AIM: To investigate the clinical values of serum free insulin-like growth factor Ⅱ (IGF-Ⅱ) levels and IGF-Ⅱ mRNA in hepatocellular carcinoma (HCC) tissues and peripheral blood for diagnosis of HCC and monitoring of...AIM: To investigate the clinical values of serum free insulin-like growth factor Ⅱ (IGF-Ⅱ) levels and IGF-Ⅱ mRNA in hepatocellular carcinoma (HCC) tissues and peripheral blood for diagnosis of HCC and monitoring of extrahepatic metastasis.METHODS: Total RNAs were extracted from HCC tissues or peripheral blood mononuclear cells from patients with HCC, liver diseases devoid of cancer, non-hepatic tumors,and healthy controls, respectively. IGF-Ⅱ cDNAs were synthesized through random primers and reversetranscriptase, amplified by polymerase chain reaction (PCR), and confirmed by DNA sequencing analysis. Serum free IGF-Ⅱ levels in patients with different liver diseases were analyzed by an enzyme-linked immunosorbent assay.RESULTS: The amplified fragments of IGF-Ⅱ mRNA by RT-PCR were identical to originally designed ones with a size of 170 bp and confirmed by sequencing analysis.The dilution experiments revealed that the lowest sensitivity of our system was 2 ng/L of total RNA. The positive frequencies of IGF-Ⅱ mRNA were 100% in HCC tissues,53.3% in para-cancerous tissues, and 0% in non-cancerous tissues, respectively. The serum free IGF-Ⅱ levels were significantly higher in HCC than those in chronic hepatitis or liver cirrhosis. The positive frequency of circulating IGF-Ⅱ mRNA was 34.2% in HCC, no amplified fragment was found in other liver diseases, extrahepatic tumors,and normal controls, respectively. The circulating IGF-Ⅱ mRNA correlated with the stage of HCC, and its positive rate was 100% in HCC with extrahepatic metastasis and 35.5% in HCC with AFP-negative. No significant correlation was found between tumor sizes and circulating IGF-Ⅱ mRNA fragment.CONCLUSION: The abnormal expressions of free IGF-Ⅱ and IGF-Ⅱ mRNA are useful tumor markers for HCC diagnosis, differentiation of extrahepatic metastasis and monitoring postoperative recurrence.展开更多
AIM: To investigate the potential impact of complications in gastric cancer patients who survive the initial postoperative period. METHODS: Between January 1, 2005 and December 31, 2006, 432 patients who received cura...AIM: To investigate the potential impact of complications in gastric cancer patients who survive the initial postoperative period. METHODS: Between January 1, 2005 and December 31, 2006, 432 patients who received curative gastrectomy with D2 lymph node dissection for gastric cancer at our department were studied. Associations between clinicopathological factors [age, sex, American Society of Anesthesiologists grade, body mass index, tumornode-metastases (TNM) stage and tumor grade], including postoperative complications (defined as any deviation from an uneventful postoperative course within 30 d of the operation and survival rates) and treatment-specific factors (blood transfusion, neoadjuvant therapy and duration of surgery). Patients were divided into 2 groups: with (n = 54) or without (n = 378) complications. Survival curves were compared between the groups, and univariate and multivariate models were conducted to identify independent prognostic factors. RESULTS: Among the 432 patients evaluated, 61 com-plications occurred affecting 54 patients (12.50%).Complications included anastomotic leakages, gastric motility disorders, anastomotic block, wound infections, intra-abdominal abscesses, infectious diarrhea, bleeding, bowel obstructions, arrhythmias, angina pectoris, pneumonia, atelectasis, thrombosis, unexplained fever, delirium, ocular fungal infection and multiple organ failure. American Society of Anesthesiologists grade, body mass index, combined organ resection and median duration of operation were associated with higher post-operative complications. The 1-, 3- and 5-year survival rates were 83.3%, 53.2% and 37.5%, respectively. In the univariate analysis, the size of lesions, TNM stage, blood transfusion, lymphovascular invasion, perineural invasion, neoadjuvant chemotherapy, and postoperative complications were significant predictors of overall survival. In the multivariate analysis, only TNM stage and the presence of complications remained significant predictors of reduced survival. CONCLUSION: The o展开更多
AIM:To evaluate the fast-track rehabilitation protocol and laparoscopic surgery(LFT)vs conventional care strategies and laparoscopic surgery(LCC).METHODS:Studies and relevant literature comparing the effects of LFT an...AIM:To evaluate the fast-track rehabilitation protocol and laparoscopic surgery(LFT)vs conventional care strategies and laparoscopic surgery(LCC).METHODS:Studies and relevant literature comparing the effects of LFT and LCC for colorectal malignancy were identified in MEDLINE,the Cochrane Central Register of Controlled Trials and EMBASE.The complications and re-admission after approximately 1 mo were assessed.RESULTS:Six recent randomized controlled trials(RCTs)were included in this meta-analysis,which related to 655 enrolled patients.These studies demonstrated that compared with LCC,LFT has fewer complications and a similar incidence of re-admission after approximately 1 mo.LFT had a pooled RR of 0.60(95%CI:0.46-0.79,P<0.001)compared with a pooled RR of 0.69(95%CI:0.34-1.40,P>0.5)for LCC.CONCLUSION:LFT for colorectal malignancy is safe and efficacious.Larger prospective RCTs should be conducted to further compare the efficacy and safety of this approach.展开更多
Background Sepsis is a leading cause of death in the intensive care units. The late inflammatory cytokine, high-mobility group box 1 （HMGB1）, plays a critical role in sepsis. In the present study, we investigated th...Background Sepsis is a leading cause of death in the intensive care units. The late inflammatory cytokine, high-mobility group box 1 （HMGB1）, plays a critical role in sepsis. In the present study, we investigated the association between the serum HMGB1 levels and the severity of organ injury in the lipopolysaccharide-induced sepsis in rats. Methods To produce an animal model of sepsis with different degree of organ injury, animals were treated with three different doses of lipopolysaccharide （4, 8 and 16 mg/kg）, and the animals in control group were treated with the same volume of the vehicle （saline）. The levels of serum HMGB1 were measured at 0, 2, 4, 8, 16, 24, 32 and 48 hours after lipopolysaccharide （LPS） or vehicle injection, meanwhile the biochemical and histopathological indicators for the severity of organ injury were assessed. Results The level of HMGB1 had a positive, high correlation with the abnormal changes of serum cardiac troponin I, alanine aminotransferase, aspartate aminotransferase, creatinine and blood urea nitrogen, as well as the pathologic scores of heart, lung, liver and kidney. Conclusions The level of serum HMGB1 is highly correlated with the severity of sepsis in rats, suggesting that HMGB1 could serve as a valuable adjunct in the diagnosis and management of sepsis.展开更多
AIM: To compare single incision laparoscopic surgery for an appendectomy (SILS-A) with conventional laparoscopic appendectomy (C-LA) when implemented by experienced surgeons. METHODS: Studies and relevant literature r...AIM: To compare single incision laparoscopic surgery for an appendectomy (SILS-A) with conventional laparoscopic appendectomy (C-LA) when implemented by experienced surgeons. METHODS: Studies and relevant literature regarding the performance of single-incision laparoscopic surgery vs conventional laparoscopic surgery for appendectomy were searched for in the Cochrane Central Register of Controlled Clinical Trials, MEDLINE, EMBASE and World Health Organization international trial register. The operation time (OR time), complications, wound infection and postoperative day using SILS-A or C-LAwere pooled and compared using a meta-analysis. The risk ratios and mean differences were calculated with 95%CIs to evaluate the effect of SILS-A. RESULTS: Sixteen recent studies including 1624 patients were included in this meta-analysis. These studies demonstrated that, compared with C-LA, SILS-A has a similar OR time in adults but needs a longer OR time in children. SILS-A has similar complications, wound infection and length of the postoperative day in adults and children, and required similar doses of narcotics in children, the pooled mean different of -0.14 [95%CI: -2.73-(-2.45), P > 0.05], the pooled mean different of 11.47 (95%CI: 10.84-12.09, P < 0.001), a pooled RR of 1.15 (95%CI: 0.72-1.83, P > 0.05), a pooled RR of 1.9 (95%CI: 0.92-3.91, P > 0.05), a pooled RR of 1.01 (95%CI: 0.51-2.0, P > 0.05) a pooled RR of 1.86 (95%CI: 0.77-4.48, P > 0.05), the pooled mean different of -0.25 (95%CI: -0.50-0, P = 0.05) the pooled mean different of -0.01 (95%CI: -0.05-0.04, P > 0.05) the pooled mean different of -0.13 (95%CI: -0.49-0.23, P > 0.05) respectively. CONCLUSION: SILS-A is a technically feasible and reliable approach with short-term results similar to those obtained with the C-LA procedure.展开更多
Sarcomatoid carcinoma of the pancreas(SCP)is a very rare pathological type of carcinoma that usually has a poor prognosis.Its pathogenesis has not been elucidated.We herein report a case of an early-stage SCP involvin...Sarcomatoid carcinoma of the pancreas(SCP)is a very rare pathological type of carcinoma that usually has a poor prognosis.Its pathogenesis has not been elucidated.We herein report a case of an early-stage SCP involving successful treatment and a good prognosis.The patient was a 48-year-old Chinese man with a5-mo history of vague abdominal pain.Ultrasonography revealed a 93 mm×94 mm×75 mm mass of mixed echogenicity in the tail of the pancreas.Laboratory test results were within the normal range,with the exception of an obviously increased pretreatment neuron-specific enolase level.The plasma transforming growth factor(TGF)β1 and interleukin-11 levels were obviously increased according to enzyme-linked immunosorbent assay.Microscopically,the excised tumor tissue comprised cancer cells and mesenchymal cells.Immunohistochemical analysis was positive forα-1-antichymotrypsin,pan-cytokeratin,cytokeratin 19,cytokeratin 8/18,and vimentin and negative for CD68and lysozyme.The pathogenetic mechanism of this case shows that TGFβ1 may regulate the epithelial-tomesenchymal transition in SCP.With early eradication of the tumor and systemic therapy,this patient has been alive for more than 3 years without tumor recurrence or distant metastasis.This case is also the first to show that TGFβ1 may regulate the epithelial-tomesenchymal transition in early-stage SCP.展开更多
基金Supported by a grants-in-aid from the Key Project of Medical Science from Jiangsu Province, China, No. RC2003100
文摘AIM: To investigate the clinical values of serum free insulin-like growth factor Ⅱ (IGF-Ⅱ) levels and IGF-Ⅱ mRNA in hepatocellular carcinoma (HCC) tissues and peripheral blood for diagnosis of HCC and monitoring of extrahepatic metastasis.METHODS: Total RNAs were extracted from HCC tissues or peripheral blood mononuclear cells from patients with HCC, liver diseases devoid of cancer, non-hepatic tumors,and healthy controls, respectively. IGF-Ⅱ cDNAs were synthesized through random primers and reversetranscriptase, amplified by polymerase chain reaction (PCR), and confirmed by DNA sequencing analysis. Serum free IGF-Ⅱ levels in patients with different liver diseases were analyzed by an enzyme-linked immunosorbent assay.RESULTS: The amplified fragments of IGF-Ⅱ mRNA by RT-PCR were identical to originally designed ones with a size of 170 bp and confirmed by sequencing analysis.The dilution experiments revealed that the lowest sensitivity of our system was 2 ng/L of total RNA. The positive frequencies of IGF-Ⅱ mRNA were 100% in HCC tissues,53.3% in para-cancerous tissues, and 0% in non-cancerous tissues, respectively. The serum free IGF-Ⅱ levels were significantly higher in HCC than those in chronic hepatitis or liver cirrhosis. The positive frequency of circulating IGF-Ⅱ mRNA was 34.2% in HCC, no amplified fragment was found in other liver diseases, extrahepatic tumors,and normal controls, respectively. The circulating IGF-Ⅱ mRNA correlated with the stage of HCC, and its positive rate was 100% in HCC with extrahepatic metastasis and 35.5% in HCC with AFP-negative. No significant correlation was found between tumor sizes and circulating IGF-Ⅱ mRNA fragment.CONCLUSION: The abnormal expressions of free IGF-Ⅱ and IGF-Ⅱ mRNA are useful tumor markers for HCC diagnosis, differentiation of extrahepatic metastasis and monitoring postoperative recurrence.
文摘AIM: To investigate the potential impact of complications in gastric cancer patients who survive the initial postoperative period. METHODS: Between January 1, 2005 and December 31, 2006, 432 patients who received curative gastrectomy with D2 lymph node dissection for gastric cancer at our department were studied. Associations between clinicopathological factors [age, sex, American Society of Anesthesiologists grade, body mass index, tumornode-metastases (TNM) stage and tumor grade], including postoperative complications (defined as any deviation from an uneventful postoperative course within 30 d of the operation and survival rates) and treatment-specific factors (blood transfusion, neoadjuvant therapy and duration of surgery). Patients were divided into 2 groups: with (n = 54) or without (n = 378) complications. Survival curves were compared between the groups, and univariate and multivariate models were conducted to identify independent prognostic factors. RESULTS: Among the 432 patients evaluated, 61 com-plications occurred affecting 54 patients (12.50%).Complications included anastomotic leakages, gastric motility disorders, anastomotic block, wound infections, intra-abdominal abscesses, infectious diarrhea, bleeding, bowel obstructions, arrhythmias, angina pectoris, pneumonia, atelectasis, thrombosis, unexplained fever, delirium, ocular fungal infection and multiple organ failure. American Society of Anesthesiologists grade, body mass index, combined organ resection and median duration of operation were associated with higher post-operative complications. The 1-, 3- and 5-year survival rates were 83.3%, 53.2% and 37.5%, respectively. In the univariate analysis, the size of lesions, TNM stage, blood transfusion, lymphovascular invasion, perineural invasion, neoadjuvant chemotherapy, and postoperative complications were significant predictors of overall survival. In the multivariate analysis, only TNM stage and the presence of complications remained significant predictors of reduced survival. CONCLUSION: The o
基金Supported by The National Natural Science Foundation of China,No.81201885 and No.81172279
文摘AIM:To evaluate the fast-track rehabilitation protocol and laparoscopic surgery(LFT)vs conventional care strategies and laparoscopic surgery(LCC).METHODS:Studies and relevant literature comparing the effects of LFT and LCC for colorectal malignancy were identified in MEDLINE,the Cochrane Central Register of Controlled Trials and EMBASE.The complications and re-admission after approximately 1 mo were assessed.RESULTS:Six recent randomized controlled trials(RCTs)were included in this meta-analysis,which related to 655 enrolled patients.These studies demonstrated that compared with LCC,LFT has fewer complications and a similar incidence of re-admission after approximately 1 mo.LFT had a pooled RR of 0.60(95%CI:0.46-0.79,P<0.001)compared with a pooled RR of 0.69(95%CI:0.34-1.40,P>0.5)for LCC.CONCLUSION:LFT for colorectal malignancy is safe and efficacious.Larger prospective RCTs should be conducted to further compare the efficacy and safety of this approach.
基金This work was supported by the grants from the National Natural Science Foundation of China （No.30471675, No.30672041 and No.30725039） the National Natural Science Foundation of Shaanxi Province （No.2004KI7-GI5） and the National Natural Science Foundation of PLA （No.06G086）.We are grateful to Drs. LI Qing and HUI Yan-ping （Department of Pathology, Fourth Military Medical University） for assisting in histopathological analysis+1 种基金 to Dr. SHANG Lei （Department of Health Statistics, Fourth Military Medical University） for his help in the statistics analysis to Dr. LIU Shan-lu （Department of Microbiology and Immunology, McGill University） for his insightful comments.
文摘Background Sepsis is a leading cause of death in the intensive care units. The late inflammatory cytokine, high-mobility group box 1 （HMGB1）, plays a critical role in sepsis. In the present study, we investigated the association between the serum HMGB1 levels and the severity of organ injury in the lipopolysaccharide-induced sepsis in rats. Methods To produce an animal model of sepsis with different degree of organ injury, animals were treated with three different doses of lipopolysaccharide （4, 8 and 16 mg/kg）, and the animals in control group were treated with the same volume of the vehicle （saline）. The levels of serum HMGB1 were measured at 0, 2, 4, 8, 16, 24, 32 and 48 hours after lipopolysaccharide （LPS） or vehicle injection, meanwhile the biochemical and histopathological indicators for the severity of organ injury were assessed. Results The level of HMGB1 had a positive, high correlation with the abnormal changes of serum cardiac troponin I, alanine aminotransferase, aspartate aminotransferase, creatinine and blood urea nitrogen, as well as the pathologic scores of heart, lung, liver and kidney. Conclusions The level of serum HMGB1 is highly correlated with the severity of sepsis in rats, suggesting that HMGB1 could serve as a valuable adjunct in the diagnosis and management of sepsis.
基金Supported by National Natural Science Foundation of China,No.81201885 and No.81172279
文摘AIM: To compare single incision laparoscopic surgery for an appendectomy (SILS-A) with conventional laparoscopic appendectomy (C-LA) when implemented by experienced surgeons. METHODS: Studies and relevant literature regarding the performance of single-incision laparoscopic surgery vs conventional laparoscopic surgery for appendectomy were searched for in the Cochrane Central Register of Controlled Clinical Trials, MEDLINE, EMBASE and World Health Organization international trial register. The operation time (OR time), complications, wound infection and postoperative day using SILS-A or C-LAwere pooled and compared using a meta-analysis. The risk ratios and mean differences were calculated with 95%CIs to evaluate the effect of SILS-A. RESULTS: Sixteen recent studies including 1624 patients were included in this meta-analysis. These studies demonstrated that, compared with C-LA, SILS-A has a similar OR time in adults but needs a longer OR time in children. SILS-A has similar complications, wound infection and length of the postoperative day in adults and children, and required similar doses of narcotics in children, the pooled mean different of -0.14 [95%CI: -2.73-(-2.45), P > 0.05], the pooled mean different of 11.47 (95%CI: 10.84-12.09, P < 0.001), a pooled RR of 1.15 (95%CI: 0.72-1.83, P > 0.05), a pooled RR of 1.9 (95%CI: 0.92-3.91, P > 0.05), a pooled RR of 1.01 (95%CI: 0.51-2.0, P > 0.05) a pooled RR of 1.86 (95%CI: 0.77-4.48, P > 0.05), the pooled mean different of -0.25 (95%CI: -0.50-0, P = 0.05) the pooled mean different of -0.01 (95%CI: -0.05-0.04, P > 0.05) the pooled mean different of -0.13 (95%CI: -0.49-0.23, P > 0.05) respectively. CONCLUSION: SILS-A is a technically feasible and reliable approach with short-term results similar to those obtained with the C-LA procedure.
基金Supported by China Postdoctoral Science Foundation,No.2013M541699Social Development of Jiangsu Province,No.BE2012705the Foundation of Northern Jiangsu People’s Hospital,No.Yzucms201213
文摘Sarcomatoid carcinoma of the pancreas(SCP)is a very rare pathological type of carcinoma that usually has a poor prognosis.Its pathogenesis has not been elucidated.We herein report a case of an early-stage SCP involving successful treatment and a good prognosis.The patient was a 48-year-old Chinese man with a5-mo history of vague abdominal pain.Ultrasonography revealed a 93 mm×94 mm×75 mm mass of mixed echogenicity in the tail of the pancreas.Laboratory test results were within the normal range,with the exception of an obviously increased pretreatment neuron-specific enolase level.The plasma transforming growth factor(TGF)β1 and interleukin-11 levels were obviously increased according to enzyme-linked immunosorbent assay.Microscopically,the excised tumor tissue comprised cancer cells and mesenchymal cells.Immunohistochemical analysis was positive forα-1-antichymotrypsin,pan-cytokeratin,cytokeratin 19,cytokeratin 8/18,and vimentin and negative for CD68and lysozyme.The pathogenetic mechanism of this case shows that TGFβ1 may regulate the epithelial-tomesenchymal transition in SCP.With early eradication of the tumor and systemic therapy,this patient has been alive for more than 3 years without tumor recurrence or distant metastasis.This case is also the first to show that TGFβ1 may regulate the epithelial-tomesenchymal transition in early-stage SCP.
基金This work wassupported by the Natural Science Foundation Council of China （No.20271007 and 20331010）and Specialized Research Fund for the Doctoral Program of Higher Education （No.20030007014）
