Cloning and characterization of a novel amylopullulanase from Bacillus megaterium Y103 with transglycosylation activity.

OBJECTIVE: To obtain a novel pullulanase with synthetic ability from a microorganism and characterize its substrates specificity. RESULTS: A novel pullulanase, PulY103A, from Bacillus megaterium Y103 was purified, characterized and expressed in Escherichia coli. PulY103A contained the signature sequences of type I pullulanases and showed 94.7% identity with a type I pullulanase (BmPul) from B. megaterium WW1210, showing similar molecular weight (110.8 kDa) and optimal pH (6.5). However, PulY103A had an optimal temperature of of 45 °C and exhibited relatively higher activity toward amylose (48.3%) compared with pullulan (100%), soluble starch (67.5%), and amylopectin (23.1%). The thin-layer chromatography results showed that the major pullulan hydrolysis products were maltotriose and maltohexaose, which differed from those reported in other pullulanases. On the basis of enzyme specificity, PulY103A was an amylopullulanase, which presented transglycosylation activity by forming α-1,4-glucosidic linkages. CONCLUSIONS: A novel amylopullulanase with transglycosylation activity was characterized. The features of this enzyme suggested its potential to produce maltohexaose.

[Epidemiology survey of gastrointestinal stromal tumor in Shanxi Province in 2011].

OBJECTIVE: To explore the incidence and distribution of gastrointestinal stromal tumor (GIST) in Shanxi Province. METHODS: Newly diagnosed and suspected GIST cases of Shanxi Province on January 1, 2011 to December 31, 2011 were collected from medical insurance records and hospital surveys. All specimens were sent to the Department of Pathology at Shanxi Provincial Tumor Hospital for examinations. And the data were analyzed by SPSS statistical analysis software. RESULTS: There were 153 newly discovered cases of GIST in Shanxi Province in 2011. And its distribution was scattered in different regions. The incidence was 4.3 per million (153/35 932 786) . The high-risk areas were Taiyuan (n = 25) and Changzhi (n = 25). There were 83 (54.2%) males and 70 (45.8%) females. And the incidence of males was not different from that of females ( (4.5 vs 4.0 )per million, P > 0.05). The median onset age was 59 (24-79) years. A high incidence of GIST occurred at an age range of 50-59 years (n = 33). Among the 139 patients, the tumor locations were stomach (n = 88, 63.3%), small intestine (n = 21, 15.1%), colon (n = 7, 5.0%), duodenum (n = 6, 4.3%), esophagus (n = 3, 2.2%) and extra-gastrointestinal (n = 14, 10.1%). And 113 cases had a record of tumor size. The median diameter was 5.78 (0.3-25.0) cm. The largest diameter was ≤ 2 cm (n = 30, 26.5%), > 2-5 cm (n = 33, 29.2%), > 5-10 cm (n = 36, 31.9%) and >10 cm (n = 14, 12.4%). The cell types of 141 cases were spindle cell (n = 112, 79.4%), epithelial (n = 11, 7.8%) and mixed (n = 18, 12.8%). CONCLUSIONS: Shanxi Province has a low incidence of GIST. And no statistically significant difference exists in the incidence between males and females. Taiyuan and Changzhi are relatively more prevalent.

[Accuracy of endorectal ultrasonography in preoperative staging of rectal cancer].

OBJECTIVE: To evaluate the accuracy of endorectal ultrasonography in preoperative staging of rectal carcinoma. METHODS: The 319 patients with rectal adenocarcinoma underwent endorectal ultrasonography evaluation from January 2007 to March 2010. There were 175 males and 144 females, and the age of patients were 22-82 year old (median 59 years). According their visiting time, 319 patients were divided into 3 groups (period A: January to December 2007; period B: January to December 2008; and period C: January 2009 to March 2010). All patients underwent endorectal ultrasonography, and the 3 doctors had finished evaluations with 272 cases (Doctor 1, 2, 3 had finished evaluations with 162, 64 and 46 cases respectively). The endorectal ultrasonography staging was compared with the pathology findings based on the surgical specimens in 319 patients who had surgery. RESULTS: Overall accuracy in assessing the level of rectal wall invasion was 67%. The accuracy of uT2 and uT3 were 43% and 81% respectively, and the difference was statistically significant (χ(2) = 30.54, P < 0.01), and the accuracy of uT4a was 59%, which was lower than uT3 (81%,χ(2) = 13.77, P < 0.01). Overall accuracy in assessing nodal involvement in the 311 patients treated with radical surgery was 66%. Staging accuracy tends to improve with experience, the accuracy with Doctor 1 in period C(staging accuracy of T and N were 84% and 81% respectively) were higher than period A(staging accuracy of T and N were 55% and 41% respectively) (χ(2) = 6.65 and 13.27, P < 0.01). CONCLUSIONS: Transrectal ultrasound for preoperative staging of rectal has higher accuracy with mastered ultrasound doctor.

Manipulation of crystallization nucleation and thermal degradation of PLA films by multi-morphologies CNC-ZnO nanoparticles.

Currently, the quest for more renewable and biodegradable materials is a scientific priority to address the problems of petroleum-based plastics are difficult to degrade. In this work, cellulose nanocrystals (CNC) have been used as a template and four morphologies of CNC-ZnO nanocomposites were prepared via a hydrothermal method, and CNC-ZnO/polylactic acid (PLA) composite films were obtained by solution casting. We find that CNC-ZnO nanocomposites as heterogeneous nucleating agents improved the crystallinity and the film with flower-like CNC-ZnO was improved by 2.4 %. Ea required for thermal degradation of the PLA films decreased to 66-81 % of that of neat PLA, calculated by the Kissinger method, the Friedman method, and the Flynn-Wall-Ozawa (FWO) method. The R2 model was the solid degradation mechanism of the PLA films, analyzed through the Coats-Redfern method and the Criado method. The H-bond content of the composite films was significantly reduced after thermal aging at 150 °C. We found that three-dimensional CNC-ZnO (ZnO-3) made more prominent contributions to the crystallization, thermal degradation, and thermal aging of PLA films than other dimensional. The thermal properties can be regulated by the dimension, size, and apparent morphology of CNC-ZnO nanoparticles.

[Analysis of predictors of axillary node metastases in 787 breast cancer patients].

OBJECTIVE: To explore the predictors of axillary nodal metastass in patients with breast cancer. METHODS: A retrospective study was performed using the clinicopathological data of breast cancer cases diagnosed and treated in our Hospital between Dec 2006 and Nov 2008. Logistic regression analysis was used to determine the predictors of axillary node positivity. RESULTS: The total number of patients was 1133. 69.5% of them (787) had complete clinical and pathological data. The median age was 49 years old (range 20-85). The average number of lymph nodes removed was 14.6 per person. The average number of involved nodes was 3.5 per person. Increasing tumor size was associated with increased risk of lymph node metastases. Assessed by multivariate analysis, the tumor size, age, ER status, and pathological type were significantly associated with node metastasis. CONCLUSIONS: Axillary nodal metastases are significantly affected by the tumor size, ER status, age, and pathological type in breast cancer patients.

[Pathological changes of rectal cancer after irinotecan, 5-fluorouracil or combined short-term radiotherapy].

OBJECTIVE: To observe and evaluate the pathologic changes and curative effects of irinotecan (CPT-11), 5-fluorouracil (5-FU) and combined short-term radiotherapy before low-set rectal cancer operation so as to provide a theoretic basis for formulating a new effective adjuvant therapeutic regimen. METHODS: A total of 41 patients of low rectal cancer were treated with CPT-11, 5-FU therapy or CPT-11 plus 5-FU combined short-term radiotherapy from April 2002 to April 2009. They were divided into 2 groups according to different treatment schemes, including irinotecan group (n = 18) and irinotecan combined short-term radiotherapy group (n = 23). The pathologic changes before and after treatment were observed and the differences of two treatment approaches compared. RESULTS: Tumor cells had different degrees of degeneration and necrosis under microscope in two groups. Compared with computed tomographic findings before therapy, tumor sizes of two groups were reduced by an average of 33.1% (13.5 mm vs 20.2 mm) and 34.4% (12.8 mm vs 19.5 mm) respectively. Two groups were graded according to the RCRG (rectal cancer regression grade) score: RCRG1: 7 cases vs 18 cases, RCRG2: 4 cases vs 3 cases and RCRG3: 7 cases vs 2 cases. According to the pathologic evaluation standard, 3-degree necrosis, cell interstitial fibrosis and intimal thickening in vessels were observed in two groups: 7 cases vs 17 cases, 6 cases vs 17 cases and 3 cases vs 14 cases respectively (all P < 0.05). Five patients achieved complete pathological remission in the irinotecan combined short-term radiotherapy group. CONCLUSION: Based on the pathological changes and mitigation results after treatment, CPT-11 and 5-FU may be used as neoadjuvant drugs for rectal cancer. If the above two drugs can be used in combination with short-term radiation, the curative effect will be better.

[Efficacy of cetuximab in therapy of metastatic colorectal cancer: a system evaluation].

OBJECTIVE: To assess the clinical efficacy of cetuximab in the treatment of individuals with metastatic colorectal cancer. METHODS: Literature searches were performed on all clinical trails reported on target-therapy agent cetuximab in treating metastatic colorectal cancer prior to August 2008. The basic characteristics and clinical efficacy data of trials meeting the screening criteria were extracted. Date analysis was performed by RevMan 4.2 if the data came from randomized controlled trials with the same objective. RESULTS: According to the selection criteria, 22 clinical studies were included. There were 8 randomized controlled trials, 1 non-randomized controlled trial and 13 single group trials. Because of different study objectives of 8 randomized controlled trials, no data could be analyzed by the Meta-analysis method. Cetuximab plus irinotecan as second-line therapy for patients with EGFR-expressing metastatic colorectal cancer who had previously failed to respond to irinotecan-added therapy could reach a tumor response rate of 16.4% - 23.0%, and median overall survival duration of 8.6 - 10.7 months. The addition of cetuximab to irinotecan as first-line therapy to treat metastatic colorectal cancer resulted in a tumor response rate of 42.0% - 67.0%, and median overall survival duration of 33.0 months. The response rate of cetuximab combined with oxaliplatin/5-FU/LV as first-line therapy for metastatic colorectal cancer was 46.0% - 72.0% and the median duration of overall survival was 28.2 - 30.0 months. Compared with the colorectal cancer population with mutant KRAS, the patients with wild-type KRAS could obtain a higher response rate and a longer progression-free survival. CONCLUSION: Cetuximab in combination with chemotherapy has promising efficacy in the therapy of metastatic colorectal cancer, and status of gene KRAS is an independent predictive marker for response of cetuximab.

Gastrointestinal stromal tumor (GIST) with liver metastases: An 18-year experience from the GIST cooperation group in North China.

Approximately 40% to 50% of gastrointestinal stromal tumor (GIST) patients will have recurrence or metastases after resection of the primary lesion, and the most common affected sites will be liver and peritoneum. Imatinib has been considered as the first-line therapy of metastatic GIST. Surgery for metastases is proposed when possible. Furthermore, there are controversies concerning hepatic resection and systemic tyrosin kinase inhibitors (TKIs). The therapeutic conditions and long-term outcome of GIST patients with liver metastases in northern China remain unknown.The clinical, pathological, and follow-up data of 144 GIST patients, who had liver metastases between June 1996 and June 2014 from 3 tertiary cancer centers in northern China, were reviewed.Thirty-two cases (22.2%) had hepatectomy with 23 (23/32, 71.9%) R0 resections and 9 (9/32, 28.1%) R1/R2 resections, respectively. Twenty-three patients were given imatinib postoperatively. Furthermore, 98 (68.1%) patients were given TKIs only to control disease progression, and sunitinib was considered after imatinib failure in 12 patients. The 1-, 3- and 5-year survival rate was 82%, 51%, and 24%, with a median overall survival of 48 months for all patients. Patients who had hepatic resection combined with TKIs had a tendency of improved outcome, and the median survival time was 89 months. This was in contrast to patients who received TKIs only, in which median survival time was 53 months. Patients who received imatinib plus sunitinib had a tendency of longer survival time, compared with patients who received imatinib only (not reached vs 50 months).TKIs combined with hepatic resection had a role in improving the outcome of GIST patients with liver metastases.

Unique Expression of Angiotensin Type-2 Receptor in Sex-Specific Distribution of Myelinated Ah-Type Baroreceptor Neuron Contributing to Sex-Dimorphic Neurocontrol of Circulation.

This study aims to understand the special expression patterns of angiotensin-II receptor (AT1R and AT2R) in nodose ganglia and nucleus of tractus solitary of baroreflex afferent pathway and their contribution in sex difference of neurocontrol of blood pressure regulation. In this regard, action potentials were recorded in baroreceptor neurons (BRNs) using whole-cell patch techniques; mRNA and protein expression of AT1R and AT2R in nodose ganglia and nucleus of tractus solitary were evaluated using real time-polymerase chain reaction, Western blot, and immunohistochemistry at both tissue and single-cell levels. The in vivo effects of 17ß-estradiol on blood pressure and AT2R expression were also tested. The data showed that AT2R, rather than AT1R, expression was higher in female than age-matched male rats. Moreover, AT2R was downregulated in ovariectomized rats, which was restored by the administration of 17ß-estradiol. Single-cell real time-polymerase chain reaction data indicated that AT2R was uniquely expressed in Ah-type BRNs. Functional study showed that long-term administration of 17ß-estradiol significantly alleviated the blood pressure increase in ovariectomized rats. Electrophysiological recordings showed that angiotensin-II treatment increased the neuroexcitability more in Ah- than C-type BRNs, whereas no such effect was observed in A-types. In addition, angiotensin-II treatment prolonged action potential duration, which was not further changed by iberiotoxin. The density of angiotensin-II-sensitive K(+) currents recorded in Ah-types was equivalent with iberiotoxin-sensitive component. In summary, the unique, sex- and afferent-specific expression of AT2R was identified in Ah-type BRNs, and AT2R-mediated KCa1.1 inhibition in Ah-type BRNs may exert great impacts on baroreflex afferent function and blood pressure regulation in females.

Learning curve of endorectal ultrasonography in preoperative staging of rectal carcinoma.

Accurate preoperative staging of rectal carcinoma is essential for optimal treatment. This study was designed to evaluate the accuracy and learning curve of endorectal ultrasonography (ERUS) in the preoperative staging of rectal carcinoma. We retrospectively analyzed the records of patients with rectal carcinoma who underwent preoperative ERUS followed by curative surgery at the Shanxi Province Tumor Hospital between January, 2007 and March, 2010. The patients were divided into three groups, namely A, B and C, depending on whether the examination was performed between January and December, 2007, between January and December, 2008 or between January, 2009 and March, 2010, respectively. Five physicians with no prior experience in ERUS performed the examinations. We compared the ERUS staging with the pathological findings using the tumor-node-metastasis (TNM) classification. The accuracy of ERUS in T and N staging after each additional consecutive 20 patients was calculated for physicians D, E and F. A total of 319 patients underwent ERUS prior to surgery. There were 38 patients in group A, 135 in group B and 146 in group C. Two of the five physicians performed only 47 of the 319 examinations, whereas the remaining 272 patients were examined by physicians D (n=162), E (n=64) and F (n=46). The overall accuracy in assessing the extent of rectal wall invasion (T) was 67%, with 16% of the cases overstaged and 17% understaged and the accuracy in assessing nodal involvement (N) was 66%, with 11% of the cases overstaged and 23% understaged. The total T and N staging accuracy of physicians D, E and F was 75 and 72%; 59 and 59%; and 50 and 52%, respectively. For physicians D, E and F, the accuracy of T and N staging after each additional 20 patients was calculated and the curve of the accuracy reached a plateau after physician D completed 80 cases. Therefore, ERUS is a valuable tool for assessing the depth of tumor invasion and it appears that after ~80 cases a physician may be considered able to apply it efficiently.

Is there a role of surgery in patients with recurrent or metastatic gastrointestinal stromal tumours responding to imatinib: a prospective randomised trial in China.

OBJECTIVES: For advanced gastrointestinal stromal tumour (GIST) patients who are responding to imatinib mesylate, the role of surgery has not been formally demonstrated. This multicenter randomised controlled trial was designed to assess whether surgery to treat residual disease for patients with recurrent/metastatic GISTs responding to imatinib mesylate (IM) improved progression free survival (PFS) compared with IM treatment alone. METHODS: Between 3 and 12months after starting IM for recurrent/metastatic GISTs, eligible patients were randomised to two arms: Arm A (surgery for residual disease) and Arm B (IM treatment alone). In Arm A (19pts), surgery was performed to remove residual macroscopic lesions as completely as possible, and IM treatment continued after surgery. In Arm B (22pts), IM was given alone at a dose of 400mg per day until disease progression. The primary end-point was PFS measured from the date IM started. This study was registered in the ChiCTR registry with the ID number ChiCTR-TRC-00000244. RESULTS: This randomised trial was closed early due to poor accrual. Only 41 patients were enrolled as opposed to 210 patients planned. 2-year PFS was 88.4% in the surgery arm and 57.7% in the IM-alone arm (P=0.089). Median overall survival (mOS) was not reached in the surgery arm and 49months in patients with IM-alone arm (P=0.024). CONCLUSIONS: While no significant differences were observed in the two arms, this study suggests that surgical removal of the metastatic lesion may improve the outcome of advanced GIST patients and should stimulate additional research on this topic.

[Standard of postoperative risk assessment for resectable gastrointestinal stromal tumor and its evaluation].

Surgery is the only possible cure protocol of gastrointestinal stromal tumor (GIST). But the risk of recurrence exists constantly. Risk assessment of relapse is very important to guide the targeted adjuvant therapy and predict the prognosis. Although the variables and grading in the risk assessment of recurrence after complete resection of primary local GIST have been identified, but either the F/NIH consensus, AFIP standards, modified NIH standards, or risk identification methods attempted to apply mathematical calculation model in recent years, including Jason S Gold risk nomogram, Rossi nomogram, Joensuu high Hotline Dengjun, are short of long-term, large-scale clinical trials without selection bias. Therefore, recurrence risk probability cannot be predicted accurately.

[Relationship of c-kit and platelet-derived growth factor receptor alpha gene mutation features with prognosis of patients with gastrointestinal stromal tumor].

OBJECTIVE: To explore the relationship between c-kit and platelet-derived growth factor receptor alpha(PDGFRA) gene mutation features and the prognosis of gastrointestinal stromal tumor(GIST). METHODS: Clinicopathological, genetic testing and follow-up informations of patients admitted to the Shanxi Tumor Hospital from June 2000 to January 2009 were collected. The survival was calculated and univariate analysis was conducted using the Kaplan-Meier method. Multivariate analysis was conducted by the Cox regression method. RESULTS: The 5-year disease-free survival rate was 61.5% and the 5-year overall survival rate was 67.4%. The 5-year disease-free survival rates of patients without disease among those with c-kit exon 11 mutation (n=77), c-kit exon 9 mutation(n=4), and PDGFRA exon 18 mutation (n=2) were 63.4%, 14.3% and 100%, and the 5-year overall survival rates were 70.8%, 50.0% and 100%, respectively. In the patients with c-kit exon 11 mutation, the 5-year disease-free survival rates among those with point mutations(n=26), deletion mutations(n=44), and duplication mutations(n=7) were 87.1%, 44.9% and 80.0%, and the 5-year overall survival rates were 88.1%, 57.0% and 100%, respectively. There were significant differences in overall survival among different factors. Multivariate analysis showed that gene mutation was not the independent factor of prognosis(P=0.492). CONCLUSIONS: In GIST patients undergoing surgery without imatinib treatment, mutated genotype is better than wild type in terms of prognosis. Gene mutation is not the independent factor of prognosis in GIST patients.

Treatment of advanced rectal cancer after renal transplantation.

Renal transplantation is a standard procedure for end-stage renal disease today. Due to immunosuppressive drugs and increasing survival time after renal transplantation, patients with transplanted kidneys carry an increased risk of developing malignant tumors. In this case report, 3 patients with advanced rectal cancer after renal transplantation for renal failure were treated with anterior resection or abdominoperineal resection plus total mesorectal excision, followed by adjuvant chemotherapy. One patient eventually died of metastasized cancer 31 mo after therapy, although his organ grafts functioned well until his death. The other 2 patients were well during the 8 and 21 mo follow-up periods after rectal resection. We therefore strongly argue that patients with advanced rectal cancer should receive standard oncology treatment, including operation and adjuvant treatment after renal transplantation. Colorectal cancer screening in such patients appears justified.

Irinotecan or oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer: a meta-analysis.

BACKGROUND: To compare clinical efficacy and toxicity of irinotecan combined with 5-fluorouracil and leucovorin with those of oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer. METHODS: Literature search was performed by keywords "irinotecan", "oxaliplatin" and "colorectal cancer" on all randomized controlled trails reported on irinotecan versus oxaliplatin combined with 5-fluorouracil and leucovorin as first-line therapy for advanced colorectal cancer in MEDLINE, OVID, Springer, Cochrane Controlled Trials Register (CCTR) and CBMdisc (Chinese Biology and Medicine disc) before January 2010. Two authors drew the details of trial design, characteristics of patients, outcomes, and toxicity from the studies included. Data analysis was performed by RevMan 4.2. RESULTS: According to the screening criteria, 7 clinical studies with 2095 participants of advanced colorectal cancer were included in this meta analysis. The baseline characteristics of irinotecan group were similar to those of oxaliplatin group. The response rate of oxaliplatin group was higher than that of irinotecan group (relative risk (RR) = 0.82, 95% confidence interval (95%CI) (0.70, 0.96), P = 0.01), and the median overall survival of oxaliplatin group was longer by 2.04 months than that of irinotecan group (95%CI (-3.54, -0.54), P = 0.008). In the comparison of grade 3 - 4 toxicity between the two groups, the incidences of nausea, emesis, diarrhoea and alopecia in irinotecan group were higher than those in oxaliplatin group (RR = 1.94, 95%CI (1.22, 3.09), P = 0.005; 1.71, 95%CI (1.34, 2.18), P < 0.001; 14.56, 95%CI (4.11, 51.66), P < 0.0001), respectively. However, the incidence of neurotoxicity, neutropenia and thrombocytopenia in irinotecan group were lower than those in oxaliplatin group (RR = 0.06, 95%CI (0.03, 0.14), P < 0.00001; 0.70, 95%CI (0.55, 0.91), P = 0.006; 0.18, 95%CI (0.05, 0.61), P = 0.006), respectively. CONCLUSIONS: Both irinotecan and oxaliplatin combined with 5-fluorouracil and leucovorin were effective in the first-line therapy of advanced colorectal cancer. However, the combined regimen of oxaliplatin plus 5-fluorouracil and leucovorin is more excellent. Irinotecan tended to result in more gastrointestinal tract reactions than oxaliplatin did, but the myelosuppression and neurotoxicity were more frequent in oxaliplatin regimen than irinotecan regimen.

[Comparison of two-year efficacy between procedure for prolapse and hemorrhoids and Milligan-Morgan hemorrhoidectomy in treatment of III and IV degree internal hemorrhoids].

OBJECTIVE: To compare the long-term efficacy of procedure for prolapse and hemorrhoids (PPH) and Milligan-Morgan hemorrhoidectomy (MMH) in the treatment of III and IV degree internal hemorrhoids. METHODS: One hundred patients were randomly divided into two groups and received PPH (n=42) and MMH (n=58) respectively. After two years, the efficacy, complications and function of defecation were compared. RESULTS: Two years after operation, the morbidities of hydrorrhea (2.38% vs 20.69%, P=0.007), dermal neoplasm formation (9.52% vs 25.86%, P=0.040) and narrowing in the caliber of the stools (2.38% vs 18.97%, P=0.027) were significantly lower in PPH group than those in MMH group (P<0.05). The morbidities of overall complication (9.52% vs 25.86%, P=0.040) and overall abnormal function of defecation (9.52% vs 29.31%, P=0.017) were lower in PPH group than those in MMH group (P<0.05). However, there were no significant differences of the morbidity of relapse (14.29% vs 10.34%, P=0.549), patient satisfactory degree (92.86% vs 87.93%, P=0.636) and overall symptom recurrence rate (19.05% vs 25.86%, P=0.424) between the two groups. CONCLUSIONS: Long-term efficacies of procedure for prolapse and hemorrhoids and Milligan-Morgan haemorrhoidectomy in the treatment of III and IV degree internal hemorrhoids are similar. PPH has better safety, less complications and less effect on abnormal function of defecation compared with MMH.

[Efficacy of intersphincteric resection in the sphincter-preserving operation for ultra-lower rectal cancer].

OBJECTIVE: To evaluate the clinical efficacy of intersphincteric resection in the sphincter- preserving operation for ultra-lower rectum cancer. METHODS: Thirty-one rectal cancer patients with the distal edge of the tumour less than 2 cm from the dentate line were evaluated. Eighteen advanced rectal cancer patients received preoperative chemo-radiation. Total mesorectal excision (TME) was performed with the rectum immobilized down, and the puborectal ligament and partial levator cut to the level of the dentate line. In some well-exposed patients, it was possible to further immobilize the rectum between the external sphincter ring and the rectum inner sphincter wall. In anal approach,good exposure was attained and the cut-line was made vertically to the anal canal 2 cm below the lower edge of the tumor, and further intersphincteric immobilization was made upright. Colon or colon pouch were anastomosed to the distal anal wall. RESULTS: There was no peri-operative death. Thirty patients had good fecal control. Twenty-nine patients showed no evidence of recurrence or metastasis after follow-up for 12 months. Recurrence occurred in one case 1 year after operation. Another one had higher CEA 19.9 level, but without evidence of metastasis. CONCLUSION: Radical resection can be attained and anal sphincter preserved by intersphincter resection which is an alternative sphincter-preserving operation.

[Study on the prognostic factors of colorectal cancer after radical resection and on suggested model for prediction].

OBJECTIVE: To study the factors of colorectal cancer (CRC) after radical resection to provide data predicting the prognosis of the patients. METHODS: 120 cases of CRC were collected in this study. Medical clinical records and 5-year follow-up data were reviewed. Streptavidin-peroxidase immunohistochemical technique was used to detect the expression of p53, C-erbB-2, nm23-H(1) and Ras on formalin-fixed, paraffin embedded sections of CRC from the 120 patients. RESULTS: Results showed that the rates of positive expression of p53, C-erbB-2, Ras and nm23-H(1) were 62.5% (75/120), 25.8% (31/120), 80.0% (96/120) and 60.8% (73/120) respectively in the CRC tissue. All pathological variables and biological markers were analyzed with Cox regression model (alpha = 0.05). Eight distinguished prognostic factors were identified in the univariate analysis as: macroscopic configuration, histology grade, depth of invasion of intestinal, lymph nodes metastasis, Dukes' classification, p53, Ras and nm23-H(1). The results of multivariate analysis (alpha = 0.05) indicated that the independent prognostic factors were Dukes' classification, p53 and nm23-H(1) (P = 0.000), with relative risk of 3.06, 6.02 and 0.40, respectively. A prognostic model: h(t, x) = h(0)(t)exp (-0.9269X(14) + 1.1197X(10) + 1.7948X(11)) was established. Sensitivity, specificity agreement and reliability of the model and Kappa were 79.1%, 83.0%, 80.8% and 0.62, respectively. CONCLUSION: Dukes' classification, p53 and nm23-H(1)seemed to be independent and important prognostic factors. This prognostic model could be used to evaluate the prognosis of patients with CRC by clinicians.