The high incidence of malnutrition in patients with colorectal cancer directly affects their clinical outcomes,and is associated with increased postoperative complications,prolonged hospital stays,and decreased tolerance of chemotherapy and radiotherapy.Therefore,the nutritional management of patients with colorectal cancer is important.The perioperative nutritional management of patients includes preoperative education,nutritional screening and evaluation,preoperative intestinal preparation,and postoperative nutritional management.This article summarizes the current status of perioperative nutritional therapy and bowel preparation for patients with colorectal cancer.

结直肠癌(colorectal cancer, CRC)是常见的消化道恶性肿瘤之一,其发病率和死亡率分别位居所有恶性肿瘤的第三位和第二位,并且发病趋于年轻化[1].处于慢性消耗状态或者存在手术创伤的肿瘤患者往往无法维持正常的营养摄入,易引发营养不良.营养不良的结直肠癌患者对手术、化疗、放疗等抗肿瘤综合治疗耐受性差,这对患者术后机体恢复、生活质量及预后均存在不同程度的影响[2].本文结合现有文献,就营养治疗及营养制剂在结直肠癌中的研究现状进行综述,并围绕营养治疗在临床应用中所存在的一些问题展开讨论,与同道交流.

We hypothesized that neural EGFL like 1 (NELL1) promoter hypermethylation might be associated with the prognosis of gastric cancer. Some studies considered NELL1 as a tumor suppressor gene and our research confirmed for the first time the hypermethylation in the promoter region of NELL1 by the application of mass spectrometry. Promoter hypermethylation can cause the silencing of tumor suppressor genes and promote tumor progression. Based on present studies and research results, we proposed that NELL1 promoter hypermethylation might be associated with cancer staging and the survival of gastric cancer patients and had prognostic value. We hoped that NELL1 promoter hypermethylation would be applied not only for early detection but also prognosis prediction of gastric cancer and would become a new prognostic biomarker.

目的 探究老年结肠癌患者腹腔镜术后认知功能障碍(POCD)发生的危险因素.方法 选取2016年1月～2018年12月哈尔滨医科大学附属第一医院接受腹腔镜手术治疗的老年结肠癌患者300例作为研究对象.根据是否发生POCD分为POCD组(62例)和非POCD组(238例).比较两组基本资料及手术指标,采用多因素logistic回归分析老年结肠癌患者腹腔镜POCD危险因素.结果 POCD组年龄、术前简易智力状态检查量表(MMSE)评分和高血压、糖尿病发生率均高于非POCD组,受教育年限低于非POCD组(P＜0.05).POCD组麻醉时间、术中出血量、术后视觉模拟评分(VAS)及苏醒期躁动例数占比均高于非POCD组,术后血红蛋白和术前使用右美托咪啶例数、术后硬膜外自控镇痛(PCEA)例数占比均低于非POCD组(P＜0.05).多因素logistic回归分析年龄、高血压、糖尿病、术前MMSE评分、麻醉时间、术中出血量、术后VAS评分、苏醒期躁动均是老年结肠癌患者腹腔镜POCD发生的独立危险因素(P＜0.05),受教育年限、术后血红蛋白增加、术前使用右美托咪啶、术后PCEA是老年结肠癌患者腹腔镜POCD发生的保护性因素(P＜0.05).结论 年龄、术前MMSE评分、麻醉时间、术中出血量、术后VAS评分的增加以及高血压、糖尿病、苏醒期躁动的发生使老年结肠癌患者腹腔镜POCD发生的风险增加,随着受教育年限、术后血红蛋白的增加以及术前使用右美托咪啶、术后PCEA,POCD的发生风险随之降低.

Hohenberger提出的完整结肠系膜切除术(CME)已成为结肠癌根治手术的标准术式.近年来,随着腹腔镜手术的广泛开展以及高清腹腔镜设备的普及,以往开腹手术中无法辨识的膜结构及精细解剖层面逐渐被认识.人体解剖结构随胚胎发育过程而发生变化,理解胚胎发育的过程,有助于加强对结肠膜解剖和CME游离层面的正确认识,对CME的标准化、规范化亦具有重要的意义.本文通过对胚胎发育和膜解剖理论的文献学习,结合笔者团队的临床实践经验,对CME手术的清扫边界、血管结扎部位、游离层面以及手术流程展开讨论.

The theory of membrane anatomy is now widely accepted due to the observation of fine anatomical structure with the help of laparoscopic magnifying effect. From the perspective of systematic anatomy, the mesentery is considered as an integral organ in the theory of mesenteric anatomy. Interfascial anatomy belongs to regional anatomy, which focuses on the guiding significance of fascial space for operation. The theory of membrane anatomy belongs to surgical anatomy or applied anatomy, which emphasizes the anatomy of membrane and mesangial bed, and reveals the existence of 'metastasis V' in the mesentery. It is considered that the essence of membrane anatomy operation is to prevent cancer leakage. Various theories of membrane anatomy seek common ground while reserving differences, complement each other, and upgrade iteratively. They help to explain the structure and function of membrane from different perspectives and they are of great benefit to improve the quality of operations. Thus, they should be treated in an eclectic manner.

OBJECTIVES:c-Met is a receptor tyrosine kinase shown inappropriate expression and actively involved in progression and metastasis in most types of human cancer. Development of c-Met-targeted imaging and therapeutic agents would be extremely useful. Previous studies reported that c-Met-binding peptide (Met-pep1, YLFSVHWPPLKA) specifically targets c-Met receptor. Here, we evaluated 18F-labeled Met-pep1 for PET imaging of c-Met positive tumor in human head and neck squamous cell carcinoma (HNSCC) xenografted mice. METHODS:c-Met-binding peptide, Met-pep1, was synthesized and labeled with 4-nitrophenyl [18F]-2-fluoropropionate ([18F]-NPFP) ([18F]FP-Met-pep1). The cell uptake, internalization and efflux of [18F]FP-Met-pep1 were assessed in UM-SCC-22B cells. In vivo pharmacokinetics, blocking and biodistribution of the radiotracers were investigated in tumor-bearing nude mice by microPET imaging. RESULTS:The radiolabeling yield for [18F]FP-Met-pep1 was over 55% with 97% purity. [18F]FP-Met-pep1 showed high tumor uptake in UM-SCC-22B tumor-bearing mice with clear visualization. The specificity of the imaging tracer was confirmed by significantly decreased tumor uptake after co-administration of unlabeled Met-pep1 peptides. Prominent uptake and rapid excretion of [18F]FP-Met-pep1 was also observed in the kidney, suggesting this tracer is mainly excreted through the renal-urinary routes. Ex vivo biodistribution showed similar results that were consistent with microPET imaging data. CONCLUSIONS:These results suggest that 18F-labeled c-Met peptide may potentially be used for imaging c-Met positive HNSCC cancer in vivo and for c-Met-targeted cancer therapy.

Malignant acute abdomen is an acute abdominal disease caused by abdominal and extra-abdominal malignant tumors or secondary to various treatments for tumors, and belongs to the category of oncologic emergencies. Malignant acute abdomen includes perforation, bowel obstruction, infection and bleeding, etc. Most of the malignant acute abdomen is urgent and critical. The postoperative morbidity and mortality of these patients are high. The treatment strategy should ideally be discussed by a multidisciplinary team, which is often infeasible in the emergent setting. Surgery should be the main measures to improve survival and quality of life, but the risk of death should be fully evaluated before surgery to determine whether the surgery can benefit patients. In addition, the timing of surgery depends mostly on the surgeon. This article explores the treatment of malignant acute abdomen from the perspective of surgical oncology.

Hereditary diffuse type of gastric cancer is a common type of hereditary gastric canc-er.It has been decades since the disease was discovered.A series of studies has been carried out over-seas and there has been a certain degree of standards and consensus on the etiology, pathological features, diagnosis and treatment of this type of gastric cancer.However, the disease lacks effective diagnosis, treatment as well as the genetic screening in China due to inadequate awareness and concern.This review focuses on the recent advances in the hereditary diffuse type of gastric cancer.

The ubiquitin-specific peptidase 22 (USP22) belongs to the largest subfamily of deubiquitylases and recent studies indicate that overexpression of USP22 may promote gastric cancer progression and predict prognosis. But little is known about the interaction network of USP22 in gastric cancer. In this study, we applied bioinformatics methods and found that USP22 was correlated with the heat shock protein 90 (HSP90) which is now considered to be a biomarker to predict the prognosis of gastric cancer. Then the siRNA transfection and western blotting were used to testify the correlation of USP22 and HSP90 in gastric cancer cells. The immunohistochemistry staining of the microarrays was applied to confirm the correlation of USP22 and HSP90 expression in gastric cancer tissue and further analysis showed that co-expression of USP22 and HSP90 was related to lymph node metastasis and more effective in predicting the prognosis of gastric cancer. In summary, our data demonstrate that correlation exists between USP22 and HSP90 expressions in gastric cancer and co-expression of USP22 and HSP90 may be more effective in predicting prognosis of gastric cancer.

T-LAK (lymphokine-activated killer T) cell-originated protein kinase (TOPK) is a MAPKK (mitogen-activated protein kinase kinase)-like protein kinase, which interacts with some tumor suppressor proteins and may play some important roles in the activation of T-LAK cells and signaling for the mediation of their cytotoxic functions against cancer cells. Here, in this study, a retrospective analysis of 79 resected gastric cancer patients was carried out to examine TOPK expression by immunohistochemistry. SGC7901 cell lines with depletion of endogenous TOPK were used to investigate if TOPK could promote cell migration. We found that the positive frequency of TOPK in cancer cells was 92.4%, whereas no TOPK expression was detected in non-cancerous mucosa. With increasing expression of TOPK, there was a significant increase in pT classification (P=0.0319) and pN classification (P=0.0337). In univariate analyses, AJCC stage (P<0.0001), pT classification (P<0.0001), pN classification (P<0.0001), differentiation (P=0.0268), peritoneal metastasis (P=0.0002) and gross features (P=0.0100) were significant prognostic factors. In multivariate analysis, AJCC stage was an independent predictor of survival (P<0.0001). Reductions of TOPK in SGC7901 cells were associated with decreases in cell invasion (P=0.0102) and migration (P=0.0278). Taken together, TOPK overexpression is associated with poor prognosis in GC. TOPK promotes gastric cancer cell migration.

目的 探讨Nell-1基因启动子区不同甲基化位点与胃癌预后有关联的各种因素之间的相关性.方法 收集2012年哈尔滨医科大学附属第四医院肿瘤外科25例接受胃癌根治术的患者资料,运用混合效应线性模型分析Nell-1基因启动子区不同甲基化位点与胃癌预后有关的各种因素之间的相关性.结果 Nell-1基因启动子区第26号甲基化位点的胃癌组织组甲基化率与胃正常组织组甲基化率之间的差别有统计学意义,混合效应线性模型分析显示胃癌预后有关的因素(癌胚抗原、糖蛋白抗原199)对Nell-1基因启动子区第26号甲基化位点的甲基化率有影响,相同影响因素下该位点胃癌组织组甲基化率受到的影响程度高于胃正常组织组.结论 不同甲基化位点其甲基化率不同,其与胃癌患者肿瘤标记物之间存在一定相关性.

Objective To investigate the expression of USP22 in gastric cancer and to explore its correlation with the occurrence,development and prognosis of gastric cancer.Methods Immunohistochemical staining was used to detect the expression of USP22 in normal gastric mucosa and cancer.And the experimental data were statistically analyzed through SPSS 13.0 software.Results The expression of USP22 was upregulated in gastric cancer tissue compared with normal tissue (P ＜ 0.05).The expression of USP22 was not associated with age,sex and the size of tumor,but with the differentiation level,the depth of invasion,metastatic lymph nodes and AJCC clinical staging.The increased expression of USP22 was associated with low five-year survival rate (P ＜ 0.05).Conclusion USP22 should play a significant role in tumorigenesis and progression of gastric cancer,the patients with high expression of USP22 may be suggest a poor prognosis.

目的:明确胃癌原发灶与其转移淋巴结中Her2过表达或扩增的差异性,为临床胃癌治疗方案的选择提供参考依据.方法:选择112例经术后病理检查证实为胃癌原发灶Her2强阳性(Her2阳性表达为3+)表达并伴有淋巴结转移的患者样本,应用免疫组化方法并参照《胃癌Her2检测指南》中规定的检测流程重新判定有Her2过表达或扩增的胃癌原发病灶其相应的转移淋巴结中Her2有无过表达或扩增,再将检测结果进行比较.结果:112例患者中,胃癌组织Her2的阳性率为74.11％,淋巴结Her2的阳性表达为66.07％,二者共同阳性表达率为61.61％,差异无统计学意义(P=0.064).两,二者一致率为83.04％,kappa检验结果为(Z=6.452,P＜0.001).胃癌组织Her2的基因表达与年龄、性别、肿瘤位置和肿瘤大小以及远端转移均无显著相关性,而与Lauren分型、组织学分级、浸润深度、淋巴结转移以及TNM分期有关(P＜0.05).结论:胃癌原发病灶中Her2过表达或扩增与其相应的转移淋巴结中Her2过表达或扩增具有一致性.胃癌组织Her2状态与Lauren分型、组织学分级、浸润深度、淋巴结转移以及TNM分期有关.

Slightly increased pressure stimulates tumor cell adhesion and proliferation. In the present study, we aimed to evaluate the effects of high pressure on gene expression and the biological behavior of gastric cancer cells. After incubation for 30 min at 37˚C under ambient and increased pressure, one portion of SGC7901 cells was used for cell proliferation and apoptosis assays, cell cycle analysis, adhesion invasion or migration assays. The other portion of cells was harvested for detection of matrix metalloproteinase-2 (MMP-2), inhibitor of DNA binding-1 (ID1), sonic Hedgehog (SHH) and E-cadherin expression by western blotting or RT-PCR. In addition, we investigated the effects of high pressure on SGC7901 cell ultrastructure by transmission electron microscopy. We found that the adhesion fold under increased pressure of 760 and 1,520 mmHg was 2.39±1.05 (P<0.05) and 2.47±0.85 (P<0.01) as compared with the control, respectively. The invasion fold was 3.42±2.06 (P<0.05) and 5.13±2.49 (P<0.01) as compared with the control, respectively. The migration was 1.65±0.20 (P<0.001) and 2.53±0.50 (P<0.001) as compared with the control, respectively. At increased pressure, MMP-2 and ID1 expression increased significantly, while the expression of SHH decreased significantly. However, we did not find significant change in proliferation, apoptosis, cell cycle or ultrastructure of the SGC7901 cells under high pressure. In conclusion, high pressure promoted the adhesion, invasion and migration of SGC7901 cells. Moreover, the present study suggests that the pressure-augmented invasion and migration may be related to the increase in MMP-2 expression. Moreover, high pressure may suppress SGC7901 cell differentiation, which may result from the change in SHH and ID1 expression.

目的探讨腹腔注射肿瘤坏死因子α（tumor necrosis factor-α,TNF-α）对鼠小肠Cajal间质细胞（interstitial cells of Cajal,ICC）的损伤作用。方法 BALB/c裸鼠20只,腹腔注射TNF-α（50μg/kg）后,随机分为4组。分别于注射后即刻（0 h）、6 h、12 h和24 h处死动物,取上段小肠标本。利用HE染色、免疫荧光及透射电镜观察小肠组织、ICC细胞及细胞网络的损伤情况,并通过Western blot方法检测干细胞因子（stem cell factor,SCF）蛋白的表达情况。结果腹腔注射TNF-α后引起小肠组织明显的炎症细胞浸润。12 h后观察到ICC细胞网络结构的缺失,ICC细胞内线粒体肿胀,变形,结构模糊,线粒体嵴结构减少或消失。SCF蛋白表达呈现升高后再降低的变化过程。结论腹腔注射TNF-α对鼠小肠ICC细胞及细胞网络具有损伤作用。

We aimed to assess the efficacy and safety of S-1 combined with cisplatin (SC) over cisplatin alone (C) for the treatment of advanced gastric cancer in China. Between July 2009 and June 2011, 72 eligible patients with advanced gastric cancer were selected and divided randomly into two groups. Thirty-six patients received SC, with S-1 on days 1 through 14 of a 21-day cycle and cisplatin (60mg/m(2) on day 1) every 4 weeks for two cycles. The other 36 patients were administered only cisplatin (in the same manner as SC). The primary outcome was overall survival. The secondary outcomes were progression-free survival and adverse events. The 2-year overall response rate was 51.5 and 42.3% for the SC and C groups, respectively, and the difference was statistically significant, whereas the median overall survival was 9.4 months (range, 1.9-24.4 months) and 7.6 months (range, 1.7-21.4 months), respectively (P=0.039). The median progression-free survival was 7.7 months for SC (range, 1.8-19.4 months), whereas it was 6.5 months (range, 1.5-16.4 months) for C (P=0.047). The toxicity profile was similar in both groups. In summary, we have shown that S-1 combined with cisplatin is more effective, with acceptable toxicity in comparison with cisplatin alone in Chinese patients with advanced gastric cancer. Chinese Clinical Trials Register: ChiCTR-TRC-13003993.

Objective To evaluate effects of high pressure on PHD3 expression and differentiation of cancer cells.Methods To increase the extracellular pressure, we designed and developed a pressure adjustable incubator, which could maintain not only the pHof culture solution by regulating the ratio of air and carbon dioxide (CO2) but also the temperature through heating system.In this study, SGC7901 cells were incubated in RPMI 1640 and divided into three groups.After incubation for 30 minutes at 37 ℃ under ambient (760 mmHg) and increased pressure (1520 mmHg) conditions, cells were harvested for detection of PHD3 and β-actin expression by Western blot or RT-PCR.Results By RT-PCR and Western blot, we found that the expression of pHD3 decreased significantly.Conclusion In conclusion, high extracellular pressure suppresses expression of PHD3 and may inhibit SGC7901 cells differentiation.