/secundário , Valor Preditivo dos Testes , Antígeno Nuclear de Célula em Proliferação/metabolismo , Neoplasias Gástricas/enzimologia , Telomerase/análiseRESUMO
AIM: To investigate the underlying mechanism by which CXCL12 and CXCL6 influences the metastatic potential of colon cancer and internal relation of colon cancer and stromal cells. METHODS: Western blotting was used to detect the expression of CXCL12 and CXCL6 in colon cancer cells and stromal cells. The co-operative effects of CXCL12 and CXCL6 on proliferation and invasion of colon cancer cells and human umbilical vein endothelial cells (HUVECs) were determined by enzyme-linked immunosorbent assay, and proliferation and invasion assays. The angiogenesis of HUVECs through interaction with cancer cells and stromal cells was examined by angiogenesis assay. We eventually investigated activation of PI3K/Akt/mTOR signaling by CXCL12 involved in the metastatic process of colon cancer. RESULTS: CXCL12 was expressed in DLD-1 cancer cells and fibroblasts. The secretion level of CXCL6 by colon cancer cells and HUVECs were significantly promoted by fibroblasts derived from CXCL12. CXCL6 and CXCL2 could significantly enhance HUVEC proliferation and migration (P < 0.01). CXCL6 and CXCL2 enhanced angiogenesis by HUVECs when cultured with fibroblast cells and colon cancer cells (P < 0.01). CXCL12 also enhanced the invasion of colon cancer cells. Stromal cell-derived CXCL12 promoted the secretion level of CXCL6 and co-operatively promoted metastasis of colon carcinoma through activation of the PI3K/Akt/mTOR pathway. CONCLUSION: Fibroblast-derived CXCL12 enhanced the CXCL6 secretion of colon cancer cells, and both CXCL12 and CXCL6 co-operatively regulated the metastasis via the PI3K/Akt/mTOR signaling pathway. Blocking this pathway may be a potential anti-metastatic therapeutic target for patients with colon cancer.
Assuntos
Quimiocina CXCL12/metabolismo , Quimiocina CXCL6/metabolismo , Colo/citologia , Neoplasias do Colo/patologia , Neovascularização Patológica/patologia , Linhagem Celular Tumoral , Movimento Celular , Proliferação de Células , Técnicas de Cocultura , Colo/metabolismo , Ensaio de Imunoadsorção Enzimática , Fibroblastos/metabolismo , Células Endoteliais da Veia Umbilical Humana , Humanos , Invasividade Neoplásica/patologia , Fosfatidilinositol 3-Quinases/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Proteínas Recombinantes/metabolismo , Transdução de Sinais , Células Estromais/metabolismo , Serina-Treonina Quinases TOR/metabolismoRESUMO
PURPOSE: To systematically review efficacyand safety of robotic gastrectomy (RG) compared with conventional laparoscopic gastrectomy (LG) for gastric carcinoma. MATERIALS AND METHODS: A systematic literature search was carried out using PubMed, Cochrane Library, CBM, CNKI, WanFang, VIP and other sources like relevant references to obtain comparative studies assessing the effectiveness and safety between RG and LG published between 2013 and 2016. Then the literature was screened and the data were extracted by 2 independent reviewers. The quality of the literature was assessed, and the data analyzed using Stata/SE 14 software. Fixed effects or random effects models wereapplied according to heterogeneity. RESULTS: A total of 12 non-randomized observational clinical studies involving 3,580 patients were included, of which 1,096 had undergone RG and 2,484 had received LG. The results of the meta-analysis showed in terms of effectiveness, RG was associated with less blood loss, less time to first flatus and greater number of harvested lymph nodes, but there were no significant differences in proximal and distal resection margins, compared with LG. In terms of efficiency, RG was associated with shorter hospital stay, but longer operative time. In terms of safety, there were no statistically significant differences in complications, mortality and conversions between RG and LG. CONCLUSIONS: RG can achieve comparable or better short-term and radical effects than LG, with respect to effectiveness, efficiency and safety in treatment of gastric carcinoma. Future studies involving RG should focus on decreasing operative time and reducing cost. Moreover, there is a need for randomized controlled trials comparing the two techniques with long-term follow-up.
Assuntos
Carcinoma/cirurgia , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Robótica/métodos , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Hospitais , Humanos , Tempo de Internação , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Segurança , Resultado do TratamentoRESUMO
OBJECTIVE: This study aims to answer the superiority of comparing laparoscopy-assisted distal gastrectomy (LADG) with open distal gastrectomy (ODG) in the treatment early gastric cancer (EGC). MATERIAL AND METHODS: A comprehensive search up to May 31, 2014 was conducted on PubMed, Web of science, and the Cochrane Library. All eligible studies comparing LADG versus ODG were included. Data synthesis and statistical analysis were performed using RevMan 5.2 software. RESULTS: Seven randomized controlled trials (RCTs) totaling 390 patients (195 LADG and 195 ODG) were analyzed. Compared to ODG, LADG showed longer operative time (WMD = 79.60; 95%CI = 59.86 to 99.35; P < 0.00001), but was associated with less blood loss (WMD = -108.11; 95%CI = -145.97 to -70.26; P < 0.00001), fewer administered analgesics (WMD = -1.70; 95%CI = -2.19 to -1.22; P < 0.00001), fewer number of harvested lymph node (WMD = -2.77; 95%CI = -4.38 to -1.16; P = 0.0007), lower incidence of postoperative complications (OR = 0.26; 95%CI = 0.13 to 0.54; P = 0.0003), shorter postoperative hospital stay (WMD = -1.0; 95% CI = -1.83 to -0.16; P = 0.02) and earlier passage of flatus (WMD = -0.62; 95% CI = -0.96 to -0.27; P = 0.0005). CONCLUSION: This meta-analysis demonstrated that LADG significantly reduced blood loss, decreased the frequency of analgesic administration, faster recovery, a shorter hospital stay and fewer postoperative complications compared with ODG, though at the price of longer operative times and the number of harvested lymph nodes lesser as compared to ODG.