Background: Esophageal cancer is a malignant tumor of the upper gastrointestinal tract caused by environmental and genetic factors. Genetic polymorphisms and expression variations of esophageal cancer susceptibility genes are key influencing factors of individual susceptibility to tumors. Due to the insufficient screening of risk factors for esophageal cancer by traditional epidemi-ology, identification of esophageal cancer risks at the molecular level may benefit esophageal cancer prevention and therapy. The p53 gene, Fragile Histidine Triad Diadenosine Triphosphatase (FHIT) gene, P16 gene, mismatch repair gene, and Phospholipase C Epsilon 1 (PLCE1) gene have been heavily studied in recent years given their roles in the genesis and progression of esophageal cancer. Therefore, this paper briefly outlines the significance of esophageal cancer susceptibility gene testing for subsequent treatment, providing a feasible pathway for early diagnosis, prognosis assessment and gene therapy of esophageal cancer.

目的 探讨腹腔镜近端胃切除双通道吻合术治疗早期胃上部癌的疗效及对患者营养状况和生存状况的影响.方法 选择2018年1月至2022年1月咸阳市第一人民医院收治的80例早期胃上部癌患者作为研究对象,按照随机数表法分为观察组与对照组各40例,对照组患者使用全胃切除术治疗,观察组患者使用腹腔镜近端胃切除双通道吻合术治疗.比较两组患者围术期情况,术前、术后6个月的血清白蛋白、总蛋白、血红蛋白水平,并比较术后并发症发生率,记录两组随访至2022年8月1日时的生存率.结果 两组患者的手术时间、术中出血量、淋巴结清扫数量、肛门排气时间、住院时间比较差异均无统计学意义(P>0.05);术后6个月,观察组患者的血清白蛋白、总蛋白、血红蛋白水平为(57.29±5.13)g/L、(66.52±5.81)g/L、(120.02±11.84)g/L,明显高于对照组的(43.05±4.33)g/L、(50.73±5.81)g/L、(108.12±8.10)g/L,差异均有统计学意义(P<0.05);观察组患者术后并发症总发生率为12.50％,明显低于对照组的32.50％,差异有统计学意义(P<0.05);两组患者均随访至2022年8月1日,观察组失访2例、对照组失访3例,观察组和对照组患者的生存率分别为94.74％、91.89％,差异无统计学意义(P>0.05).结论 腹腔镜近端胃切除双通道吻合术有助于改善早期胃上部癌患者术后的营养状况,降低并发症,但对生存状况的改善效果不明显.

目的 选取腹腔镜胃癌根治术对老年早期胃癌患者血清肿瘤标志物、炎性因子的影响.方法 依据手术方式的不同将75例老年早期胃癌患者分为对照组(n=37)和观察组(n=38),对照组患者给予传统开腹胃癌根治术治疗,观察组患者给予腹腔镜胃癌根治术治疗.比较两组患者手术相关指标、血清肿瘤标志物[神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)、糖类抗原125(CA125)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)]水平、炎性因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平、并发症发生情况及复发情况.结果 观察组患者住院时间、胃肠功能恢复时间均明显短于对照组,术中出血量、自控镇痛泵按压次数均明显低于对照组,差异均有统计学意义(P﹤0.01).术后3天,两组患者CEA、NSE、CYFRA21-1、CA125水平均低于本组术前,TNF-α、IL-6、CRP水平均高于本组术前,观察组患者血清CEA、NSE、CYFRA21-1、CA125、TNF-α、IL-6、CRP水平均低于对照组,差异均有统计学意义(P﹤0.05).观察组患者的术后并发症总发生率为5.26%,低于对照组患者的21.62%,差异有统计学意义(P﹤0.05).观察组患者的复发率为2.63%,与对照组患者的13.51%比较,差异无统计学意义(P﹥0.05).结论 腹腔镜胃癌根治术可改善老年早期胃癌患者的手术相关指标,降低肿瘤标志物水平和并发症总发生率,减轻炎性反应,促进患者的术后恢复.

目的 分析胃癌组织中豆蔻酰化的富含丙氨酸的蛋白激酶C底物(MARCKS)、缺氧诱导因子-1α(HIF-1α)的表达水平与临床病理特征的关系.方法 回顾性分析2020年7月至2021年7月陕西中医药大学第二附属医院收治的80例胃癌患者的临床资料,以手术切除采集其病灶组织及癌旁组织,检测胃癌组织和癌旁组织中的MARCKS、HIF-1α表达水平,比较胃癌组织和癌旁组织中MARCKS、HIF-1α表达阳性率;比较不同临床病理特征患者胃癌组织中MARCKS、HIF-1α表达阳性率.随访1年,比较胃癌组织中MARCKS阳性及阴性患者、胃癌组织中HIF-1α阳性及阴性患者无进展生存期(PFS)和1年生存率.结果 Ⅲ期、Ⅳ期患者胃癌组织中MARCKS阳性率分别为91.67%、90.91%,HIF-1α阳性率分别为91.67%、100.00%,明显高于Ⅰ期、Ⅱ期患者[MARCKS阳性率分别为57.89%、61.54%,HIF-1α阳性率分别为63.16%、73.08%],差异均有统计学意义(P<0.05);中分化和低分化者胃癌组织中MARCKS阳性率分别为80.00%、91.67%,HIF-1α阳性率分别为88.00%、95.83%,明显高于高分化者的54.84%、61.29%,差异均有统计学意义(P<0.05);有淋巴结转移患者胃癌组织中MARCKS、HIF-1α阳性率分别为93.10%、96.55%,明显高于无淋巴结转移患者的62.75%、70.59%,差异均有统计学意义(P<0.05);肿瘤浸润至浆膜层患者胃癌组织中MARCKS、HIF-1α阳性率分别为89.19%、94.59%,明显高于未浸润至浆膜层患者的60.47%、67.44%,差异均有统计学意义(P<0.05);胃癌组织中MARCKS、HIF-1α表达阳性率分别为73.75%、80.00%,明显高于癌旁组织的38.75%、43.75%,差异均有统计学意义(P<0.05);胃癌组织中MARCKS、HIF-1α阳性和阴性患者PFS和1年生存率比较差异均无统计学意义(P>0.05).结论 胃癌组织中MARCKS、HIF-1α表达与患者胃癌分期、肿瘤细胞分化程度、淋巴转移情况、肿瘤浸润深度密切相关,可考虑作为辅助制定胃癌患者临床治疗方案的参考指标.

目的 探讨miR-375、miR-92b靶向Nemo样激酶(Nemo-like kinase,NLK)对非小细胞肺癌(non-small cell lung cancer,NSCLC)细胞增殖、迁移、侵袭及上皮间质转化(epithelial-mesenchymal transition,EMT)的影响.方法 以人NSCLC细胞A549为实验细胞,分为7组:正常对照组、miR-375阴性对照组、miR-92b阴性对照组、miR-375+miR92b阴性对照组、miR-375抑制组、miR-92b抑制组和miR-375+miR-92b抑制组.采用双荧光素酶报告法观察miR-375、miR-92b与NLK之间的靶向关系.培养72 h时采用实时荧光定量PCR(qRT-PCR)法检测miR-375、miR-92b、NLK mRNA表达,CCK-8法检测细胞增殖(OD值),划痕实验法(wound healing)检测细胞迁移,Transwell实验法检测各组细胞侵袭,蛋白免疫印迹法(Western blot)检测EMT标记蛋白(E-cadherin、vimentin)的表达差异.结果 miR-375、miR-92b与NLK存在靶向结合位点且在A549细胞中存在靶向关系.细胞培养72 h,miR-375抑制组、miR-92b抑制组、miR-375+miR-92b抑制组与相应的阴性对照组和正常对照组比较,NLK mRNA表达、OD值、迁移距离、侵袭细胞数降低(均P<0.05).miR-375阴性对照组、miR-92b阴性对照组、miR-375+miR-92b阴性对照组与正常对照组比较,E-cadherin、vimentin表达差异不具有统计学意义(P>0.05);与相应的阴性对照组和正常对照组比较,miR-375抑制组、miR-92b抑制组、miR-375+miR-92b抑制组E-cadherin蛋白表达均增高,vimentin蛋白表达均降低,差异具有统计学意义(P<0.05).结论 miR-375、miR-92b靶向NLK对NSCLC的生物学功能和EMT具有抑制作用,NLK表达调控可能是NSCLC的预后生物标志物和治疗靶点.

Let-7 microRNAs have been reported to have tumor suppressive functions; however, the effect of Let-7 when used in combination with chemotherapies is uncertain, but may have potential for use in clinical practice. In this study, we used RT-qPCR, western blot analysis, cell proliferation assay, flow cytometry analysis, immunohistochemistry (IHC) staining, luciferase assays, cell sorting analysis and xenografted tumor model to explore the role of Let-7 in the chemotherapy sensitivity of breast cancer stem cells. The findings of the current study indicated that Let-7 enhances the effects of endocrine therapy potentially by regulating the self-renewal of cancer stem cells. Let-7c increased the anticancer functions of tamoxifen and reduced the ratio of cancer stem-like cells (CSCs), sensitizing cells to therapy-induced repression in an estrogen receptor (ER)-dependent manner. Notably, Let-7 decreased the tumor formation ability of estrogen-treated breast CSCs in vivo and suppressed Wnt signaling, which further consolidated the previously hypothesis that Let-7 decreases the self-renewal ability, contributing to reduced tumor formation ability of stem cells. The suppressive effects exerted by Let-7 on stem-like cells involved Let-7c/ER/Wnt signaling, and the functions of Let-7c exerted with tamoxifen were dependent on ER. Taken together, the findings identified a biochemical and functional link between Let-7 and endocrine therapy in breast CSCs, which may facilitate clinical treatment in the future using delivery of suppressive Let-7.

目的 观察胃近端根治术保留远端残胃联合食管-空肠与残胃-空肠双通道吻合术治疗胃上部癌的效果.方法 选取41例接受胃近端根治术联合食管-空肠与残胃-空肠双通道吻合术治疗的胃上部癌患者(双通道组)和41例接受常规胃全切术联合食管-空肠Roux-en-Y吻合术治疗的胃上部癌患者(常规组).观察两组患者的手术治疗指标(手术时间、术中出血量、术后首次排气时间、术后住院时间)、术后并发症(倾倒综合征、反流性食管炎、术后出血、术后梗阻、吻合口瘘/狭窄、残胃无张力)的发生情况、术后1年营养状态(血浆总蛋白、血浆白蛋白、血红蛋白及减轻体重)及生活质量、术后3年的生存情况.结果 双通道组患者的手术时间明显长于常规组,术中出血量明显少于常规组,术后首次排气时间、术后住院时间均明显短于常规组,差异均有统计学意义(P﹤0.01).双通道组患者术后倾倒综合征、反流性食管炎的发生率均低于常规组,差异均有统计学意义(P﹤0.05).术后1年,双通道组患者的血浆总蛋白、血浆白蛋白、血红蛋白及SF-36生活质量量表各维度评分均高于常规组,体重减轻低于常规组,差异均有统计学意义(P﹤0.05).术后3年,双通道组患者的生存率为97.6％,高于常规组的85.4％,差异有统计学意义(χ2=3.977,P=0.046).结论 保留远端残胃联合双通道吻合术治疗胃上部癌患者,疗效满意,术后并发症的发生率低,可有效地改善患者术后营养状态和生活质量,提高远期生存率,有临床应用价值.

目的 评估西北地区三个医学中心食管癌根治术后患者发生吻合口瘘的风险因素.方法 回顾性分析西北地区三个医学中心接受食管癌根治手术的544例患者的临床资料,分析患者相关基础疾病及围手术期处理策略与术后吻合口瘘发生率的关系.结果 入组患者来源的3家医院均具有一定的区域代表性.544例患者术后吻合口瘘发生率为9.2%(50/544),发生瘘的平均时间为(6.4±1.02)d,无死亡.食管癌根治术后吻合口瘘单因素分析结果显示,患者年龄、糖尿病、术前血清白蛋白水平、呼吸系统疾病、吻合部位及手术时间均与食管癌根治术后吻合口瘘有关(P<0.05).多因素Logistic回归分析结果显示,术前合并糖尿病、呼吸系统疾病、术前血清清蛋白水平低、手术时间≥4h是食管癌患者根治术后发生吻合口瘘的独立危险因素(P<0.05).Spearman相关分析结果显示,肠内营养开始时间与吻合口愈合情况及术后第7天血清白蛋白浓度均呈现正相关(P<0.05).结论 合并有糖尿病、高血压、呼吸系统疾病、低白蛋白血症及较长手术时间的患者更易发生食管吻合口的愈合不良,术后早期进行肠内营养支持治疗,有利于吻合口愈合及术后第7天血清白蛋白水平的恢复.

To determine the most suitable strategy in treating patients with invasive breast cancer from Northwest China. Lower recurrence score (RS) correlated with lower recurrence ratio. Patients having a medium-high 21-gene RS who received adjuvant therapy presented lower recurrence risk. Younger patients having RS results (⩾31) tended to accept adjuvant therapy more often, however, those having intermediate RS results were inclined to wait and did not receive chemotherapy. These results suggested that RS-based precision medicine will allow individualized diagnosis and treatment, resulting in better outcomes and preserved medical resources.

Objective:To investigate inhibiting Hedgehog signaling activity sensitized triple negative breast cancer cells to Let-7 suppression of proliferation.Methods:In this study,muhiple molecular and biology technologies were used,such as qRT-PCR,Western Blot,immunohistochemistry,immunofluorescence,ect,to study the possible roles and implicated mechanisms in vitro and in clinical samples.Results:We found the inhibition of Hedgehog inhibited MDA-MB-231 cells and BT-20 cells' proliferation,and help to sensitize MDA-MB-231 and BT-20 cells to Let-7 induced proliferation inhibition.Let-7 showed no significant effects on the Cyclin D1 level,but its effects were greatly strengthened by Hedgehog pathway inhibitor of cyclopamine.We also found that cyclopamine inhibits the ratio of ALDH1 + cells of both MDA-MB-231 and BT-20 cells,and strengthened the inhibitory effects of Let-7.Conclusion:Hedgehog inhibitor could improve the effects of Let-7 miRNAs in repressing breasts cancer cells proliferation.

Objective To investigate the incidence of biliary complications after laparoscopic common bile duct exploration combined with primary suture in the treatment of patients with common bile duct stones and related risk factors.Methods A total of 134 patients with common bile duct stones who underwent common bile duct exploration combined with primary suture in The First People's Hospital of Xianyang from June 2013 to June 2016 were enrolled,and biliary complications were evaluated according to the Clavien-Dindo classification.A univariate analysis was performed for 13 possible factors for biliary complications after primary suture,the chi-square test was used for comparison between groups,and a multivariate logistic regression analysis was performed for the factors screened out in the univariate analysis.Results A total of 12 patients experienced biliary complications after surgery,resulting in an incidence rate of 8.96％;among these patients,8 had bile leakage,2 had residual stones in the bile duct,1 had biliary stricture,and 1 had hematobilia.According to the Clavien-Dindo classification,3 had grade Ⅰ,5 had grade Ⅱ,2 had grade Ⅲa,and 2 had Ⅲb diseases.The univariate analysis showed that postoperative biliarycomplications were associated with plasma albumin level,biliary reoperation,nasobiliary drainage,and surgeon's experience (x2 =4.012,4.942,4.336,and 5.975,all P ＜0.05),while they were not associated with age,sex,increased bilirubin level,maximum stone diameter,number of stones,medical diseases,gallstones,surgical procedure,and suture method (all P ＞ 0.05).The multivariate analysis showed that biliary reoperation and surgeon's experience were independent risk factors for postoperative biliary complications (x2 =6.448 and 6.842,both P ＜ 0.05).Conclusion There are certain risks of biliary complications after common bile duct exploration combined with primary suture,and biliary leakage is the most common complication,especially in patients undergoing biliary reoperation and when there is a lack of experience in surgeons.

Evaluating the clinicopathological features of patients receiving definitive treatment for esophageal cancer may facilitate the identification of patterns and factors associated with post-operative complications, and enable the development of a surveillance strategy for surviving patients at a higher risk of disease recurrence. In the present study, clinical data from 579 patients with esophageal cancer that underwent radical resection of esophagus were collected. These patients were admitted to two medical centers in Northwest China, and information regarding the presence or absence of basic chronic diseases and post-operative results were retrospectively analyzed. The level of selected stem cell markers, including aldehyde dehydrogenase 1, CD133, integrin subunit α 6, integrin subunit β 4 and T-cell factor-4, were determined in esophageal cancer tissue samples in order to determine whether these markers may be useful predictors of disease prognosis and recurrence. Post-operative complications in patients receiving radical resection of the esophagus included respiratory system complications, cardiovascular abnormalities and esophageal anastomotic fistulae. Diabetes, basic respiratory disease and lower pre-surgical serum albumin levels were observed to be individual risk factors associated with post-operative complications, including respiratory system complications of acute respiratory failure and pulmonary infection, cardiovascular abnormalities of atrial fibrillation and arrhythmia, as well as the development of esophageal anastomotic fistulae. Diagnosis of esophageal cancer at later stage was significantly correlated with anastomotic fistula. Molecular detection of stem cell markers for prognosis prediction was achieved by immunohistochemical and immunofluorescence staining assays. The results demonstrated that the presence of stem-like cells in cancer tissues was associated with poor disease prognosis and a high recurrence ratio. In conclusion, the results of the current study suggested that post-operative complications were more likely to occur in patients with diabetes, basic respiratory disease or lower serum albumin levels prior to surgery. Therefore, sufficient intensive peri-operative care, rigorous operative risk assessments, and the selection of the patients with early or mid-stage esophageal cancer, may decrease the risk of post-surgical complications in patients receiving radical resection of the esophagus. In addition, a high ratio of esophageal cancer stem-like cells was associated with cancer recurrence. These results suggest that an intensive surveillance strategy should be implemented in order to facilitate early detection of disease recurrence and improve the clinical management of these patients post-surgery.

Lung carcinoma tops the categories of cancer related motility, and has been treated as the main threat to human health. The functions and related mechanism of FBXW7 controlled lung cancer stem cells' signatures is barely unknown, and the miR-367 regulations of FBXW7 via Wnt signaling have not been explored. Cancer stem cells of either ALDH1+ or CD133+ phenotype were found to be referred to advanced stages in patients with NSCLC (non-small cell lung carcinoma). To study the roles of miR-367, we found greater miR-367 level or FBXW7 level was reserved in NSCLC than that of paired adjacent normal tissues, and their upregulations were positively correlated with Wnt signaling activation. On the contrary, increased miR-367 was correlated with Let-7 repression. MiR-367 was related to stronger sphere forming ability in stem cells of NSCLC. We then explored the functions of the endogenous miR-367 in stem-like cells isolated from NSCLC cell lines. In HEK-293 cells, we identified FBXW7 as the direct downstream gene of miR-367, which consequently released the LIN-28 dependent inhibition of suppressive Let-7. Through informatics analysis, miR-367 was predicated to function through Wnt signaling, and decreased Let-7 played the pivotal role to maintain TCF-4/Wnt pathway activity. The reintroduction of FBXW7 abolished the oncogenic stimulation of miR-367 on TCF-4 activity, with Wnt signaling factors depression. In conclusion, our findings demonstrated the oncogenic roles of miR-367 exerting on the self-renewal ability of cancer stem-like cells through degrading the suppressive FBXW7, eventually helping to maintain Wnt signaling activation through a LIN28B/Let-7 dependent manner.

目的：探讨成人先天性胆管扩张症的手术治疗方法。方法：对21例成人先天性胆管扩张症患者根据Flanigan分为：Ⅰ型16例，Ⅱ型2例，Ⅳ型2例，Ⅴ型1例，除Ⅴ型1例行保守治疗后好转出院外，其余20例均行囊肿切除。结果：术后发生胆汁漏5例，急性胰腺炎2例，本组18例经随访1～8年，随访率为85．7％，5例表现为轻度胆管炎，3例出现吻合口狭窄，其余病例痊愈。结论：囊肿切除、胆管空肠Roux-y吻合是成人先天性胆管扩张症的首选治疗方法。切除囊肿时，囊肿近端在尽量切净囊肿的基础上行大口吻合防止术后吻合口狭窄；囊肿远端在保证胰液引流通畅，不损伤胰管开口的基础上，尽量切净囊肿内膜。

目的：探讨VEGF和endostatin与肝细胞癌患者手术预后的相关性研究。方法采用ELISA法检测37例肝细胞癌患者、30例肝硬变患者和32例健康者外周血清VEGF、内皮抑素水平。分析外周血VEGF、内皮抑素水平与肝细胞癌患者手术预后的关系。结果肝细胞癌患者外周血清VEGF水平、内皮抑素水平均明显高于肝硬变患者和健康者(P<0.05)。肝硬变患者外周血清VEGF水平明显高于健康者(P<0.05)。VEGF与生存时间显著负相关（r=-0.74； P<0.001）。血清VEGF较高的肝癌患者的生存时间明显短于血清VEGF较低的肝癌患者(P=0.004)。结论肝细胞癌患者外周血清VEGF、内皮抑素水平升高。检测外周血清VEGF、内皮抑素水平有助于肝细胞癌患者预后评估。

目的：探讨开展腹腔镜胆总管探查（LCBDE ）术的治疗方法。方法：对51例胆囊结石并胆总管结石的患者行LCBDE手术，并对临床资料加以分析。结果：51例患者中3例中转开腹，其余均顺利完成手术，其中术后3例出现胆瘘，5例术后胆管内残留结石，二期“T”型管窦道胆道镜成功取石。结论：在严格控制手术适应证、合适病例选择的基础上，开展LCBDE治疗胆管结石是安全和行之有效的。

目的：探讨炎症细胞和炎症因子（白介素6和C反应蛋白）在急性胆囊炎腹腔镜胆囊切除术时预测中转开腹的效果。方法分析343例急性胆囊炎患者腹腔镜胆囊切除术病史,无中转开腹患者311例,中转开腹患者32例,患者术前留取血样，检测白细胞数、血浆中白介素6和C反应蛋白浓度，并分析其与中转开腹的相关性。结果 C反应蛋白与中转开腹率密切相关，白细胞数和白介素6与中转开腹无明显相关性，年龄与中转开腹率显著相关。结论 C反应蛋白增高的患者中转开腹几率增高，C反应蛋白可预测急性胆囊炎腹腔镜胆囊切除术的中转开腹率。

目的:比较微波与平阳霉素治疗皮肤海绵状血管瘤的临床效果。方法:将54例皮肤海绵状血管瘤患者随机分为治疗组和对照组,治疗组32例进行微波治疗,对照组22例行平阳霉素注射治疗。术后1月分别评价治疗后效果。结果:治疗组治疗血管瘤有效率为84.4%,对照组有效率为45.5%,治疗组效果明显优于对照组(P?0.01)。结论:应用微波治疗皮肤海绵状血管瘤见效快,治疗效果肯定。

Objective To study the clinical effect of endovenous microwave treatment (EMT) for the lower limb varicose veins. Methods Sixty-three patients with varicose veins were treated by EMT (the study group), and 58 patients with varicose veins were treated by the varicose veins stripping (the control group). The operation time, blood loss during operation, the length of hospital stay were compared between the two groups. Results The study group showed significantly shorter operation time (P0.01), less blood loss during operation (P0.05), less incisions (P0.05), shorter length of hospital stay and lower incidence of haemostasis than the control group (P0.05). Conclusion EMT was a safe, minimally invasive and easily operated technique for the treatment of varicose veins.

Objective To study the clinical outcome of endovenous microwave treatment(EMT) for the lower limbs varicose veins.Methods Thirty-six patients with varicose veins were treated by EMT(the EMT group) in the Department of General Surgery,First Hospital of Xianyang,Shaanxi Province,and the clinical data of 50 patients treated by the varicose veins stripping(the control group) were retrospectively compared.Results The two therapeutic regimens reached similar clinical outcomes.The operative time was shorter in the EMT group with less operation bleeding and less incisions.The length of hospital stay and the incidence rate of haemostasis was lower in the EMT group than in the control group;the limb numbness did not differ between the two groups.Conclusions EMT is a newly,safe,minimally invasion and easily operated technique in the treatment of varicose veins.