Gastric cancer (GC) is the leading diagnosed malignancy worldwide, especially in China. Radical surgery is the cornerstone of GC treatment. We reviewed previous clinical trials and aimed to provide an update on the factors related to the surgical treatment of GC. The number of registered clinical trials in the field of GC surgery is rapidly increasing. With the development and popularization of endoscopic, laparoscopic, and robotic techniques, GC surgery has gradually entered a new era of precise minimally invasive surgery. Postoperative quality of life has become a major issue in addition to surgical oncological safety. Although great progress has been made in clinical research on GC in China, there are still deficiencies. Many studies enrolled large numbers of patients, but the research data were not of high quality. The characteristics of GC in China include a high incidence, large population, and large proportion of patients with advanced GC, which provides sufficient reason for studying this disease. There is still a need for well-designed, large, randomized clinical trials to improve our knowledge of the surgical treatment of GC.

Surgery is the main curative treatment for gastric cancer. As surgical techniques continue to improve, the scope of radical resection and lymph node dissection has formed consensus and guidelines, so people's attention has gradually shifted to the quality of life (QOL) of patients after surgery. Postgastrectomy syndrome is a series of symptoms and signs caused by complications after gastrectomy, which can affect the quality of life of patients with gastric cancer after surgery. Gastrectomy and anastomosis are closely related to postgastrectomy syndrome. The selection of appropriate surgical methods is very important to the quality of life of patients after surgery. This article reviews the effects of gastrectomy procedures on postoperative quality of life of patients with gastric cancer and its evaluation methods.

Introduction. Serine hydroxymethyltransferase 2 (SHMT2) has a critical role in serine-glycine metabolism to drive cancer cell proliferation. Yet, the function of SHMT2 in tumorigenesis, especially in human colorectal cancer (CRC) progression, remains largely unclear. Materials and Methods. CRC and paired normal samples were collected in the Department of Colorectal Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, and assessed by real-time polymerase chain reaction (qPCR) analysis, western blot (WB), and immunohistochemistry (IHC). Moreover, SHMT2 expression in human CRC cells was identified by qPCR and WB. The CRC cell proliferation, migration, and invasion after SHMT2 knockdown were explored through in vitro and in vivo assays. mRNA-seq assays were used to investigate the underlying mechanisms behind the SHMT2 function. Results. It was found that SHMT2 mRNA and protein were overexpressed in CRC tissue compared to the levels in normal mucosa. Positive expression of SHMT2 was significantly correlated with TNM stage and lymph node metastasis, and elevated expression of SHMT2 resulted as an independent prognostic factor in patients with CRC. SHMT2 knockdown impaired the proliferation of CRC in vitro and in vivo and induced cell cycle arrest by regulating UHRF1 expression. Conclusion. Taken together, our findings reveal that UHRF1 is a novel target gene of SHMT2, which can be used as a potential therapeutic strategy for CRC therapy.

目的 比较3D腹腔镜下完全腹腔镜根治性全胃切除术(TLTG)与腔镜辅助根治性全胃切除术(LATG)治疗食管胃结合部癌的短期疗效.方法 回顾性分析上海市东方医院胃肠外科2017年1月至2020年9月间116例食管胃结合部癌行3D腹腔镜下根治性全胃切除术的临床资料,分为全腔镜组及腔镜辅助组,通过1:1倾向性评分配对进行匹配,筛选出其中各48例病例,比较两组间的短期疗效.结果 两组所有病例均为R0切除.全腔镜组的术后VAS疼痛评分[术后第一天为(6.12±1.08)分,术后第3天为(3.52±0.95)分]及手术切口长度[(6.04±1.41)cm]明显低于腔镜辅助组,差异存在统计学意义(P<0.05).而术中出血量、手术时间、食道空肠吻合时间、术后排气时间、术后进食时间、术后住院时间、术后病理情况及并发症发生情况等结果差异无统计学意义(P>0.05).结论 3D腹腔镜下TLTG的创伤更小,术后疼痛更轻,腹腔镜下食管空肠吻合时间与腔镜辅助手术耗时相当,且并不增加吻合口并发症的发生率,值得推广应用.

Colorectal adenocarcinoma (CRC) ranks one of the five most lethal malignant tumors both in China and worldwide. Early diagnosis and treatment of CRC could substantially increase the survival rate. Emerging evidence has revealed the importance of gut microbiome on CRC, thus fecal microbial community could be termed as a potential screen for non-invasive diagnosis. Importantly, few numbers of bacteria genus as non-invasive biomarkers with high sensitivity and specificity causing less cost would be benefitted more in clinical compared with the whole microbial community analysis. Here we analyzed the gut microbiome between CRC patients and healthy people using 16s rRNA sequencing showing the divergence of microbial composition between case and control. Furthermore, ExtraTrees classifier was performed for the classification of CRC gut microbiome and heathy control, and 13 bacteria were screened as biomarkers for CRC. In addition, 13 biomarkers including 12 bacteria genera and FOBT showed an outstanding sensitivity and specificity for discrimination of CRC patients from healthy controls. This method could be used as a non-invasive method for CRC early diagnosis.

Newcastle disease virus (NDV) is endowed with the oncolytic ability to kill tumor cells, while rarely causing side effects in normal cells. Both estrogen receptor α (ERα) and the G protein estrogen receptor (GPER) modulate multiple biological activities in response to estrogen, including apoptosis in breast cancer (BC) cells. Here, we investigated whether NDV-D90, a novel strain isolated from natural sources in China, promoted apoptosis by modulating the expression of ERα or the GPER in BC cells exposed to 17β-estradiol (E2). We found that NDV-D90 significantly killed the tumor cell lines MCF-7 and BT549 in a time- and dose-dependent manner. We also found that NDV-D90 exerted its effects on the two cell lines mainly by inducing apoptosis but not necrosis. NDV-D90 induced apoptosis via the intrinsic and extrinsic signaling pathways in MCF-7 cells (ER-positive cells) during E2 exposure not only by disrupting the E2/ERα axis and enhancing GPER expression but also by modulating the expression of several apoptosis-related proteins through ERα-and GPER-independent processes. NDV-D90 promoted apoptosis via the intrinsic signaling pathway in BT549 cells (ER-negative cells), possibly by impairing E2-mediated GPER expression. Furthermore, NDV-D90 exerted its antitumor effects in vivo by inducing apoptosis. Overall, these results demonstrated that NDV-D90 promotes apoptosis by differentially modulating the expression of ERα and the GPER in ER-positive and negative BC cells exposed to estrogen, respectively, and can be utilized as an effective approach to treating BC.

肺癌是全球发病率及病死率最高的恶性肿瘤,其远处转移常发生于骨、脑、肝和肾上腺,而发生于小肠十分罕见[1].因其症状常隐匿,且诊断也较困难,国内外文献少有报道.上海市东方医院胃肠肛肠外科收治了1例肺鳞癌小肠转移并消化道出血的病人.现报告如下. 1 病例简介 病人男性,45岁.因“咳嗽咳痰伴间断黑便5个月余,右胸壁疼痛1月余”于2017-12-18入院.正电子发射计算机断层显像(PET-CT)提示右上肺巨大软组织肿块伴右上肺不张,胸廓入口处气管旁小淋巴结,考虑恶性肿瘤;左中上腹小肠局部管壁明显增厚,病灶旁见肿大淋巴结,考虑恶性肿瘤;右肩部皮下软组织葡萄糖代谢增高,考虑肿瘤转移.

Abstract Background: Colorectal adenocarcinoma (CRC) ranks one of the 5 most lethal malignant tumors both in China and worldwide. Emerging evidences have revealed the importance of gut microbiome on CRC, thus microbial community could be termed as a potential screen for early diagnosis. Importantly, compared with the whole microbial community analysis, few numbers of bacteria genus as non-invasive biomarkers with high sensitivity and specificity causing less cost would benefit more in clinical. Methods: Here we analyzed the gut microbiome from 226 CRC patients and 156 healthy people by 16s rRNA sequencing. We analyzed the microbiome diversity between CRC patients and healthy controls. We used ExtraTrees classifier to screening the biomarkers and took SVM (Support Vector Machine) model to test the specificity and sensitivity of our biomarkers. Results: Compared with the healthy gut, the microbial composition are divergent in CRC, especially the increase of some bacteria related to CRC and the decrease of some healthy bacteria. 40 bacteria genus exhibiting high weight for the healthy and CRC microbiome classification were screened as biomarkers for CRC. In addition, the combination of 40 biomarkers and FOBT showed an outstanding sensitivity and specificity for discrimination CRC patients from healthy controls. Conclusion: The method could be used as a non-invasive method for CRC early diagnosis.

In order to improve the adhesion between a PGA scaffold and islet cells, it is necessary to find a suitable method to modify the scaffold.

摘要 背景:胰岛移植是一种比较有效的糖尿病治疗方法,运用生物医学工程技术将生物材料引入胰岛移植,可保 持胰岛活力,提高移植效率。 目的:将培养的聚乙醇酸-胰岛移植物移植到糖尿病受体大鼠肌肉内,观察聚乙醇酸-胰岛移植物治疗糖尿病 的效果。 方法:取Wistar大鼠 18只,采用腹腔注射链脲菌素方法建立糖尿病模型,建模成功后即刻随机分 3组干预, 对照组腿部肌肉注射生理盐水,实验 1组腿部肌肉注射异种胰岛细胞,实验 2组腿部埋植聚乙醇酸-异种胰岛 细胞移植物。移植后 3,7,14,21,30 d,检测各组大鼠血糖及胰岛素水平;移植后 14,30 d,取实验组 移植物标本,进行扫描电镜观察。 结果与结论:1实验 1组、实验 2组移植后 3,7 d的血糖值明显低于对照组(P < 0.05),实验 2组移植后 14, 21,30 d的血糖值低于实验 1组(P < 0.05);2实验 1组、实验 2组移植后 3,7 d的胰岛素水平明显高于对 照组(P < 0.05),实验 2组移植后不同时间点的胰岛素水平明显高于实验 1组(P < 0.05);3扫描电镜显示, 移植后 14 d,实验组可见较多形态良好的胰岛细胞仍黏附于聚乙醇酸纤维支架上,胰岛细胞间可见呈细纤维 交织成网状的细胞外基质形成,在胰岛细胞周围可见少量红细胞;随着埋植时间的延长,聚乙醇酸纤维支架 开始降解,纤维支架逐渐断裂,长的纤维降解为短的纤维,30 d后最终支架层层脱落成碎片;4结果表明, 聚乙醇酸-胰岛细胞移植能有效降低糖尿病大鼠的血糖水平,并提高血清胰岛素水平。 关键词: 聚乙醇酸;胰岛;糖尿病;扫描电镜;生物材料;国家自然科学基金 主题词: 聚乙醇酸;糖尿病;胰岛;组织工程 基金资助: 国家自然科学基金资助项目(30570931)

Schwann cell (SC) is the primary structural and functional part of the peripheral nervous system, and it plays a key role in the repair and regeneration of peripheral nerve. In order to develop a suitable scaffold for SC nerve tissue engineering, three kinds of scaffolds, including pristine collagen, pure oxidized regenerated cellulose-Ca (ORCCa) and collagen/ORC-Ca composite scaffolds, have been fabricated for carrying SC in this study. SC is then seeded on the scaffolds to form SC-scaffold nerve tissue engineering composites and evaluate their biocompatibility. The chemical and physical structure of the scaffolds are investigated by FTIR, NMR and SEM. The wettability of the collagen/ORC-Ca composite scaffold is close to that of pristine collagen, and the tensile strength of the composite scaffold (0.58 MPa) is better than that of pristine collagen (0.36 MPa). Cytotoxicity, cell proliferation, cell adhesion and western blotting assays are conducted to evaluate the biocompatibility and properties of different scaffolds. The results show that the three scaffolds exhibit no toxicity, and the proliferation rate of SC on the collagen/ORC-Ca composite scaffold is significantly higher than that of the other scaffolds (p < 0.05). The number of the adhesion cells on the composite scaffold (244.67 ± 13.02) is much more than that in the pure ORC-Ca group (p < 0.01). Furthermore, the expression of N-Cadheri and PMP22 proteins in the collagen/ORC-Ca composite scaffold is significantly superior to the other two scaffolds (both p < 0.01). Therefore, it could be concluded that the collagen/ORC-Ca composite is a promising candidate as a scaffold for carrying SC to form nerve tissue engineering composites in order to assist the peripheral nervous in the repair and regeneration.

直肠癌目前是世界上最常见的恶性肿瘤之一,其手术适应证、手术方式及时间的选择仍有较多争议.本文通过对低位直肠癌患者各项相关数据的统计学计算,分析肿瘤下缘距肛缘的距离在低位直肠癌保肛手术中的影响,探讨腹腔镜手术及术前新辅助治疗在低位直肠癌保肛手术中的作用.报告如下.

Background: Colorectal cancer incidence and mortality have been increasing in China and as one of the most important health problems facing the nation. Adequate dissemination of correct information about colorectal cancer could help in reducing cancer-related morbidity and mortality. This study aims to assess the completeness and reliability of colorectal cancer-related information available on the video website of Youku in mainland China. Methods: Youku (https://www.youku.com/) was searched on September 15, 2016 for the search terms colorectal cancer. Only Chinese videos were included. Two reviewers independently evaluate the videos for characteristics, information source and usefulness. Content was analysed under six categories (aetiology, anatomy, symptoms, preventions, treatments and prognosis). Completeness was evaluated with a checklist developed by the researchers. Any discrepancies were resolved by consensuses. SPSS software was used to analyze data. Results: There were 242 videos with relevant information about colorectal cancer. The type of source were as follows: independent users, 118 (49%); health information web sites, 60 (25%); medical doctors, 31 (13%); news network, 22 (9%); and hospital/university, 11 (4%). In all, 57% of videos had useful information about colorectal cancer, 21% were misleading. Videos posted by medical doctors (P = 0.021) and health information web sites (p = 0.039) were less incomplete than videos by independent users. Of the Traditional Chinese medicine (TCM) videos, 97 (76%) had information about treatments of colorectal cancer. 30% TCM videos contain misleading information, whose misleading rate was higher than total's (21%). Conclusions: The colorectal cancer videos in mainland China represented by Youku varied base on ownership and content and information incompleteness were fairly high. It is necessary that professionals adapt to the advanced technology and think useful methods to solve the variable quality of information of internet video websites in mainland China.

目的 探讨腹腔镜远端胃癌消化道重建行非离断Roux-en-Y(uncut Roux-en-Y,Roux-en-Y)吻合术的安全性与可行性.方法 回顾性分析上海市东方医院胃肠外科2016年1月至2016年12月间15例接受腹腔镜远端胃癌根治术改良非离断Roux-en-Y吻合术患者的临床资料.结果 本研究15例患者平均手术时间(175±30)分钟,手术操作顺利,术后无严重并发症及死亡病例,术后无非离断口再通.结论 在腹腔镜远端胃癌根治术时,使用改良非离断Roux-en-Y吻合术是安全可行的.

Objective To study the application status and feasibility of natural orifice specimen extraction surgery(NOSES)in colorectal neoplasms by collecting the NOSES cases in 79 hospitals around China.Methods A total of 718 cases of NOSES were collected.The data of patients included demographic data,surgical data,postoperative pathology and follow-up data.Results The average age of patients was 59.4±10.8 years,the average BMI is 22.9±6.3 kg/m2,72.3% of patients received rectal NOSES,and 3.5% of patients received neoadjuvant therapy.Pathological results showed that patients in stage I~IV were 31.3%,26.8%,30.8% and 0.8% respectively.The proportion of adenocarcinoma was 62.1%,the average diameter of tumor was 4.1±1.8 cm,and the number of lymph nodes was 13.4±3.5.In this study,76.2% of patients underwent laparoscopic anterior resection combined with NOSES.90.4% of the patients were treated with rectal specimen extractions and 9.6% by vaginal extractions.The average operation time was 210.5± 39.4 minutes,the average blood loss was 61.8±23.1 ml,the average postoperative exhaust time was 44.5±10.3 hours,and the time of postoperative feeding time was 64.9±14.6 hours,the average of postoperative hospital stay was 12.1±4.0 days,the incidence of complications was 10.6%,postoperative anal dysfunction accounted for 1.5% of the total,no vaginal dysfunction was detected.Conclusion NOSES in colorectal neoplasms is widely carried out in China and has shown great potential for promotion.At the same time,NOSES surgery followed the requirement of tumor radical surgery,presenting with good short-term effect.Therefore,this technology is a safe and reliable minimally invasive surgery.

Objective To investigate the mechanisms of NDV-D90 killling human oral squamous cell carcinoma CAL-27.Methods CAL-27 cells were infected with D90 (MOI=0.1) and cells were processed for flow cytometry at different time points(0,12,24 and 36 h after infection).NDV-D90 strains influence on apoptosis of human oral squamous cell carcinoma CAL-27 cells was detected with Annexin V-FITC/PI stai-ning and flow cytometry; CAL-27 cells were cultured in a 24-well plate and infected with D90 at an MOI of 0.1 for 12 h, the NDV-D90 strains effect on CAL-27 cell morphology were observed with the militiamen DAPI fluorescence;CAL-27 cells were infected with D90 MOI =0.1) at different time points (12,24 and 36 h after infection ) ,while the normal control group was set up.The protein content of the lysates was meas-ured using a BCA Protein Assay kit, and the expression of apoptosis-related proteins of cultured CAL-27 cells was detected using Western Blot detection.Results NDV-D90 strain could induce apoptosis of CAL-27,and the percentage of the apoptotic cells increased with increasing of the infection time [the percentage of CAL-27 cells infected by NDV D90 that were apoptotic significantly increased from (3.68 ±1.50)% at 0 h to (19.22 ±0.99)%,(82.8 ±0.74)% and (99.69 ±0.13)% at 12,24 and 36 h respectively];D90 induced a typical apoptosis-like morphology,characterized by chromatin condensation and nuclear fragmenta-tion;with the increasing of virus effects,the levels of cytochrome C increased,the levels of procaspase-9 and procaspase-3 decreased,and the level of procaspase-8 was almost unchanged,however,TNF-αprotein was not detected.Conclusion NDV-D90 strain can induce apoptosis in human oral squamous cell carcinoma CAL-27, and D90 decreasing the viability of CAL-27 is time-dependent;the apoptosis induced by D90 is mainly dependent on the mitochondrial pathway ,while the death receptor pathway is not activated or has very little effect.

目的 探讨腹腔镜直肠癌前切除术中转开腹的影响因素. 方法 回顾性分析2006年4月～2012年10月我科472例腹腔镜直肠癌前切除术的临床资料,采用单因素分析及logistic回归分析中转开腹的原因. 结果 中转开腹47例,占10.0％(47/472).单因素分析显示,BMI、肿瘤直径、肿瘤浸润深度、大体分型、术中出血、术野暴露情况及手术团队成员稳定性有显著性差异(P＜0.05).logistic回归分析显示,肿瘤浸润(OR =2.453,95％ CI:1.251 ～4.773,P=0.009)、术中出血(OR=1.116,95％ CI:1.052 ～1.232,P=0.002)及术野暴露情况(OR=0.491,95％ CI:0.250～0.964,P=0.039)是中转开腹的独立影响因素. 结论 肿瘤浸润较重、局部病期较晚的患者不推荐腹腔镜手术.术中出血过多难以控制须立即中转开腹.腹腔镜手术组应固定人员组成,尤其是持镜医师不能随意更换,良好的暴露是成功完成腹腔镜直肠癌前切除术的关键.

Breast metastasis can mimic a primary breast cancer and may present confusing diagnostic problems. Its management differs from that of primary breast cancer, as illustrated by this case of a colonic metastasis to the breast. An 80-year-old woman whose breast tumor showed features of adenocarcinoma received wide excision. After one month, the patient presented with abdominal pain. In evaluation colon cancer was diagnosed. Considering endoscopy indicated stenosis of the sigmoid that would lead to obstruction of colon, laparoscopy-assisted sigmoidectomy was done. We searched Pubmed up to April, 2016. Metastasis to the breast from colorectal carcinoma is very rare and only 32 such cases have been reported in the literature. Most patients were female, the median age was 51.1 years, and the majority of metastases (48%) were to the left breast. In 5 cases the patients died an average of 14.5 months after the diagnosis of breast metastasis. Colorectal carcinoma metastatic to the breast is indicative of widely disseminated disease and a poor prognosis. It is important to make this distinction between primary breast cancer and a metastatic process, in order to provide the most effective and appropriate treatment for the patient and to avoid any harmful or unnecessary surgical procedures.

Objective To investigate surgical skills, experience, and efficacy of laparoscopic anterior resection of rectal cancer. Methods Clinical data and operation videos of 472 patients who underwent laparoscopic rectal resection between April 2006 and October 2012 in this department were analyzed retrospectively.The surgical resection followed principles of total mesorectal excision ( TME) and no-tumor techniques, which dissected through medial access and reconstructed digestive tract by double-stapling technique ( DST) . Results ①The laparoscopic anterior resection was successfully performed in 425 patients.The operative time was 62-238 min, with an average of 119 min.The blood loss was 15-320 ml, with an average of 62.5 ml.②The number of lymph node removal was 7-41, with an average of 19.Central ligation of the supplying vessels was performed.Pathological evalution showed 379 specimens as Grade 3 (89.2%) and 46 as Grade 2 (10.8%).③Conversions to laparotomy were required in 47 cases, 22 of which were caused by unfamiliar cooperation and unclear exposure due to changes of operators, 3 of which were caused by pelvic adhesion, 13 of which were caused by uncontrollable bleeding, and 9 of which were caused by advanced local disease severer than preoperative evaluation.④There was no postoperative mortality.Complications occurred in 37 cases (8.7%) cases, including 5 cases of anastomotic bleeding, 9 cases of anastomotic leakage, 14 cases of wound infection, and 9 cases of incision hernia.⑤The 1-, 3-and 5-year survival rates of 332 cases followed for 24-102 months (mean, 58 months) were 99.7%, 90.3%, and 79.1%, respectively. Conclusions The key steps of laparoscopic anterior resection of rectal cancer should be noted, such as the skills of presacral and perirectal dissection, which play an important role in TME resection, keeping resected and removed specimens intact.Laparoscopic indications should be strictly controlled to reduce conversion rate.The staff of laparoscopy group should not be changed frequently to ensure the team cooperation.