There exist differences in the epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selections between gastric cancer patients from the Eastern and ...There exist differences in the epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selections between gastric cancer patients from the Eastern and Western countries.The Chinese Society of Clinical Oncology(CSCO)has organized a panel of senior experts specializing in all sub-specialties of gastric cancer to compile a clinical guideline for the diagnosis and treatment of gastric cancer since 2016 and renews it annually.Taking into account regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted expert consensus judgment on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes in China.The 2021 CSCO Clinical Practice Guidelines for Gastric Cancer covers the diagnosis,treatment,follow-up,and screening of gastric cancer.Based on the 2020 version of the CSCO Chinese Gastric Cancer guidelines,this updated guideline integrates the results ofmajor clinical studies from China and overseas for the past year,focused on the inclusion of research data from the Chinese population for more personalized and clinically relevant recommendations.For the comprehensive treatment of non-metastatic gastric cancer,attentions were paid to neoadjuvant treatment.The value of perioperative chemotherapy is gradually becoming clearer and its recommendation level has been updated.For the comprehensive treatment of metastatic gastric cancer,recommendations for immunotherapy were included,and immune checkpoint inhibitors fromthird-line to the first-line of treatment for different patient groups with detailed notes are provided.展开更多
China is one of the countries with the highest incidence of gastric cancer.There are differences in epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and ...China is one of the countries with the highest incidence of gastric cancer.There are differences in epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selection between gastric cancer patients from the Eastern and Western countries.Non-Chinese guidelines cannot specifically reflect the diagnosis and treatment characteristics for the Chinese gastric cancer patients.The Chinese Society of Clinical Oncology(CSCO)arranged for a panel of senior experts specializing in all sub-specialties of gastric cancer to compile,discuss,and revise the guidelines on the diagnosis and treatment of gastric cancer based on the findings of evidence-based medicine in China and abroad.By referring to the opinions of industry experts,taking into account of regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted experts’consensus judgement on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes.This guideline uses tables and is complemented by explanatory and descriptive notes covering the diagnosis,comprehensive treatment,and follow-up visits for gastric cancer.展开更多
AIM To analyze the diagnostic value of a circular RNA(circR NA), circ-LDLRAD3, in pancreatic cancer.METHODS Expression levels of circ-LDLRAD3 were tested in both cells and clinical samples; the latter included 30 pair...AIM To analyze the diagnostic value of a circular RNA(circR NA), circ-LDLRAD3, in pancreatic cancer.METHODS Expression levels of circ-LDLRAD3 were tested in both cells and clinical samples; the latter included 30 paired pancreatic cancer tissues and adjacent non-tumorous tissues, 31 plasma samples from patients with pancreatic cancer, and 31 plasma samples from healthy volunteers. Real-time quantitative reverse transcriptionpolymerase chain reaction(q RT-PCR) was performed to measure expression levels of circ-LDLRAD3 in cells and clinical samples; then, the relationship between clinicopathological factors of patient samples and expression of circ-LDLRAD3 in pancreatic cancer was analyzed. The diagnostic value of circ-LDLRAD3 was verified by receiver operating characteristic(ROC) curve analysis.RESULTS Circ-LDLRAD3 was up-regulated in pancreatic cancer cell lines(P < 0.01), pancreatic cancer tissues(P < 0.01), and plasma samples from patients with pancreatic cancer(P < 0.01). High expression of circLDLRAD3 was significantly associated with venous invasion, lymphatic invasion, and metastasis. The area under the ROC curve of circ-LDLRAD3 alone or combination with CA19-9 was 0.67 and 0.87, respectively, with a sensitivity and specificity of 0.5738(alone) and 0.7049(alone), and 0.8033(combination) and 0.9355(combination), respectively.CONCLUSION These data suggest that circ-LDLRAD3 may be a biomarker in the diagnosis of pancreatic cancer.展开更多
AIM: To evaluate the epithelial-to-mesenchymal transition(EMT) of circulating tumor cells(CTCs) in gastric cancer patients.METHODS: We detected tumor cells for expression of four epithelial(E^+) transcripts(keratins 8...AIM: To evaluate the epithelial-to-mesenchymal transition(EMT) of circulating tumor cells(CTCs) in gastric cancer patients.METHODS: We detected tumor cells for expression of four epithelial(E^+) transcripts(keratins 8, 18, and 19 and epithelial cell adhesion molecule) and two mesenchymal(M^+) transcripts(Vimentin and Twist) by a quantifiable, dual-colorimetric RNA-in situ hybridization assay. Between July 2014 and October 2014, 44 patients with gastric cancer were recruited for CTC evaluation. Blood samples were obtained from selected patients during the treatment course [before surgery, after surgery and at the 6^(th) cycle of XELOX based chemotherapy(about 6 mo postoperatively)].RESULTS: We found the EMT phenomenon in which there were a few biphenotypic E^+/M^+ cells in primary human gastric cancer specimens. Of the 44 patients, the presence of CTCs was reported in 35(79.5%) patients at baseline. Five types of cells including from exclusively E^+ CTCs to intermediate CTCs and exclusively M^+ CTCs were identified(4 patients with M^+ CTCs and 10 patients with M^+ or M^+ > E^+ CTCs). Further, a chemotherapy patient having progressive disease showed a proportional increase of mesenchymal CTCs in the post-treatment blood specimens. We used NCI-N87 cells to analyze the linearity and sensitivity of Can Patrol^(TM) system and the correlation coefficient(R^2) was 0.999.CONCLUSION: The findings suggest that the EMT phenomenon was both in a few cells of primary tumors and abundantly in CTCs from the blood of gastric cancer patients, which might be used to monitor therapy response.展开更多
Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of the acute coronary syndrome （ACS）. It is of potential significance to explore the blood indexes ...Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of the acute coronary syndrome （ACS）. It is of potential significance to explore the blood indexes predicting plaque characteristics. Little studies have focused on this field. Therefore we investigated the relationship between hypersensitive C-reactive protein （hs-CRP）, pro-matrix metalloproteinase-1 （proMMP-1）, tissue inhibitors of matrix metalloproteinase-1 （TIMP-1） and coronary plaque morphology. Methods Intravascular ultrasound （IVUS） examination was done in 152 patients with confirmed coronary heart disease before percutaneous coronary intervention from February 2003 to July 2005. Plasma samples of arterial blood were collected prior to the procedure. The level of hs-CRP, proMMP-1 and TIMP-1 were respectively measured by enzyme-linked immunosorbent assay （ELISA）. Results Unstable and ruptured plaque were found more frequently in patients with acute myocardial infarction and unstable angina. External elastic membrane cross-sectional area （EEM CSA）, plaque area, lipid pool area and plaque burden were significantly larger in ruptured and unstable plaque group. Positive remolding, thinner fabric-cap, smaller minimal lumen cross-sectional area （MLA）, dissection and thrombus were significantly more frequent in ruptured and unstable plaque group. The levels of plasma hs-CRP, proMMP-1 and TIMP-1 were higher in ruptured plaque group, hs-CRP〉8.94 mg/L was used to predict ruptured plaque with a ROC curve area of 0.76 [95% confidence interval （CI）, 67.0%-85.8%], sensitivity of 71.8%, specificity of 77.0% and accuracy of 69.2% （P〈0.01）, similarly for proMMP-1〉0.12 ng/ml with a ROC curve area of 0.69 [95% CI, 58.2%- 80.2%], sensitivity of 69.2%, specificity of 75.2% and accuracy of 66.2% （P〈0.01）, and TIMP-1〉83.45 ng/ml with a ROC curve area of 0.67 [95% CI, 56.2%-78.3%], sensitivity of 66.7%, specificity of 61.9% and accuracy of 66.2% （P〈0.01）. Co展开更多
Gastric cancer(GC), with its high incidence and mortality rates, is a highly fatal cancer that is common in East Asia particularly in China. Its recurrence and metastasis are the main causes of its poor prognosis. Cir...Gastric cancer(GC), with its high incidence and mortality rates, is a highly fatal cancer that is common in East Asia particularly in China. Its recurrence and metastasis are the main causes of its poor prognosis. Circulating tumor cells(CTCs) or other blood biomarkers that are released into the circulating blood stream by tumors are thought to play a crucial role in the recurrence and metastasis of gastric cancer. Therefore, the detection of CTCs and other blood biomarkers has an important clinical significance; in fact, they can help predict the prognosis, assess the staging, monitor the therapeutic effects and determine the drug susceptibility. Recent research has identified many blood biomarkers in GC, such as various serum proteins, autoantibodies against tumor associated antigens, and cell-free DNAs. The analysis of CTCs and circulating cell-free tumor DNA(ctDNA) in the peripheral blood of patients with gastric cancer is called as liquid biopsy. These blood biomarkers provide the disease status for individuals and have clinical meaning. In this review, we focus on the recent scientific advances regarding CTCs and other blood biomarkers, and discuss their origins and clinical meaning.展开更多
The 2023 update of the Chinese Society of Clinical Oncology(CSCO)Clini-cal Guidelines for Gastric Cancer focuses on standardizing cancer diagnosis and treatment in China,reflecting the latest advancements in evidence-...The 2023 update of the Chinese Society of Clinical Oncology(CSCO)Clini-cal Guidelines for Gastric Cancer focuses on standardizing cancer diagnosis and treatment in China,reflecting the latest advancements in evidence-based medicine,healthcare resource availability,and precision medicine.These updates address the differences in epidemiological characteristics,clinicopatho-logical features,tumor biology,treatment patterns,and drug selections between Eastern and Western gastric cancer patients.Key revisions include a structured template for imaging diagnosis reports,updated standards for molecular marker testing in pathological diagnosis,and an elevated recommendation for neoadju-vant chemotherapy in stage III gastric cancer.For advanced metastatic gastric cancer,the guidelines introduce new recommendations for immunotherapy,anti-angiogenic therapy and targeted drugs,along with updated management strategies for human epidermal growth factor receptor 2(HER2)-positive and deficient DNA mismatch repair(dMMR)/microsatellite instability-high(MSI-H)patients.Additionally,the guidelines offer detailed screening recommendations for hereditary gastric cancer and an appendix listing drug treatment regimens for various stages of gastric cancer.The 2023 CSCO Clinical Guidelines for Gastric Cancer updates are based on both Chinese and international clinical research and expert consensus to enhance their applicability and relevance in clinical practice,particularly in the heterogeneous healthcare landscape of China,while maintaining a commitment to scientific rigor,impartiality,and timely revisions.展开更多
Grain number per-panicle is one of the most important components for rice yield. Spikelets on the primary and secondary branches determine the grain number per-panicle in rice. In this study, we identified a natural m...Grain number per-panicle is one of the most important components for rice yield. Spikelets on the primary and secondary branches determine the grain number per-panicle in rice. In this study, we identified a natural mutant, gnp4, lack of lateral spikelet on the secondary branches in the field condition. In addition, the Gnp4 and Lax1-1 double mutant showed dramatically reduced secondary branches and spikelets in panicle at reproductive stage, and tillers at vegetative stage. By map-based cloning approach, and using four F2 segregating populations, the Gnp4 gene was finally mapped to a 10.7-kb region on the long arm of chromosome 4 in rice. In this region, only one gene was predicted, and genomic DNA sequencing of the 10.7-kb region showed no nucleotide differences between the mutant and wild type. Interestingly, we found that the methylation level of several cytosines in the promoter CpG islands region of the predicted gene in gnp4 were different from the wild type. Thus, we propose that the DNA methylation changes at these sites may induce to decrease expression level of Gnp4, consequently, resulting in phenotypic variation.展开更多
AIM To determine the feasibility,safety,and oncological outcome of laparoscopic resection of gastric gastrointestinal stromal tumors(GISTs)based on favorable or unfavorable location.METHODS Our hospital database inclu...AIM To determine the feasibility,safety,and oncological outcome of laparoscopic resection of gastric gastrointestinal stromal tumors(GISTs)based on favorable or unfavorable location.METHODS Our hospital database included 207 patients who underwent laparoscopic removal of gastric GISTs from January 2004 to September 2015.Patient demographics,clinical presentation,surgery,histopathology,postoperative course,and oncological outcomes were reviewed and analyzed.RESULTS Gastric GIST in favorable locations was present in81/207(39.1%)cases,and in unfavorable locations in 126/207(60.9%)cases.Overall mean tumor size was 3.28±1.82 cm.No conversions occurred,and complete R0 resection was achieved in 207(100%)cases.There were three incidences of iatrogenic tumor rupture.The feasibility and safety of laparoscopic surgery were comparable in both groups with no statistical difference between unfavorable and favorable location groups,respectively:for operative time:83.86±44.41 vs 80.77±36.46 min,P=0.627;conversion rate:0%vs 0%;estimated blood loss:27.74±45.2vs 29.59±41.18 m L,P=0.780;tumor rupture during surgery:0.90%vs 2.82%,P=0.322;or postoperative complications:3.74%vs 7.04%,P=0.325.The follow-up period recurrence rate was 1.89%with no significant differences between the two groups(3.03%vs 0%,P=0.447).Overall 5-year survival rate was98.76%and survival rates were similar between the two groups:98.99%vs 98.39%,P=0.623(unfavorable vs favorable,respectively).CONCLUSION The laparoscopic approach for gastric GISTs is safe and feasible with well-accepted oncological surgical outcomes.Strategies for laparoscopic resection should be selected according to the location and size of the tumor.Laparoscopic treatment of gastric GISTs in unfavorable locations should not be restricted in gastrointestinal centers.展开更多
AIM To evaluate the clinical value of staging laparoscopyin treatment decision-making for advancedgastric cancer （GC）.METHODS： Clinical data of 582 patients with advancedGC were retrospectively analyzed. All patien...AIM To evaluate the clinical value of staging laparoscopyin treatment decision-making for advancedgastric cancer （GC）.METHODS： Clinical data of 582 patients with advancedGC were retrospectively analyzed. All patientsunderwent staging laparoscopy. The strength ofagreement between computed tomography （CT） stage,endoscopic ultrasound （EUS） stage, laparoscopic stage,and final stage were determined by weighted Kappastatistic （Kw）. The number of patients with treatmentdecision-changes was counted. A χ 2 test was used toanalyze the correlation between peritoneal metastasisor positive cytology and clinical characteristics.RESULTS： Among the 582 patients, the distributions ofpathological T classifications were T2/3 （153, 26.3%）,T4a （262, 45.0%）, and T4b （167, 28.7%）. Treatmentplans for 211 （36.3%） patients were changed after staging laparoscopy was performed. Two （10.5%） of19 patients in M1 regained the opportunity for potentialradical resection by staging laparoscopy. Unnecessarylaparotomy was avoided in 71 （12.2%） patients. Thestrength of agreement between preoperative T stageand final T stage was in almost perfect agreement （Kw= 0.838; 95% confidence interval （CI）： 0.803-0.872;P 〈 0.05） for staging laparoscopy; compared with CTand EUS, which was in fair agreement. The strengthof agreement between preoperative M stage andfinal M stage was in almost perfect agreement （Kw= 0.990; 95% CI： 0.977-1.000; P 〈 0.05） for staginglaparoscopy; compared with CT, which was in slightagreement. Multivariate analysis revealed that tumorsize （≥ 40 mm）, depth of tumor invasion （T4b）, andBorrmann type （Ⅲ or Ⅳ） were significantly correlatedwith either peritoneal metastasis or positive cytology.The best performance in diagnosing P-positive wasobtained when two or three risk factors existed.CONCLUSION： Staging laparoscopy can improvetreatment decision-making for advanced GC anddecrease unnecessary exploratory laparotomy.展开更多
AIM:To investigate the feasibility and optimal approach for laparoscopic pancreasand spleen-preserving splenic hilum lymph node dissection in advanced proximal gastric cancer.METHODS:Between August 2009 and August 201...AIM:To investigate the feasibility and optimal approach for laparoscopic pancreasand spleen-preserving splenic hilum lymph node dissection in advanced proximal gastric cancer.METHODS:Between August 2009 and August 2012,12 patients with advanced proximal gastric cancer treated in Nanfang Hospital,Southern Medical University,Guangzhou,China were enrolled and subsequently underwent laparoscopic total gastrectomy with pancreasand spleen-preserving splenic hilum lymph node(LN)dissection.The clinicopathological characteristics,surgical outcomes,postoperative course and followup data of these patients were retrospectively collected and analyzed in the study.RESULTS:Based on our anatomical understanding of peripancreatic structures,we combined the characteristics of laparoscopic surgery and developed a modified approach(combined supraand infra-pancreatic approaches)for laparoscopic pancreasand spleenpreserving splenic hilum LN dissection.Surgery was completed in all 12 patients laparoscopically without conversion.Only one patient experienced intraoperative bleeding when dissecting LNs along the splenic artery and was handled with laparoscopic hemostasis.The mean operating time was 268.4 min and mean number of retrieved splenic hilum LNs was 4.8.One patient had splenic hilum LN metastasis(8.3%).Neither postoperative morbidity nor mortality was observed.Peritoneal metastasis occurred in one patient and none of the other patients died or experienced recurrent disease during the follow-up period.CONCLUSION:Laparoscopic total gastrectomy with pancreasand spleen-preserving splenic hilum LN dissection using the modified approach for advanced proximal gastric cancer could be safely achieved.展开更多
AIM: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages Ⅱ and Ⅲ rectal cancer.METHODS:This study enrolled 406 consecutive patients who underwent curative resection for stagesⅡand...AIM: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages Ⅱ and Ⅲ rectal cancer.METHODS:This study enrolled 406 consecutive patients who underwent curative resection for stagesⅡandⅢrectal cancer between January 2000 and December 2009[laparoscopic rectal resection(LRR),n=152;open rectal resection(ORR),n=254].Clinical characteristics,operative outcomes,pathological outcomes,postoperative recovery,and 5-year survival outcomes were compared between the two groups.RESULTS:Most of the clinical characteristics were similar except age(59 years vs 55 years,P=0.033)between the LRR group and ORR group.The proportion of anterior resection was higher in the LRR group than that in the ORR group(81.6%vs 66.1%,P=0.001).The LRR group had less estimated blood loss(50m L vs 200 m L,P<0.001)and a lower rate of blood transfusion(4.6%vs 11.8%,P=0.019)compared to the ORR group.The pathological outcomes of the two groups were comparable.The LRR group was associated with faster recovery of bowel function(2.8 d vs 3.7 d,P<0.001)and shorter postoperative hospital stay(11.7 d vs 13.7 d,P<0.001).The median followup time was 63 mo in the LRR group and 65 mo in the ORR group.As for the survival outcomes,the 5-year local recurrence rate(16.0%vs 16.4%,P=0.753),5-year disease-free survival(DFS)rate(63.0%vs63.1%,P=0.589),and 5-year overall survival(OS)rate(68.1%vs 63.5%,P=0.682)were comparable between the LRR group and the ORR group.Stageby stage,there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate(stageⅡ:6.3%vs 8.7%,P=0.623;stageⅢ:26.4%vs 23.2%,P=0.747),5-year DFS rate(stageⅡ:77.5%vs 77.6%,P=0.462;stageⅢ:46.5%vs 50.9%,P=0.738),and5-year OS rate(stageⅡ:81.4%vs 74.3%,P=0.242;stageⅢ:53.9%vs 54.1%,P=0.459).CONCLUSION:LRR for stagesⅡandⅢrectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.展开更多
AIM:To investigate the regulative effect of miRNA-3383p(miR-338-3p) on cell growth in colorectal carcinoma(CRC).METHODS:The lentiviral vector pLV-THM-miR-338-3p and pLV-THM-miR-338-3p-inhibitor were constructed.The re...AIM:To investigate the regulative effect of miRNA-3383p(miR-338-3p) on cell growth in colorectal carcinoma(CRC).METHODS:The lentiviral vector pLV-THM-miR-338-3p and pLV-THM-miR-338-3p-inhibitor were constructed.The recombinant viral vector encoding the pre-miR338-3p or miR-338-3p-inhibitor and the two packaging plasmids psPAX2 and pMD2.G were cotransfected into human embryonic kidney 293T cells to package lentivirus.The supernatant containing the lentivirus particles was harvested to determine the viral titer,and this supernatant was then used to transduce CRCderived cell line,SW-620.Flow cytometry was utilized for sorting the green fluorescent protein(GFP) + cells to establish the SW-620 cell line stably expressing premiR-338-3p or miR-338-3p-inhibitor.Moreover,the expression of miR-338-3p was determined by real-time reverse transcriptase polymerase chain reaction,andWestern blotting was used to detect the expression of the smoothened(SMO,the possible target of miR-3383p) protein in SW-620 cells.Furthermore,the status of CRC cell proliferation and apoptosis were detected by 3-(4,5-dimethyl-2 thiazoyl)-2,5-diphenyl-2H-tetrazolium bromide assay and flow cytometry,respectively.RESULTS:Restriction enzyme digestion and DNA sequencing demonstrated that the lentiviral vector pLVTHM-miR-338-3p and pLV-THM-miR-338-3p-inhibitor were constructed successfully.GFP was expressed after the SW-620 cells were transduced by the lentivirus.Expression of miR-338-3p in SW-620 cells transduced with the lentivirus pLV-THM-miR-338-3p was significantly increased(relative expression 3.91 ± 0.51 vs 2.36 ± 0.44,P < 0.01).Furthermore,overexpression of miR-338-3p inhibited the expression of SMO protein in SW-620 cells,which showed obviously suppressed proliferation ability [cellular proliferation inhibition rate(CPIR) 61.9% ± 5.2% vs 41.6% ± 4.8%,P < 0.01].Expression of miR-338-3p in SW-620 cells transduced with the lentivirus pLV-THM-miR-338-3p-inhibitor was significantly decreased(relative expression 0.92 ± 0.29 vs 2.36 ± 0.44,P < 0.展开更多
Effects of mold electromagnetic stirring （M-EMS） on the solidification structure of 45# steel billet were investigated by examination of interdendritic corrosion. The results show that the primary and secondary dend...Effects of mold electromagnetic stirring （M-EMS） on the solidification structure of 45# steel billet were investigated by examination of interdendritic corrosion. The results show that the primary and secondary dendrite arm spacings increase from the edge of the billet to the center and decrease obviously with increasing electromagnetic torque, which will be beneficial to refine the solidification structure and enlarge the equiaxed crystal zone. The ratio of equiaxed crystal increases by 15.9% with the electromagnetic torque increasing from 230 to 400 cN·cm. The increase of stirring intensity can improve the cooling rate and the impact of M-EMS on it reduces from the edge of the billet to the central area, where the cooling rates are similar at different torques. The closer to the central area, the less the influence of M-EMS on the cooling rate is. The ratio of the primary to secondary dendrite arm spacing is approximately 2.0, namely, λ1≈2λ2, and is constant irrespective of the stirring intensity and position of the billet. Original position analysis （OPA） results indicate that the center segregation of the billet is greatly improved, and the more uniform and compact solidification structure will be obtained with the increase of stirring intensity.展开更多
Objectives： This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy （PELD） in a transforaminal approach at the L4/5 and L5/S1 levels. Methods： We retrospectively reviewed the f...Objectives： This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy （PELD） in a transforaminal approach at the L4/5 and L5/S1 levels. Methods： We retrospectively reviewed the first 60 cases at the L4/5 level （Group I） and the first 60 cases at the L5/S1 level （Group II） of PELD performed by one spine surgeon. The patients were divided into subgroups A, B, and C （Group I： A cases 1-20, B cases 21-40, C cases 41-60; Group I1： A cases 1-20, B cases 21-40, C cases 41-60）. Operation time was thoroughly analyzed. Results： Compared with the L4/5 level, the learning curve of transforaminal PELD at the L5/S1 level was flatter. The mean operation times of Groups IA, IB, and IC were （88.75±17.02）, （67.75±6.16）, and （64.85±7.82） min, respectively. There was a significant difference between Groups A and B （P〈0.05）, but no significant difference between Groups B and C （P=-0.20）. The mean operation times of Groups IIA, liB, and IIC were （117.25±13.62）, （109.50±11.20）, and （92.15±11.94） rain, respectively. There was no significant difference between Groups A and B （P=0.06）, but there was a significant difference between Groups B and C （P〈0.05）. There were 6 cases of postoperative dysesthesia （POD） in Group I and 2 cases in Group IIA （P=-0.27）. There were 2 cases of residual disc in Group I, and 4 cases in Group II （P=0.67）. There were 3 cases of recurrence in Group I, and 2 cases in Group II （P〉0.05）. Conclusions： Compared with the L5/S1 level, the learning curve of PELD in a transforaminal approach at the L4/5 level was steeper, suggesting that the L4/5 level might be easier to master after short-term professional training.展开更多
AIM: to evaluate the feasibility, safety, and oncologic outcomes of laparoscopic extended right hemicolectomy (LERH) for colon cancer. METHODS: Since its establishment in 2009, the Southern Chinese Laparoscopic Colore...AIM: to evaluate the feasibility, safety, and oncologic outcomes of laparoscopic extended right hemicolectomy (LERH) for colon cancer. METHODS: Since its establishment in 2009, the Southern Chinese Laparoscopic Colorectal Surgical Study (SCLCSS) group has been dedicated to promoting patients' quality of life through minimally invasive surgery. The multicenter database was launched by combining existing datasets from members of the SCLCSS group. The study enrolled 220 consecutive patients who were recorded in the multicenter retrospective database and underwent either LERH (n = 119) or open extended right hemicolectomy (OERH) (n = 101) for colon cancer. Clinical characteristics, surgical outcomes, and oncologic outcomes were compared between the two groups. RESULTS: There were no significant differences in terms of age, gender, body mass index (BMI), history of previous abdominal surgery, tumor location, and tumor stage between the two groups. The blood loss was lower in the LERH group than in the OERH group [100 (100-200) mL vs 150 (100-200) mL, P < 0.0001]. The LERH group was associated with earlier first flatus (2.7 +/- 1.0 d vs 3.2 +/- 0.9 d, P < 0.0001) and resumption of liquid diet (3.6 +/- 1.0 d vs 4.2 +/- 1.0 d, P < 0.0001) compared to the OERH group. The postoperative hospital stay was significantly shorter in the LERH group (11.4 +/- 4.7 d vs 12.8 +/- 5.6 d, P = 0.009) than in the OERH group. The complication rate was 11.8% and 17.6% in the LERH and OERH groups, respectively (P = 0.215). Both 3-year overall survival [LERH (92.0%) vs OERH (84.4%), P = 0.209] and 3-year disease-free survival [LERH (84.6%) vs OERH (76.6%), P = 0.191] were comparable between the two groups. CONCLUSION: LERH with D3 lymphadenectomy for colon cancer is a technically feasible and safe procedure, yielding comparable short-term oncologic outcomes to those of open surgery. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.展开更多
AIM: To investigate the causes of small intestinal bleed- ing as well as its diagnosis and therapeutic approaches. METHODS: A retrospective analysis was conducted ac- cording to the clinical records of 76 patients wit...AIM: To investigate the causes of small intestinal bleed- ing as well as its diagnosis and therapeutic approaches. METHODS: A retrospective analysis was conducted ac- cording to the clinical records of 76 patients with small intestinal bleeding admitted to our hospital in the past 5 years. RESULTS: In these patients, tumor was the most fre- quent cause of small intestinal bleeding (37/76), fol- lowed by Meckel’s diverticulum (21/76), angiopathy (15/76) and ectopic pancreas (3/76). Of the 76 patients, 21 were diagnosed by digital subtraction angiography, 13 by barium and air double contrast X-ray examination of the small intestine, 11 by 99mTc-sestamibi scintigraphy of the abdominal cavity, 6 by enteroscopy of the small intestine, 21 by laparoscopic laparotomy, and 4 by ex- ploratory laparotomy. Although all the patients received surgical treatment, most of them (68/76) received part enterectomy covering the diseased segment and entero- anastomosis. The follow-up time ranged from 1 year to 5 years. No case had recurrent alimentary tract bleeding or other complications. CONCLUSION: Tumor is the major cause of small in- testinal bleeding followed by Meckel’s diverticulum and angiopathy. The main approaches to definite diagnosis of small intestinal bleeding include digital subtraction an- giography, 99mTc-sestamibi scintigraphy of the abdominal cavity, barium and air double contrast X-ray examina- tion of the small intestine, laparoscopic laparotomy or exploratory laparotomy. Part enterectomy covering the diseased segment and enteroanastomosis are the most effective treatment modalities for small intestinal bleed- ing.展开更多
In order to evaluate interstitial strengthening effect on the properties of high entropy alloy(HEA),a nitrogen-doped Cr Mn Fe VTi6 HEA was fabricated by mechanical alloying(MA)and spark plasma sintering(SPS).XRD,SEM,T...In order to evaluate interstitial strengthening effect on the properties of high entropy alloy(HEA),a nitrogen-doped Cr Mn Fe VTi6 HEA was fabricated by mechanical alloying(MA)and spark plasma sintering(SPS).XRD,SEM,TEM and FIB were used to characterize the phase composition and microstructure of this material.The sintered bulk HEA exhibits a microstructure comprising TiNx,BCC,Laves and B2 phases.The HEA exhibits high yield strength(>2729 MPa)and hardness in lower temperature range of<380℃.Quantitative calculations of the contributions from each strengthening mechanism in the BCC phase indicate that the interstitial strengthening by nitrogen is the dominant mechanism.Nitrogen additions in the BCC phase can produce a yield strength increase of-634 MPa/at.%,which is much higher than the strengthening effects of carbon or boron additions in other alloys.This demonstrates that adding nitrogen is a viable approach for enhancing the strength of HEAs.展开更多
AIM To analyze the effects of premedication with Pronase for endoscopic ultrasound(EUS) examination of the stomach.METHODS This was a prospective, randomized and controlled clinical study. All patients were randomly a...AIM To analyze the effects of premedication with Pronase for endoscopic ultrasound(EUS) examination of the stomach.METHODS This was a prospective, randomized and controlled clinical study. All patients were randomly assigned to either the Pronase group or placebo group. The pretreatment solution was a mixed solution of 20000 U of Pronase and 60 m L sodium bicarbonate solution in the Pronase group, while an equal amount of sodium bicarbonate solution was administered to the placebo group. All operators, image evaluators and experimental recorders in EUS did not participate in the preparation and allocation of pretreatment solution. Two blinded investigators assessed the obscurity scores for the EUS images according to the size of artifacts(including ultrasound images of the gastric cavity and the gastric wall). Differences in imaging quality, the duration of examination and the usage of physiological saline during the examination process between the Pronase group and the control group were compared.RESULTS No differences existed in patient demographics between the two groups. For the gastric cavity, the Pronase group had significantly lower mean obscurity scores than the placebo group(1.0476 ± 0.77 vs 1.6129 ± 0.96, respectively, P = 0.000). The mean obscurity scores for the gastric mucosal surface were significantly lower in the Pronase group than the placebo group(1.2063 ± 0.90 vs 1.7581 ± 0.84, respectively, P = 0.001). The average EUS procedure duration for the Pronase group was 11.60 ± 3.32 min, which was significantly shorter than that of the placebo group(13.13 ± 3.81 min, P = 0.007). Less saline was used in the Pronase group than the placebo group, and the difference was significant(417.94 ± 121.38 m L vs 467.42 ± 104.52 mL, respectively, P = 0.016).CONCLUSION The group that had Pronase premedication prior to the EUS examination had clearer images than the placebo group. With Pronase premedication, the examination time was shorter, and the amount of saline used during the EUS examination was less.展开更多
文摘There exist differences in the epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selections between gastric cancer patients from the Eastern and Western countries.The Chinese Society of Clinical Oncology(CSCO)has organized a panel of senior experts specializing in all sub-specialties of gastric cancer to compile a clinical guideline for the diagnosis and treatment of gastric cancer since 2016 and renews it annually.Taking into account regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted expert consensus judgment on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes in China.The 2021 CSCO Clinical Practice Guidelines for Gastric Cancer covers the diagnosis,treatment,follow-up,and screening of gastric cancer.Based on the 2020 version of the CSCO Chinese Gastric Cancer guidelines,this updated guideline integrates the results ofmajor clinical studies from China and overseas for the past year,focused on the inclusion of research data from the Chinese population for more personalized and clinically relevant recommendations.For the comprehensive treatment of non-metastatic gastric cancer,attentions were paid to neoadjuvant treatment.The value of perioperative chemotherapy is gradually becoming clearer and its recommendation level has been updated.For the comprehensive treatment of metastatic gastric cancer,recommendations for immunotherapy were included,and immune checkpoint inhibitors fromthird-line to the first-line of treatment for different patient groups with detailed notes are provided.
文摘China is one of the countries with the highest incidence of gastric cancer.There are differences in epidemiological characteristics,clinicopathological features,tumor biological characteristics,treatment patterns,and drug selection between gastric cancer patients from the Eastern and Western countries.Non-Chinese guidelines cannot specifically reflect the diagnosis and treatment characteristics for the Chinese gastric cancer patients.The Chinese Society of Clinical Oncology(CSCO)arranged for a panel of senior experts specializing in all sub-specialties of gastric cancer to compile,discuss,and revise the guidelines on the diagnosis and treatment of gastric cancer based on the findings of evidence-based medicine in China and abroad.By referring to the opinions of industry experts,taking into account of regional differences,giving full consideration to the accessibility of diagnosis and treatment resources,these experts have conducted experts’consensus judgement on relevant evidence and made various grades of recommendations for the clinical diagnosis and treatment of gastric cancer to reflect the value of cancer treatment and meeting health economic indexes.This guideline uses tables and is complemented by explanatory and descriptive notes covering the diagnosis,comprehensive treatment,and follow-up visits for gastric cancer.
基金Supported by Natural Science Foundation of Liaoning Province,No.20170541024the Shengjing Free Researcher Project Foundation,No.200812
文摘AIM To analyze the diagnostic value of a circular RNA(circR NA), circ-LDLRAD3, in pancreatic cancer.METHODS Expression levels of circ-LDLRAD3 were tested in both cells and clinical samples; the latter included 30 paired pancreatic cancer tissues and adjacent non-tumorous tissues, 31 plasma samples from patients with pancreatic cancer, and 31 plasma samples from healthy volunteers. Real-time quantitative reverse transcriptionpolymerase chain reaction(q RT-PCR) was performed to measure expression levels of circ-LDLRAD3 in cells and clinical samples; then, the relationship between clinicopathological factors of patient samples and expression of circ-LDLRAD3 in pancreatic cancer was analyzed. The diagnostic value of circ-LDLRAD3 was verified by receiver operating characteristic(ROC) curve analysis.RESULTS Circ-LDLRAD3 was up-regulated in pancreatic cancer cell lines(P < 0.01), pancreatic cancer tissues(P < 0.01), and plasma samples from patients with pancreatic cancer(P < 0.01). High expression of circLDLRAD3 was significantly associated with venous invasion, lymphatic invasion, and metastasis. The area under the ROC curve of circ-LDLRAD3 alone or combination with CA19-9 was 0.67 and 0.87, respectively, with a sensitivity and specificity of 0.5738(alone) and 0.7049(alone), and 0.8033(combination) and 0.9355(combination), respectively.CONCLUSION These data suggest that circ-LDLRAD3 may be a biomarker in the diagnosis of pancreatic cancer.
基金Supported by Major Program of Science and Technology Program of Guangzhou,No.201300000087Research Fund of Public Welfare in Health Industry of National Health and Family Planning Commission of China,No.201402015 and No.201502039+1 种基金National Key Technology R&D Program,No.2013BAI05B05Key Clinical Specialty Discipline Construction Program
文摘AIM: To evaluate the epithelial-to-mesenchymal transition(EMT) of circulating tumor cells(CTCs) in gastric cancer patients.METHODS: We detected tumor cells for expression of four epithelial(E^+) transcripts(keratins 8, 18, and 19 and epithelial cell adhesion molecule) and two mesenchymal(M^+) transcripts(Vimentin and Twist) by a quantifiable, dual-colorimetric RNA-in situ hybridization assay. Between July 2014 and October 2014, 44 patients with gastric cancer were recruited for CTC evaluation. Blood samples were obtained from selected patients during the treatment course [before surgery, after surgery and at the 6^(th) cycle of XELOX based chemotherapy(about 6 mo postoperatively)].RESULTS: We found the EMT phenomenon in which there were a few biphenotypic E^+/M^+ cells in primary human gastric cancer specimens. Of the 44 patients, the presence of CTCs was reported in 35(79.5%) patients at baseline. Five types of cells including from exclusively E^+ CTCs to intermediate CTCs and exclusively M^+ CTCs were identified(4 patients with M^+ CTCs and 10 patients with M^+ or M^+ > E^+ CTCs). Further, a chemotherapy patient having progressive disease showed a proportional increase of mesenchymal CTCs in the post-treatment blood specimens. We used NCI-N87 cells to analyze the linearity and sensitivity of Can Patrol^(TM) system and the correlation coefficient(R^2) was 0.999.CONCLUSION: The findings suggest that the EMT phenomenon was both in a few cells of primary tumors and abundantly in CTCs from the blood of gastric cancer patients, which might be used to monitor therapy response.
基金This work was supported by grants from the Health Bureau of Zhejiang Province (No. 2004A075) and the Scientific Bureau of Hangzhou, Zhejiang Province (No. 2004433Q06).
文摘Background Rupture of unstable plaque with subsequent thrombus formation is the common pathophysiological substrate of the acute coronary syndrome （ACS）. It is of potential significance to explore the blood indexes predicting plaque characteristics. Little studies have focused on this field. Therefore we investigated the relationship between hypersensitive C-reactive protein （hs-CRP）, pro-matrix metalloproteinase-1 （proMMP-1）, tissue inhibitors of matrix metalloproteinase-1 （TIMP-1） and coronary plaque morphology. Methods Intravascular ultrasound （IVUS） examination was done in 152 patients with confirmed coronary heart disease before percutaneous coronary intervention from February 2003 to July 2005. Plasma samples of arterial blood were collected prior to the procedure. The level of hs-CRP, proMMP-1 and TIMP-1 were respectively measured by enzyme-linked immunosorbent assay （ELISA）. Results Unstable and ruptured plaque were found more frequently in patients with acute myocardial infarction and unstable angina. External elastic membrane cross-sectional area （EEM CSA）, plaque area, lipid pool area and plaque burden were significantly larger in ruptured and unstable plaque group. Positive remolding, thinner fabric-cap, smaller minimal lumen cross-sectional area （MLA）, dissection and thrombus were significantly more frequent in ruptured and unstable plaque group. The levels of plasma hs-CRP, proMMP-1 and TIMP-1 were higher in ruptured plaque group, hs-CRP〉8.94 mg/L was used to predict ruptured plaque with a ROC curve area of 0.76 [95% confidence interval （CI）, 67.0%-85.8%], sensitivity of 71.8%, specificity of 77.0% and accuracy of 69.2% （P〈0.01）, similarly for proMMP-1〉0.12 ng/ml with a ROC curve area of 0.69 [95% CI, 58.2%- 80.2%], sensitivity of 69.2%, specificity of 75.2% and accuracy of 66.2% （P〈0.01）, and TIMP-1〉83.45 ng/ml with a ROC curve area of 0.67 [95% CI, 56.2%-78.3%], sensitivity of 66.7%, specificity of 61.9% and accuracy of 66.2% （P〈0.01）. Co
基金Supported by the Guangdong Provincial Natural Science Foundation,No.2016A030313843
文摘Gastric cancer(GC), with its high incidence and mortality rates, is a highly fatal cancer that is common in East Asia particularly in China. Its recurrence and metastasis are the main causes of its poor prognosis. Circulating tumor cells(CTCs) or other blood biomarkers that are released into the circulating blood stream by tumors are thought to play a crucial role in the recurrence and metastasis of gastric cancer. Therefore, the detection of CTCs and other blood biomarkers has an important clinical significance; in fact, they can help predict the prognosis, assess the staging, monitor the therapeutic effects and determine the drug susceptibility. Recent research has identified many blood biomarkers in GC, such as various serum proteins, autoantibodies against tumor associated antigens, and cell-free DNAs. The analysis of CTCs and circulating cell-free tumor DNA(ctDNA) in the peripheral blood of patients with gastric cancer is called as liquid biopsy. These blood biomarkers provide the disease status for individuals and have clinical meaning. In this review, we focus on the recent scientific advances regarding CTCs and other blood biomarkers, and discuss their origins and clinical meaning.
文摘The 2023 update of the Chinese Society of Clinical Oncology(CSCO)Clini-cal Guidelines for Gastric Cancer focuses on standardizing cancer diagnosis and treatment in China,reflecting the latest advancements in evidence-based medicine,healthcare resource availability,and precision medicine.These updates address the differences in epidemiological characteristics,clinicopatho-logical features,tumor biology,treatment patterns,and drug selections between Eastern and Western gastric cancer patients.Key revisions include a structured template for imaging diagnosis reports,updated standards for molecular marker testing in pathological diagnosis,and an elevated recommendation for neoadju-vant chemotherapy in stage III gastric cancer.For advanced metastatic gastric cancer,the guidelines introduce new recommendations for immunotherapy,anti-angiogenic therapy and targeted drugs,along with updated management strategies for human epidermal growth factor receptor 2(HER2)-positive and deficient DNA mismatch repair(dMMR)/microsatellite instability-high(MSI-H)patients.Additionally,the guidelines offer detailed screening recommendations for hereditary gastric cancer and an appendix listing drug treatment regimens for various stages of gastric cancer.The 2023 CSCO Clinical Guidelines for Gastric Cancer updates are based on both Chinese and international clinical research and expert consensus to enhance their applicability and relevance in clinical practice,particularly in the heterogeneous healthcare landscape of China,while maintaining a commitment to scientific rigor,impartiality,and timely revisions.
基金funded by the Project of the 973 Program(2010CB125904)the 948 Program (2011-G2B)+1 种基金the National Natural Science Foundation of China(31171521)the National Key Technology R&D Program of China (2009BADA2B01)
文摘Grain number per-panicle is one of the most important components for rice yield. Spikelets on the primary and secondary branches determine the grain number per-panicle in rice. In this study, we identified a natural mutant, gnp4, lack of lateral spikelet on the secondary branches in the field condition. In addition, the Gnp4 and Lax1-1 double mutant showed dramatically reduced secondary branches and spikelets in panicle at reproductive stage, and tillers at vegetative stage. By map-based cloning approach, and using four F2 segregating populations, the Gnp4 gene was finally mapped to a 10.7-kb region on the long arm of chromosome 4 in rice. In this region, only one gene was predicted, and genomic DNA sequencing of the 10.7-kb region showed no nucleotide differences between the mutant and wild type. Interestingly, we found that the methylation level of several cytosines in the promoter CpG islands region of the predicted gene in gnp4 were different from the wild type. Thus, we propose that the DNA methylation changes at these sites may induce to decrease expression level of Gnp4, consequently, resulting in phenotypic variation.
文摘AIM To determine the feasibility,safety,and oncological outcome of laparoscopic resection of gastric gastrointestinal stromal tumors(GISTs)based on favorable or unfavorable location.METHODS Our hospital database included 207 patients who underwent laparoscopic removal of gastric GISTs from January 2004 to September 2015.Patient demographics,clinical presentation,surgery,histopathology,postoperative course,and oncological outcomes were reviewed and analyzed.RESULTS Gastric GIST in favorable locations was present in81/207(39.1%)cases,and in unfavorable locations in 126/207(60.9%)cases.Overall mean tumor size was 3.28±1.82 cm.No conversions occurred,and complete R0 resection was achieved in 207(100%)cases.There were three incidences of iatrogenic tumor rupture.The feasibility and safety of laparoscopic surgery were comparable in both groups with no statistical difference between unfavorable and favorable location groups,respectively:for operative time:83.86±44.41 vs 80.77±36.46 min,P=0.627;conversion rate:0%vs 0%;estimated blood loss:27.74±45.2vs 29.59±41.18 m L,P=0.780;tumor rupture during surgery:0.90%vs 2.82%,P=0.322;or postoperative complications:3.74%vs 7.04%,P=0.325.The follow-up period recurrence rate was 1.89%with no significant differences between the two groups(3.03%vs 0%,P=0.447).Overall 5-year survival rate was98.76%and survival rates were similar between the two groups:98.99%vs 98.39%,P=0.623(unfavorable vs favorable,respectively).CONCLUSION The laparoscopic approach for gastric GISTs is safe and feasible with well-accepted oncological surgical outcomes.Strategies for laparoscopic resection should be selected according to the location and size of the tumor.Laparoscopic treatment of gastric GISTs in unfavorable locations should not be restricted in gastrointestinal centers.
基金Supported by Guangdong Provincial Science and Technology Key Projectthe National Key Technology R and D Program+8 种基金No.2013BAI05B00the Major Program of Science and Technology Program of GuangzhouNo.201300000087research Fund of Public Welfare in Health IndustryHealth Ministry of ChinaNo.201402015Research Fund of Public Welfare in Health IndustryNo.201502039Key Clinical Specialty Discipline Construction Program
文摘AIM To evaluate the clinical value of staging laparoscopyin treatment decision-making for advancedgastric cancer （GC）.METHODS： Clinical data of 582 patients with advancedGC were retrospectively analyzed. All patientsunderwent staging laparoscopy. The strength ofagreement between computed tomography （CT） stage,endoscopic ultrasound （EUS） stage, laparoscopic stage,and final stage were determined by weighted Kappastatistic （Kw）. The number of patients with treatmentdecision-changes was counted. A χ 2 test was used toanalyze the correlation between peritoneal metastasisor positive cytology and clinical characteristics.RESULTS： Among the 582 patients, the distributions ofpathological T classifications were T2/3 （153, 26.3%）,T4a （262, 45.0%）, and T4b （167, 28.7%）. Treatmentplans for 211 （36.3%） patients were changed after staging laparoscopy was performed. Two （10.5%） of19 patients in M1 regained the opportunity for potentialradical resection by staging laparoscopy. Unnecessarylaparotomy was avoided in 71 （12.2%） patients. Thestrength of agreement between preoperative T stageand final T stage was in almost perfect agreement （Kw= 0.838; 95% confidence interval （CI）： 0.803-0.872;P 〈 0.05） for staging laparoscopy; compared with CTand EUS, which was in fair agreement. The strengthof agreement between preoperative M stage andfinal M stage was in almost perfect agreement （Kw= 0.990; 95% CI： 0.977-1.000; P 〈 0.05） for staginglaparoscopy; compared with CT, which was in slightagreement. Multivariate analysis revealed that tumorsize （≥ 40 mm）, depth of tumor invasion （T4b）, andBorrmann type （Ⅲ or Ⅳ） were significantly correlatedwith either peritoneal metastasis or positive cytology.The best performance in diagnosing P-positive wasobtained when two or three risk factors existed.CONCLUSION： Staging laparoscopy can improvetreatment decision-making for advanced GC anddecrease unnecessary exploratory laparotomy.
基金Supported by The National High Technology Research and Development Program of China (863 Program) issued by the Ministry of Science and Technology of China,No. 2012AA021103the Ministry of Health of China,No. W2011WAI44
文摘AIM:To investigate the feasibility and optimal approach for laparoscopic pancreasand spleen-preserving splenic hilum lymph node dissection in advanced proximal gastric cancer.METHODS:Between August 2009 and August 2012,12 patients with advanced proximal gastric cancer treated in Nanfang Hospital,Southern Medical University,Guangzhou,China were enrolled and subsequently underwent laparoscopic total gastrectomy with pancreasand spleen-preserving splenic hilum lymph node(LN)dissection.The clinicopathological characteristics,surgical outcomes,postoperative course and followup data of these patients were retrospectively collected and analyzed in the study.RESULTS:Based on our anatomical understanding of peripancreatic structures,we combined the characteristics of laparoscopic surgery and developed a modified approach(combined supraand infra-pancreatic approaches)for laparoscopic pancreasand spleenpreserving splenic hilum LN dissection.Surgery was completed in all 12 patients laparoscopically without conversion.Only one patient experienced intraoperative bleeding when dissecting LNs along the splenic artery and was handled with laparoscopic hemostasis.The mean operating time was 268.4 min and mean number of retrieved splenic hilum LNs was 4.8.One patient had splenic hilum LN metastasis(8.3%).Neither postoperative morbidity nor mortality was observed.Peritoneal metastasis occurred in one patient and none of the other patients died or experienced recurrent disease during the follow-up period.CONCLUSION:Laparoscopic total gastrectomy with pancreasand spleen-preserving splenic hilum LN dissection using the modified approach for advanced proximal gastric cancer could be safely achieved.
基金Supported by National Key Clinical Specialty Construction Project of China,the National High Technology Research and Development Program of China No.2012AA021103the Research Fund of Public Welfare in Health Industry,National Health and Family Planning Commission of China,No.201502039
文摘AIM: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages Ⅱ and Ⅲ rectal cancer.METHODS:This study enrolled 406 consecutive patients who underwent curative resection for stagesⅡandⅢrectal cancer between January 2000 and December 2009[laparoscopic rectal resection(LRR),n=152;open rectal resection(ORR),n=254].Clinical characteristics,operative outcomes,pathological outcomes,postoperative recovery,and 5-year survival outcomes were compared between the two groups.RESULTS:Most of the clinical characteristics were similar except age(59 years vs 55 years,P=0.033)between the LRR group and ORR group.The proportion of anterior resection was higher in the LRR group than that in the ORR group(81.6%vs 66.1%,P=0.001).The LRR group had less estimated blood loss(50m L vs 200 m L,P<0.001)and a lower rate of blood transfusion(4.6%vs 11.8%,P=0.019)compared to the ORR group.The pathological outcomes of the two groups were comparable.The LRR group was associated with faster recovery of bowel function(2.8 d vs 3.7 d,P<0.001)and shorter postoperative hospital stay(11.7 d vs 13.7 d,P<0.001).The median followup time was 63 mo in the LRR group and 65 mo in the ORR group.As for the survival outcomes,the 5-year local recurrence rate(16.0%vs 16.4%,P=0.753),5-year disease-free survival(DFS)rate(63.0%vs63.1%,P=0.589),and 5-year overall survival(OS)rate(68.1%vs 63.5%,P=0.682)were comparable between the LRR group and the ORR group.Stageby stage,there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate(stageⅡ:6.3%vs 8.7%,P=0.623;stageⅢ:26.4%vs 23.2%,P=0.747),5-year DFS rate(stageⅡ:77.5%vs 77.6%,P=0.462;stageⅢ:46.5%vs 50.9%,P=0.738),and5-year OS rate(stageⅡ:81.4%vs 74.3%,P=0.242;stageⅢ:53.9%vs 54.1%,P=0.459).CONCLUSION:LRR for stagesⅡandⅢrectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.
基金Supported by National Natural Science Foundation of China,No.81101896
文摘AIM:To investigate the regulative effect of miRNA-3383p(miR-338-3p) on cell growth in colorectal carcinoma(CRC).METHODS:The lentiviral vector pLV-THM-miR-338-3p and pLV-THM-miR-338-3p-inhibitor were constructed.The recombinant viral vector encoding the pre-miR338-3p or miR-338-3p-inhibitor and the two packaging plasmids psPAX2 and pMD2.G were cotransfected into human embryonic kidney 293T cells to package lentivirus.The supernatant containing the lentivirus particles was harvested to determine the viral titer,and this supernatant was then used to transduce CRCderived cell line,SW-620.Flow cytometry was utilized for sorting the green fluorescent protein(GFP) + cells to establish the SW-620 cell line stably expressing premiR-338-3p or miR-338-3p-inhibitor.Moreover,the expression of miR-338-3p was determined by real-time reverse transcriptase polymerase chain reaction,andWestern blotting was used to detect the expression of the smoothened(SMO,the possible target of miR-3383p) protein in SW-620 cells.Furthermore,the status of CRC cell proliferation and apoptosis were detected by 3-(4,5-dimethyl-2 thiazoyl)-2,5-diphenyl-2H-tetrazolium bromide assay and flow cytometry,respectively.RESULTS:Restriction enzyme digestion and DNA sequencing demonstrated that the lentiviral vector pLVTHM-miR-338-3p and pLV-THM-miR-338-3p-inhibitor were constructed successfully.GFP was expressed after the SW-620 cells were transduced by the lentivirus.Expression of miR-338-3p in SW-620 cells transduced with the lentivirus pLV-THM-miR-338-3p was significantly increased(relative expression 3.91 ± 0.51 vs 2.36 ± 0.44,P < 0.01).Furthermore,overexpression of miR-338-3p inhibited the expression of SMO protein in SW-620 cells,which showed obviously suppressed proliferation ability [cellular proliferation inhibition rate(CPIR) 61.9% ± 5.2% vs 41.6% ± 4.8%,P < 0.01].Expression of miR-338-3p in SW-620 cells transduced with the lentivirus pLV-THM-miR-338-3p-inhibitor was significantly decreased(relative expression 0.92 ± 0.29 vs 2.36 ± 0.44,P < 0.
文摘Effects of mold electromagnetic stirring （M-EMS） on the solidification structure of 45# steel billet were investigated by examination of interdendritic corrosion. The results show that the primary and secondary dendrite arm spacings increase from the edge of the billet to the center and decrease obviously with increasing electromagnetic torque, which will be beneficial to refine the solidification structure and enlarge the equiaxed crystal zone. The ratio of equiaxed crystal increases by 15.9% with the electromagnetic torque increasing from 230 to 400 cN·cm. The increase of stirring intensity can improve the cooling rate and the impact of M-EMS on it reduces from the edge of the billet to the central area, where the cooling rates are similar at different torques. The closer to the central area, the less the influence of M-EMS on the cooling rate is. The ratio of the primary to secondary dendrite arm spacing is approximately 2.0, namely, λ1≈2λ2, and is constant irrespective of the stirring intensity and position of the billet. Original position analysis （OPA） results indicate that the center segregation of the billet is greatly improved, and the more uniform and compact solidification structure will be obtained with the increase of stirring intensity.
文摘Objectives： This study aimed to compare the learning curves of percutaneous endoscopic lumbar discectomy （PELD） in a transforaminal approach at the L4/5 and L5/S1 levels. Methods： We retrospectively reviewed the first 60 cases at the L4/5 level （Group I） and the first 60 cases at the L5/S1 level （Group II） of PELD performed by one spine surgeon. The patients were divided into subgroups A, B, and C （Group I： A cases 1-20, B cases 21-40, C cases 41-60; Group I1： A cases 1-20, B cases 21-40, C cases 41-60）. Operation time was thoroughly analyzed. Results： Compared with the L4/5 level, the learning curve of transforaminal PELD at the L5/S1 level was flatter. The mean operation times of Groups IA, IB, and IC were （88.75±17.02）, （67.75±6.16）, and （64.85±7.82） min, respectively. There was a significant difference between Groups A and B （P〈0.05）, but no significant difference between Groups B and C （P=-0.20）. The mean operation times of Groups IIA, liB, and IIC were （117.25±13.62）, （109.50±11.20）, and （92.15±11.94） rain, respectively. There was no significant difference between Groups A and B （P=0.06）, but there was a significant difference between Groups B and C （P〈0.05）. There were 6 cases of postoperative dysesthesia （POD） in Group I and 2 cases in Group IIA （P=-0.27）. There were 2 cases of residual disc in Group I, and 4 cases in Group II （P=0.67）. There were 3 cases of recurrence in Group I, and 2 cases in Group II （P〉0.05）. Conclusions： Compared with the L5/S1 level, the learning curve of PELD in a transforaminal approach at the L4/5 level was steeper, suggesting that the L4/5 level might be easier to master after short-term professional training.
基金Supported by National High Technology Research and Development Program of China,No.2012AA021103the Program of Guangdong Provincial Department of Science and Technology,No.2012A030400012+1 种基金the Major Program of Science and Technology Program of Guangzhou,No.201300000087the Sub-project under National Science and Technology Support Program,No.2013BAI05B00
文摘AIM: to evaluate the feasibility, safety, and oncologic outcomes of laparoscopic extended right hemicolectomy (LERH) for colon cancer. METHODS: Since its establishment in 2009, the Southern Chinese Laparoscopic Colorectal Surgical Study (SCLCSS) group has been dedicated to promoting patients' quality of life through minimally invasive surgery. The multicenter database was launched by combining existing datasets from members of the SCLCSS group. The study enrolled 220 consecutive patients who were recorded in the multicenter retrospective database and underwent either LERH (n = 119) or open extended right hemicolectomy (OERH) (n = 101) for colon cancer. Clinical characteristics, surgical outcomes, and oncologic outcomes were compared between the two groups. RESULTS: There were no significant differences in terms of age, gender, body mass index (BMI), history of previous abdominal surgery, tumor location, and tumor stage between the two groups. The blood loss was lower in the LERH group than in the OERH group [100 (100-200) mL vs 150 (100-200) mL, P < 0.0001]. The LERH group was associated with earlier first flatus (2.7 +/- 1.0 d vs 3.2 +/- 0.9 d, P < 0.0001) and resumption of liquid diet (3.6 +/- 1.0 d vs 4.2 +/- 1.0 d, P < 0.0001) compared to the OERH group. The postoperative hospital stay was significantly shorter in the LERH group (11.4 +/- 4.7 d vs 12.8 +/- 5.6 d, P = 0.009) than in the OERH group. The complication rate was 11.8% and 17.6% in the LERH and OERH groups, respectively (P = 0.215). Both 3-year overall survival [LERH (92.0%) vs OERH (84.4%), P = 0.209] and 3-year disease-free survival [LERH (84.6%) vs OERH (76.6%), P = 0.191] were comparable between the two groups. CONCLUSION: LERH with D3 lymphadenectomy for colon cancer is a technically feasible and safe procedure, yielding comparable short-term oncologic outcomes to those of open surgery. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.
文摘AIM: To investigate the causes of small intestinal bleed- ing as well as its diagnosis and therapeutic approaches. METHODS: A retrospective analysis was conducted ac- cording to the clinical records of 76 patients with small intestinal bleeding admitted to our hospital in the past 5 years. RESULTS: In these patients, tumor was the most fre- quent cause of small intestinal bleeding (37/76), fol- lowed by Meckel’s diverticulum (21/76), angiopathy (15/76) and ectopic pancreas (3/76). Of the 76 patients, 21 were diagnosed by digital subtraction angiography, 13 by barium and air double contrast X-ray examination of the small intestine, 11 by 99mTc-sestamibi scintigraphy of the abdominal cavity, 6 by enteroscopy of the small intestine, 21 by laparoscopic laparotomy, and 4 by ex- ploratory laparotomy. Although all the patients received surgical treatment, most of them (68/76) received part enterectomy covering the diseased segment and entero- anastomosis. The follow-up time ranged from 1 year to 5 years. No case had recurrent alimentary tract bleeding or other complications. CONCLUSION: Tumor is the major cause of small in- testinal bleeding followed by Meckel’s diverticulum and angiopathy. The main approaches to definite diagnosis of small intestinal bleeding include digital subtraction an- giography, 99mTc-sestamibi scintigraphy of the abdominal cavity, barium and air double contrast X-ray examina- tion of the small intestine, laparoscopic laparotomy or exploratory laparotomy. Part enterectomy covering the diseased segment and enteroanastomosis are the most effective treatment modalities for small intestinal bleed- ing.
文摘In order to evaluate interstitial strengthening effect on the properties of high entropy alloy(HEA),a nitrogen-doped Cr Mn Fe VTi6 HEA was fabricated by mechanical alloying(MA)and spark plasma sintering(SPS).XRD,SEM,TEM and FIB were used to characterize the phase composition and microstructure of this material.The sintered bulk HEA exhibits a microstructure comprising TiNx,BCC,Laves and B2 phases.The HEA exhibits high yield strength(>2729 MPa)and hardness in lower temperature range of<380℃.Quantitative calculations of the contributions from each strengthening mechanism in the BCC phase indicate that the interstitial strengthening by nitrogen is the dominant mechanism.Nitrogen additions in the BCC phase can produce a yield strength increase of-634 MPa/at.%,which is much higher than the strengthening effects of carbon or boron additions in other alloys.This demonstrates that adding nitrogen is a viable approach for enhancing the strength of HEAs.
基金Supported by the National Natural Science Foundation of China,No.81470908
文摘AIM To analyze the effects of premedication with Pronase for endoscopic ultrasound(EUS) examination of the stomach.METHODS This was a prospective, randomized and controlled clinical study. All patients were randomly assigned to either the Pronase group or placebo group. The pretreatment solution was a mixed solution of 20000 U of Pronase and 60 m L sodium bicarbonate solution in the Pronase group, while an equal amount of sodium bicarbonate solution was administered to the placebo group. All operators, image evaluators and experimental recorders in EUS did not participate in the preparation and allocation of pretreatment solution. Two blinded investigators assessed the obscurity scores for the EUS images according to the size of artifacts(including ultrasound images of the gastric cavity and the gastric wall). Differences in imaging quality, the duration of examination and the usage of physiological saline during the examination process between the Pronase group and the control group were compared.RESULTS No differences existed in patient demographics between the two groups. For the gastric cavity, the Pronase group had significantly lower mean obscurity scores than the placebo group(1.0476 ± 0.77 vs 1.6129 ± 0.96, respectively, P = 0.000). The mean obscurity scores for the gastric mucosal surface were significantly lower in the Pronase group than the placebo group(1.2063 ± 0.90 vs 1.7581 ± 0.84, respectively, P = 0.001). The average EUS procedure duration for the Pronase group was 11.60 ± 3.32 min, which was significantly shorter than that of the placebo group(13.13 ± 3.81 min, P = 0.007). Less saline was used in the Pronase group than the placebo group, and the difference was significant(417.94 ± 121.38 m L vs 467.42 ± 104.52 mL, respectively, P = 0.016).CONCLUSION The group that had Pronase premedication prior to the EUS examination had clearer images than the placebo group. With Pronase premedication, the examination time was shorter, and the amount of saline used during the EUS examination was less.
