The intricate involvement of Rho GTPases in a multitude of human malignancies and their diverse array of biological functions has garnered substantial attention within the scientific community. However, their expression pattern and potential role in gastric cancer (GC) remain unclear. In this study, we successfully identified two distinct subtypes associated with Rho GTPase-related gene (RGG) through consensus clustering analysis, which exhibited significant disparities in overall survival and the tumor microenvironment. Subsequently, an extensively validated risk model termed RGGscore was meticulously constructed to prognosticate the outcomes of GC patients. This model was further assessed and validated using an external cohort. Notably, the high RGGscore group was indicative of a poorer prognosis. Univariate and multivariate Cox regression analyses unveiled the RGGscore as an autonomous prognostic indicator for GC patients. Subsequent external validation, utilizing two cohorts of patients who underwent immunotherapy, demonstrated a significant correlation between a low RGGscore and improved response to immunotherapy. Additionally, the expression levels of three genes associated with RGGscore were examined using qRT-PCR. Taken together, a pioneering RGGscore model has been successfully established, showcasing its potential efficacy in offering valuable therapeutic guidance for GC.

目的 通过分析1例腹茧症(abdominal cocoon syndrome,AC)病例,探讨这一罕见病的诊断与治疗.方法 回顾性分析腹茧症患者1例,并复习相关文献.结果 患者男性,72岁,以恶心、呕吐、腹痛入院,消化道造影考虑高位不全肠梗阻,腹部CT可疑AC,行剖腹探查术见胃、小肠、结肠及肠系膜均被纤维膜包裹,遂行肠黏连松解术,术后患者症状好转出院.结论 AC缺乏特征性临床表现,患者通常以恶心、呕吐、停止排气排便等肠梗阻表现就诊,需通过病史及影像学检查、甚至剖腹探查来诊断.手术是最为彻底的治疗方法,可有效缓解患者症状.

Objective To evaluate the value of hand assisted laparoscopic radical resection for distal gastric cancer. Methods The clinical data of 80 patients with advanced gastric cancer from August 2015 to December 2017 were retrospectively analyzed. Among them, 30 patients underwent hand-assisted laparoscopic surgery, 25 patients underwent open surgery, and 25 patients underwent laparoscopic assisted surgery. The operative time, bleeding volume, number of recected lymph nodes, time to postoperative exhaust, postoperative complications, length of hospitalization, hospitalization expenses, length of incision and so on were compared among the three groups. The data were analyzed with SPSS 21.0 software. Measurement data are expressed as mean±standard deviation. ANOVA was used to compare measurement data, and the chi square test or Fisher exact test was used to compare count data. P<0.05 indicated that the difference was statistically significant. Results There was no significant difference in the number of recected lymph nodes, postoperative hospitalization expenses, or postoperative complications among the three groups (P>0.05). The hand-assisted laparoscopic surgery group, laparoscopy assisted surgery group, and open surgery group had significantly different operative time [(186.30±15.27) min vs (230.80±17.06) min vs (183.36±16.03) min] , intraoperative bleeding volume [(93.33±46.86) mL vs (98.80±55.10) mL vs (246.80±92.90) mL] , time to postoperative exhaust [(2.3±0.6) d vs (2.42±0.44) d vs (3.04±0.56) d] , length of stay [(8.90±1.19) d vs (9.40±1.44) d vs (10.92±1.73) d] , and incision length [(7.97±0.49) cm vs (8.04±0.61) cm vs (24.04±2.11) cm] (P<0.001 for all). The length of incision, blood loss, time to postoperative exhaust, and hospital stay were significantly lower in the hand-assisted laparoscopic operation group and laparoscopically assisted operation group than in the open operation group (P<0.001). The operative time was significantly shorter in the hand-assisted laparoscopic surgery group and laparotomy group than in the laparoscopically assisted operation group (P<0.001). Conclusion Hand assisted laparoscopic distal gastrectomy is safe and feasible, can achieve the radical effect of open surgery for tumor resection and lymph node dissection, and does not increase the economic burden of patients. Hand assisted laparoscopic surgery has the advantages of less intraoperative bleeding, faster postoperative recovery, and shorter operative time than laparoscopic assisted surgery. Key words: Hand assisted laparoscopy; Laparoscopy assisted; Traditional laparotomy; Advanced gastric cancer

Objective To explore the influence of laparoscopic totally external inguinal hernia repair (TEP) on the blood supply and function of the testicle in male patients.Methods There were 34 male patients with unilateral inguinal hernia using TEP method,the blood test and ultrasound for reproductive system of patients were conducted on the day before operation,the 4th and the 24th week after operation respectively in the Second Hospital of Hebei Medical University from April 2013 to April 2014.The indexes included the WBC in blood routine,the concentration of serum testosterone,the testicular temperature,the testicular volume (TV),the diameter of testicular artery [the systolic peak of blood flow velocity (PSV),the end-diastolic blood flow velocity (EDV)],the resistance index (RI) in testicular artery and the diameter and flow velocity of spermatic vein and so on.Results All the 34 cases were successfully operated,but there were two cases lost follow-up at the 24th weeks after the operation,the data of the other patients was collected.The WBC at the 4th week after operation was higher than that of the day before operation (P ＜ 0.05),but there was no statistical significant difference between the WBC at the 24th week after operation and the day before operation (P ＞ 0.05).The concentration of serum testosterone at the day before operation and the 4th week after operation did not exist significant difference (P ＞ 0.05),the same condition also existed at the day before operation and the 24th week after operation (P ＞ 0.05);there were no statistical significant differences in the data of the testicular temperature,the testicular volume,the diameter of testicular artery,the diameter and flow velocity of spermatic vein and so on in the affected side among the day before operation,the 4th week and the 24th week after operation (P ＞ 0.05);all the data also did not exist statistical significant difference between the affected side and the unaffected side at the day before operation,the 4th week and the 24th week after operation (P ＞ 0.05).Conclusions The TEP operation is safe and viable,and it has no significant influence on the blood supply and function of the testicle in male patients.

We designed a hand-assisted device for laparoscopic D2 dissection for gastric cancer that allows the placement in peritoneal cavity of surgical instrument and the entry and maneuvering of the left hand of a surgeon. Here, we describe the surgical technique for radical resection of gastric cardia cancer using the hand-assisted laparoscopic technique. Our preliminary experience with three gastric cardia cancer patients shows that this new approach is safe, feasible and effective and may offer a cost-effective to other.

患者女性,53岁,主因腰背部胀痛1个月于2016年3月就诊于河北医科大学第二医院门诊,体格检查无阳性体征。腹部超声显示可疑脾占位性病变,CT显示脾占位性病变,考虑脾淋巴管瘤(图1)。患者既往于2009年9月因“下腹部不适2个月”于河北医科大学第二医院行CT检查,发现盆腔肿物,住院治疗；在全身麻醉下行传统开腹手术探查,发现肿物来源于卵巢,遂按卵巢肿瘤手术原则,行子宫、双附件、大网膜及阑尾切除术；术后病理回报为卵巢黏液性囊腺瘤,术后恢复良好。术后每3个月复查CA19-9,CA19-9水平一直波动在200 U/ml左右,但近6个月来CA19-9水平呈上升趋势；2016年3月复查CA19-9,CA19-9为672.90 U/ml。为明确脾占位性质,决定再次手术治疗,但患者既往有手术史,腹腔情况复杂,传统腹腔镜手术操作风险大,遂决定行改良手助腹腔镜脾切除术。

BACKGROUND & AIM:Gastric cancer is a leading cause of cancer-related mortality worldwide. We have invented a novel hand-assist device that allows the placement of surgical instruments and the maneuvering of the surgeon's hand, and we have established a new hand-assisted laparoscopic technique called Three United Laparoscopic Surgery (TULS) for laparoscopic dissection of advanced gastric cancer. The present study aimed at exploring the usefulness of TULS in the treatment of advanced gastric cardia cancer. METHOD:A retrospective study on 100 patients with advanced gastric cardia cancer admitted from January 2014 to June 2015 was done. There were 38 cases of TULS, 30 cases of laparotomy, and 32 cases of laparoscopy-assisted surgery. Statistical comparisons between three treatment groups in operative time, incision length, amount of bleeding, number of lymph nodes dissected, time to flatus after surgery, rate of postoperative complications, hospital stay, and expense were done. RESULTS:For lymph node dissection, there were no significant differences between TULS, laparotomy, and laparoscopy-assisted surgery. However, compared with conventional laparotomy, TULS and laparoscopy-assisted surgery were found to be able to minimize incision length, reduce blood loss during surgery, lower postoperative complication rate, and shorten time to flatus and hospital stay. The differences were statistically significant (P < .05). The operative time of TULS was significantly shorter than that of the laparoscopy-assisted surgery (P < .05), and it was comparable to that of laparotomy. CONCLUSION:TULS is as efficient as laparotomy in lymph node dissection, and it shows the advantages of minimally invasive surgery. It can be considered a novel and promising surgical intervention for treatment of advanced gastric cancer.

目的：探讨改良入路腹腔镜手术或三联合外科手术在胃贲门癌根治术中的可行性。方法河北医科大学第二医院胃肠外科设计了一种能够将开腹手术、手辅助或腹腔镜手术结合在同一台手术的专利装置（腹腔镜手助器），并将这3种手术结合在一起的方式称为TULS。回顾性分析2014年6—8月行TULS贲门癌根治术治疗的8例患者临床资料。结果本组8例患者均顺利完成手术，无中转开腹患者，平均手术时间为186（155～218） min，术中出血量为110（80～200） ml，清扫淋巴结数目为27（19～38）枚／例，无术中及术后严重并发症的发生，于术后9～14（中位数11） d痊愈出院。术后随访5（4～6）月，均无明显不适。结论 TULS应用于贲门癌根治术，安全可行，短期疗效满意。

Objective To investigate the expression of miR-126 in human colon cancer cells and its effect on drug resistance. Methods Forty five cases of colon cancer tissues, para-carcinoma tissues and 30 cases of normal colon tissues were collected from July 2010 to August 2013 in Department of Oncology of our hospital. By detecting miR-126 expression levels using fluorescent PCR, culturing HCT116 cells in vitro, suppressing the expression of miR-126 by transfecting the suppressing sequence, we studied the drug resistance effect of miR-126 in HCT116 cells. Results The positive rate of miR-126 expression in colon cancer tissues was significantly lower than that in para-carcinoma tissues and normal tissues(P 0.05); moreover, this rate in para-carcinoma tissues was also lower than that in normal tissues, but the difference was not significant(P 0.05). No significant differences of miR-126 expression in age, gender, differentiation,and, tumor size were observed(P 0.05), but miR-126 expression was found to be associated with lymph node metastasis, Dukes′staging and clinical staging; the differences among miR-126 expression levels was also significant(P 0.05).In 0, 5, 10,20 mg/L oxaliplatin medium, cancer cell activity(absorbance) in miR-126 positive group was significantly lower than in miR-126 negative group(P 0.05). Conclusion The positive expression of miR-126 in colon cancer tissues is relatively low, whereas this positive expression can reduce drug resistance of cancer cells and is beneficial to the treatment of colon cancer.

目的观察复方聚乙二醇电解质散用于结直肠癌术前肠道准备对肠道免疫屏障组织损伤的影响。方法将60例结直肠癌手术患者随机分为观察组和对照组各30例,观察组术前口服复方聚乙二醇电解质散、对照组口服甘露醇行肠道准备。分别观察患者对C-反应蛋白(CRP)含量的变化。结果观察组患者CRP含量显著低于对照组(P<0.05)。结论复方聚乙二醇电解质散作为结直肠癌术前肠道准备能减轻肠道免疫屏障组织损伤,是较为安全的一种肠道准备方法。

Recent data support the role of S100A10 in tumorigenesis. In this study, we evaluated the value of S100A10 positivity as a possible biomarker in colorectal cancer. We evaluated S100A10 positivity by immunohistochemistry in a large population of colorectal cancer patients ( n = 882). The relationships between S100A10 positivity and clinicopathological features and clinical outcome were analyzed. There were 36 % (319/882) tumors positive for S100A10 in all colorectal cancer samples. In contrast, normal colorectal epithelium was negative for S100A10 among all 562 specimens of adjacent normal mucosa. S100A10 positivity was correlated with poor differentiation ( p = 0.0012) and disease stage ( p = 0.003). S100A10 positivity was significantly correlated with shortened specific [log-rank p < 0.001; multivariate hazard ratio (HR), 1.49; 95 % confidence interval (CI), 1.09–2.04] and overall survival (log-rank p = 0.0012; multivariate HR, 1.34; 95 % CI, 1.06–1.73). Knockdown of S100A10 by siRNA significantly reduced the proliferation, migration, and invasion capacity of colorectal cancer cell lines. Our results suggest a role for S100A10 as a prognostic marker and potential therapeutic target in colorectal cancer.

患者 男性,39岁,1个月前无诱因出现间断发热,体温最高达39℃,伴寒战、头痛,曾就诊于当地医院,症状无好转,以"败血症"于2009年5月17日入院.体检:体温36.7℃,心率72次/min,呼吸18次/min,血压90/60 mmHg(1 mmHg=0.133 kPa).意识清楚,腹平坦,未见胃肠型及蠕动波,腹软,无压痛、反跳痛及肌紧张,肝脾未触及,叩诊鼓音,移动性浊音阴性,肠鸣音正常.查白细胞计数15.9×109/L,中性粒细胞0.90,红细胞沉降率53 mm/1h.

Objective To explore the clinical value of laparoscopic auxiliary adding small incisions operation for primary small bowel tumors. Methods Laparoscopic auxiliary operation and traditional open surgery were performed for 54 patients with primary small bowel tumors from Jan 2005 to Dec 2011, including 30 cases of laparoscopy and 24 cases of laparotomy. The clinical data were collected and analyzed retrospectively, including the CRP level of serum at 30 min preoperative and 6 h , 48 h after injury , operative time, blood loss, incision length, exsufflation time, complications, hospital stay and hospitalization cost. Results There were no significant differences in serum CRP level at 30min preoperative( P > 0.05 ) .The level of CRP at 6 h , 48 h after injury in laparoscopic group were significantly less than open group( P < 0.05 ) The operative time of laparoscopic and open group was ( 1.5 ± 0.2 ) h and ( 1.6 ± 0.2 ) h , respectively ( P > 0.05 ). The blood loss was ( 40.7 ± 7.7 ) ml and ( 67.3 ± 14.5 ) ml , respectively ( P < 0.05 ). The incision length was ( 4.3 ± 0.6 ) cm and ( 8.6 ± 1.1 ) cm , respectively ( P < 0.05 ). The exsufflation time was ( 1.6 ± 0.7 ) d and ( 2.3 ± 0.8 ) d , respectively ( P < 0.05 ). The operative complication rate was 0 and 19.04 % ( P < 0.05 ). The hospital stay was ( 6.2 ± 0.8 )d and( 9.0 ± 1.6 )d ( P < 0.05 ). The hospitalization cost was ( 7621.7 ± 590.3 ) yuan and ( 7444.2 ± 472.2 ) yuan ( P > 0.05 ). Conclusions Laparoscopic auxiliary operation is not only effective for patients with advantages of less injury, less bleeding and more rapid recovery, but also it could help to clear diagnosis for small bowel tumors.