目的:探讨腹腔镜脾部分切除术(LPS)在脾脏良性病变治疗中的应用价值.方法:选取2019年1月至2021年12月收治的脾脏良性病变患者64例,按随机数字表法分为两组,各32例.对照组予以腹腔镜全脾切除术(LTS)治疗,观察组接受LPS治疗.比较两组手术情况,手术前后免疫功能、生活质量及并发症发生情况.结果:观察组手术时间长于对照组,术中出血量多于对照组,术后排气时间、排便时间及住院时间短于对照组,差异有统计学意义(P<0.05);观察组术后CD3+、CD4+、CD4+/CD8+水平高于对照组,CD8+水平低于对照组,差异有统计学意义(P<0.05);观察组术后生理、心理、社会及环境领域评分高于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05).结论:采用LPS治疗脾脏良性病变能缩短患者术后排气、排便及住院时间,减轻患者免疫功能损害,减少并发症发生,加快患者生活质量恢复.

目的 研究外伤性肝破裂患者腹腔镜修补术后并发症的危险因素.方法 收集2017年4月至2020年10月本院102例外伤性肝破裂患者作为研究对象,患者均接受腹腔镜下修补术,记录并发症发生情况.采用Logistic多因素分析法探讨其术后并发症的危险因素,并建立指数方程,分析其判断并发症的应用价值.结果 102例患者中,共发生并发症38例,发生率为37.25％,其中术后感染14例,术后胆漏12例,出血8例,肝脓肿4例.Logistic多因素分析结果显示,受伤至入院时间、失血量、低血压持续时间及Alb水平是影响术后并发症的独立影响因素(P<0.05).根据Logistic多因素分析结果建立指数方程Y=0.603 X1+0.654 X2+0.471 X3+0.798 X4+0.899 X5(X1=受伤至入院时间,X2=失血量,X3=肝破裂分级,X4=低血压持续时间,X5=Alb).ROC分析结果显示指数方程判断术后并发症的AUC为0.796(SE=0.066,95％C I=0.666～0.926,P<0.001).结论 外伤性肝破裂患者腹腔镜下修补术后并发症发生率较高,其并发症与受伤至入院时间、失血量、肝破裂分级、低血压持续时间及A lb水平相关.

The treatment of peritoneal metastasis (PM) has been a long-standing significant challenge in clinical oncology. In the past two decades, considerable progress has been made in the diagnosis and treatment of PM, due to concerted research efforts in the field. This is characterized by the development and refinement of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). In this time, China has achieved remarkable success in PM prevention and treatment, particularly by developing new treatment methods, optimizing new technologies, cultivating groups of experts who specialize in PM, establishing nationwide academic organizations, and collaborating with international organizations such as the Peritoneal Surface Oncology Group International (PSOGI). Examples of landmark progress in China include a series of clinical studies on PM associated with gastric cancer, which have been internationally adopted as reference data; the adoption and promotion of the China-HIPEC (C-HIPEC) concept; and hosting the 12th International Congress on Peritoneal Surface Malignancies in 2021. These historical achievements have contributed to China becoming one of the international leaders in the development of treatments for PM. However, because of the large number of patients requiring effective CRS and HIPEC, the prevention and treatment of PM in China requires further development. Nationwide concerted efforts among clinical oncologists should be emphasized for further advancement in this crucial area of clinical oncology.

目的 探究半乳糖凝集素9(Galectin-9)、NADPH氧化酶1(NOX-l)mRNA在胆囊癌中表达变化及与癌细胞生物学行为指标的关系.方法 选取本院胆囊癌患者84例,检测对比癌组织与与距离癌组织边缘5 cm左右的癌旁正常组织中Galectin-9、NOX-1 mRNA相对表达量,分析癌组织中Galectin-9 mRNA与NOX-1 mRNA关联性及两者与临床病理特征、癌细胞生物学行为指标的关系.结果 癌组织中Galectin-9 mRNA相对表达量低于癌旁正常组织,NOX-1 mRNA相对表达量高于癌旁正常组织,差异有统计学意义(P＜0.05);癌组织中Galectin-9 mRNA与NOX-1 mRNA呈负相关(r-=-0.688,P＜0.001);Galectin-9 mRNA与临床分期、淋巴结转移、分化程度显著相关(P＜0.05);NOX-1 mRNA与临床分期、淋巴结转移、分化程度、肿瘤浸润深度显著相关(P＜0.05);Galectin-9 mRNA与p-STAT3、Bcl-2、MMP-7 mRNA呈负相关,NOX-1 mRNA 与p-STAT3、Bcl-2、MMP-7 mRNA呈正相关(P＜0.05).结论 Galectin-9 mRNA下调、NOX-1mRNA上调可能是胆囊癌发生的重要机制,且两者表达水平与临床病理特征、生物学行为指标密切相关,能为临床诊治提供有效信息.

Objective:To compare the efficacy and safety of laparoscopic combined with duodenoscope (IO-ERCP/EST+ LC) and laparoscopic combined with intraoperative choledochoscope (LC/LCBDE+ IOC) in the treatment of gallstones and choledocholithiasis in the elderly.Methods:From October 2017 to October 2020, clinical data of 80 elderly patients with gallstones and choledocholithiasis were analyzed retrospectively. According to different surgical plans, 40 cases were divided into the group A (IO-ERCP/EST+ LC), and 40 cases were divided into group B (LC/LCBDE+ IOC). Statistical software SPSS21.0 were used for data analysis. Measurement data such as intraoperative and postoperative indicators, liver function indicators and other measurement data were expressed as (±s), and were examined by independent t test. Chi-square test were performed for the analysis of postoperative complications, stones Counting data such as clearance rate and stone residual rate. A P value of <0.05 was considered statistically significant difference.Results:The operation time in group A were significantly shorter than that of group B (P<0.05). There were no statistically significant difference between groups in terms of postoperative complications such as stone removal rate, residual stone rate, postoperative bleeding, perforation, bile leakage, pancreatitis and cholangitis (P>0.05). There were no statistically significant difference between groups in terms of liver function levels of bilirubin, ALT, AST, and ALPbefore and after the operation (P>0.05); The postoperative exhaust time of group A was shorter than that of group B, and the hospitalization time and cost of group A were higher than that of group B, with statistically significant differences (P<0.05).Conclusions:The IO-ERCP/EST+ LC treatment has a shorter operation time and quicker postoperative recovery, however the hospitalization cost is relatively high. Clinically, the most reasonable and optimal program choice should be made according to the specific conditions of the patient.

Objective:s To evaluate the impacts of prior surgical scores(PSS) on the clinical efficacy and perioperative safety of cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) for pseudomyxoma peritonei(PMP).Methods:From the comprehensive PMP database, we collect the cases treated for the first time by CRS+ HIPEC, to form this study cohort. The clinicopathological features, PSS, CRS+ HIPEC details, overall survival(OS), and serious adverse events(SAEs) are systematically analyzed, to study the correlations between PSS and OS or SAEs.Results:335 PMP cases received standardized CRS+ HIPEC in this study. The median OS is 58.2 months for PSS-0 patients, 63.7 months for PSS-1, and 55.4 months for PSS-2/3, with no statistically significant differences in OS among the different PSS groups(χ 2=0.499, P=0.779). Subgroup analysis by pathologic types also found no statistically significant differences among the different PSS groups. Moreover, no significantly statistical differences are observed in overall SAEs(χ 2=0.625, P=0.722), CRS-related SAEs(χ 2=0.267, P=0.901), and non-CRS-related SAEs(χ 2=0.677, P=0.715), among the different PSS groups. Conclusions:PSS does not pose significant impacts on the efficacy and safety of CRS+ HIPEC for PMP patients at experienced treatment center.

Objective:To investigate the risk factors of acute urinary infections after ureteroscopy lithotripsy.Methods:From February 2013 to November 2014, 843 patients who underwent retrograde cavity lithotripsy in Guizhou medical university affiliated hospital were selected.All patients were divided into two gropus according to whether or not acute urinary infection occurred postoperativel, group A without infection(747 cases), group B with infection(96 cases). Two groups of patients with clinical data were collected, and the analysis of retrograde cavity gravel postoperative concurrent risk factor for acute urinary infection source was proformed by using single factor analysis and logistic regression analysis.Results:Univariate results showed that age, sex, stone diameter, operation time, diabetes, surgical mode selection and preoperative antibiotics were the influencing factors for postoperative urinary infection. Logistic regression analysis showed that the independent risk factors for postoperative acute urinary infection were female, stone diameter>2 cm, operation time >90 min, diabetes, 10>/HP of urinary leukocytes, and positive urine culture( P<0.05). Conclusions:Female patients, >2 cm in stone diameter, >90 min in operation time, diabetes, 10>/HP of urinary leukocyte, and positive urine culture are risk factors for postoperative acute urinary tract infection in these patients. Postoperative vigilance should be paid attention to the occurrence of urinary tract infection in these patients.

Objective: To establish the patient derived xenograft (PDX) model of pseudomyxoma peritonei (PMP), and identify the key characteristics of tumor biology of this model, in order to provide a reliable model for studying the pathological mechanisms and new therapeutic strategies of PMP. Methods: PMP tumor tissue was obtained from surgery and cut into pieces after washing. Then tumor pieces were implanted subcutaneously in BAL B/c-nu mice for 6 stable passages. In the 7th passage, tumor tissue was implanted orthotopically into abdomen. Subcutaneous tumor and orthotopic tumor were then homogenized to make tumor cell suspension, implanted into abdomen of 10 BAL B/c-nu mice through midline laparotomy, 100 μl for each. The key experimental parameters including body weight changes in the observation period, experimental peritoneal cancer index (ePCI) score at the autopsy, histopathological and immunohistochemical characteristics, and gene expression profiles by high-throughput whole-genome exon sequencing were detected and recorded. Results: The successful rate of established orthotopic PDX model of human PMP was 100% (10/10). The animals showed smooth body weight increases after tumor inoculation until day 27, then the body weight began to decrease steadily. Widespread tumor dissemination of PMP tumor through the whole abdomen was found by autopsy, including the diaphragm, liver, spleen, stomach, kidney, parietal peritoneum, bowel and mesenterium. Gelatinous ascites was also observed in abdominopelvic cavity. The ePCI score ranged from 5 to 9, with a 8 of median ePCI. Histopathological studies showed peritoneal mucinous carcinomatosis accompanied with signet ring cells (PMCA-S), obvious tumor cell atypia and parenchymal invasion.Immunohistochemistry showed the expressions of MUC1, MUC2, MUC5AC, CEA, CA199, CK20, CDX-2 and Ki-67 were positive, MUC6, CK7 and p53 were negative. Whole-exome sequencing identified that the most significant genetic alteration is the exon10 missense mutation c. 1621A>C of KIT gene, the mutation abundance was 89.7%. Conclusion: PDX model of PMCA-S is successfully established, which displays the characters of high-degree malignancy, high proliferation and strong aggressiveness.

目的 分析Ⅱ、Ⅲ型胃食管结合部腺癌腹腔淋巴结转移病例的临床资料,探讨临床病理特征与腹腔淋巴结转移之间的关系.方法 收集2017年6月1日-2018年5月31日解放军总医院收治的53例Ⅱ、Ⅲ型胃食管结合部腺癌临床资料,采用Pearsonx2检验和logistic回归分析进行腹腔淋巴结转移的单因素和多因素分析.53例患者,男性46例,女性7例,中位年龄63岁.结果 单因素分析显示:性别、年龄、体质量指数、Siewert分型、Bormann类型以及手术切除方式与胃食管结合部肿瘤淋巴转移无关(P＞0.05),肿瘤大小、分化程度、浸润深度与淋巴转移相关(P＜0.05).多因素回归分析提示浸润深度是胃食管结合部癌淋巴结转移的独立危险因素(OR=12.646,95％ CI:1.236～129.382,P=0.032).结论 胃食管结合部肿瘤淋巴结转移与病变的浸润深度密切相关.

腹膜假黏液瘤(PMP)以腹腔大量黏液聚积为最显著特征,黏液聚积常导致顽固性腹痛、进行性肠梗阻、腹腔脏器粘连及营养不良.但肿瘤高表达黏蛋白的分子病理机制尚不明确,并缺乏相应治疗措施.人源异种移植模型(PDX模型)是探索PMP发病机制、干预性治疗的可靠平台.目前,我国尚缺乏构建PMP PDX模型的经验,国外已有多种不同病理分型的模型,但构建方法各不相同.对不同造模方法的研究有助于比较各种造模方法的优劣,以便构建更加标准的PMP PDX模型.

甲状腺结节是指多种原因导致甲状腺内出现一个或多个组织结构异常、可随甲状腺伴吞咽动作而上下移动的团块,该病是最常见的内分泌疾病之一,其患病率近年来呈明显增高趋势[1]. 临床工作中,半数甲状腺外科手术都属于甲状腺结节范畴[2]. 结节性甲状腺肿合并囊内出血也是甲状腺外科手术的常见原因之一.

Coding and noncoding RNAs serve a crucial role in tumorigenesis. Circulating RNAs have been recognized as a novel category of biomarkers for a variety of physiological and pathological conditions. To identify plasma RNA biomarkers for gastric cancer (GC), a genome-wide transcriptome analysis using GeneChip® Human Transcriptome Array, which contains probe sets covering exons of ~67500 coding and noncoding transcripts of annotated genes, was performed to screen for the RNAs that exhibited differential expression in the plasma samples of patients with GC and controls. The expression levels of 6 candidate RNAs, including regulator of G-protein signaling 18 (RGS18), integral membrane protein 2B, pro-platelet basic protein (PPBP), nucleosome assembly protein1-like 1, n324674 and ENST00000442382 were assessed in the plasma samples of 81 patients with GC and 77 healthy participants using reverse transcription-quantitative polymerase chain reaction. Furthermore, the expression levels of RGS18 and PPBP mRNAs were indicated to be significantly differentially expressed (P<0.0001) in an independent panel of plasma samples of 36 patients with GC compared with 34 healthy participants. The potential association of RGS18 and PPBP mRNA expression levels with clinicopathological features was subsequently analyzed. Receiver operating characteristic analysis indicated that the combination of these 2 mRNAs with an area under curve <0.812 was an improved indicator for gastric cancer compared with respective individual levels. The results of the present study indicate that RGS18 and PPBP mRNA expression was significantly downregulated in the plasma of patients with GC, and the combination of these 2 mRNAs may be a useful diagnostic or prognostic marker for GC.

25 Background: Liquid biopsy including circulating tumor cells (CTCs) and cell-free nucleic acids (cfNAs) has offered a minimally invasive approach for detection and measurement of gastric cancer (GC). Reports regarding associations between liquid biopsy and gastric cancer have been emerging rapidly in recent decades, yet their prognostic value still remains paradoxical. Methods: We searched Medline, Embase, Cochrane Central Register of Controlled Trials database for relevant studies that assessed the prognosis significance of CTCs and cfNAs in gastric cancer from peripheral blood(PB). Newcastle-Ottawa Scale (NOS) was used to assess the quality of evidence. Stata 12.0 was used for pooled analysis and subgroup analysis was performed to determine the association of CTCs or cfNAs’ presence and major clinical characteristics. Pooled results were displayed as hazard ratios (HRs) with their 95% confidence intervals (95% CI) with random effect models. Results: We identified 1258 studies, and then 43 were finally eligible for analysis. A total of 3792 patients were included for final evaluation. Pooled analysis showed that detection of certain CTCs, ctDNA or circulating miRNA was associated with poorer overall survival (OS) (CTCs, HR=2.05, 95%CI 1.65-2.55, p < 0.001; circulating miRNA HR=1.74, 95%CI 1.13-2.69, p=0.013; ctDNA, HR=1.77, 95%CI 1.28-2.44, p=0.001) and disease-free survival(DFS) (CTCs, HR=2.92, 95%CI 1.93-4.40, p < 0.001; circulating miRNA, HR=3.30, 95%CI 2.39-4.55, p < 0.001; ctDNA, HR=4.69, 95%CI 2.23-9.86, p < 0.001) of gastric cancer patients, regardless of the disease’s early or late stage. Conclusions: Several high-quality circulating biomarkers or detection methods for gastric cancer prognosis prediction were identified by subgroup analysis, including the Cellsearch system, cytokeratins, miR-20a, miR-200c, etc. Detection of these certain dysregulation circulating markers in patients’ PB indicates poor prognosis with advanced GC patients.

Background and Objectives We compared the clinical outcomes of laparoscopic and open spleen-preserving splenic hilar lymphadenectomy (LSPL and OSPL) for gastric cancer. Methods Results We performed a single-center, randomized, controlled trial to compare the short-term surgical outcomes between LSPL and OSPL. The study was registered in ClinicalTrials.gov (NCT02980861). A total of 222 patients were enrolled (114 in the LSPL group and 108 in the OSPL group). There were no significant differences between the two groups in operative time (P = 0.152), a number of harvested lymph nodes (P = 0.669) including no. 10 lymph nodes (2.1 +/- 1.4 vs 2.3 +/- 1.2, P = 0.713). The time taken for no. 10 lymph node dissection was similar in both groups (13.9 +/- 10.4 vs 15.2 +/- 9.4 minutes, P = 0.217); however, the LSPL group experienced less total blood loss (P < 0.001) and less blood loss during no. 10 lymph node dissection compared with the OSPL group (15.3 +/- 37.8 vs 29.5 +/- 36.4 mL, P < 0.001). The postoperative complication rates of LSPL and OSPL were 18.3% and 16.1%, respectively (P = 0.331). Conclusion LSPL is a safe and feasible surgical procedure in no. 10 LN dissection for patients with advanced proximal gastric cancer. Thus, this prospective trial is continuing.

Methyl jasmonate is found universally in the plant kingdom and functions to regulate plant growth and development, as well as in stress responses through signal transduction pathways. The present study aimed to investigate the anticancer effect of methyl jasmonate on SW620 human colorectal cancer cells and its potential underlying mechanism. SW620 cells were treated with 0, 0.5, 0.75, 1.5 and 2.0 mM methyl jasmonate for 12, 24 and 48 h. Methyl jasmonate was shown to be able to inhibit cell growth and induce apoptosis of SW620 cells in a concentration and time-dependent manner, whilst promoting an increase in caspase-3 protein expression. Compared with control, the anticancer effect of methyl jasmonate inhibited Enhancer of zeste homolog 2 (EZH2) protein expression and activated microRNA (miR)-101 expression in SW620 cells. However, knockdown of miR-101 suppresses methyl jasmonate-induced cell growth inhibition, activation of caspase-3 expression and inhibition of EZH2 expression in SW620 cells. These results demonstrate that methyl jasmonate induced the apoptosis of human colorectal cancer cells via downregulation of EZH2 expression by miR-101.

Medical concepts are constantly evolving along with the advances in science and technology. In an era of precision medicine, clinicians may precisely classify patients to achieve the tailored treatment of one disease; in return, the accurate diagnosis and classification of patients also have potential impact on subsequent treatment modalities. Precise surgery and minimally invasive surgery aim to reduce the surgical trauma stress, enhanced recovery after surgery (initially known as “fast-track surgery”) tries to accelerate postoperative recovery, whereas multidisciplinary collaborative team aims to use multidisciplinary strategies for the treatment of various diseases. The application of multiple treatment strategies will ultimately improve both prognosis and quality of life.

Background/Aims: Autologous, tumor-derived, heat shock protein gp96 peptide complexes have antitumor potential. We conducted the first Phase II trial to evaluate the safety and efficacy of gp96 vaccination in adjuvant settings for patients with gastric cancer. Methods: We enrolled 73 consecutive patients from October 2012 to December 2015. Thirty-eight patients received gp96 vaccination plus chemotherapy and 35 received chemotherapy alone. The primary endpoints were disease-free survival (DFS) and toxicity. The secondary endpoints were overall survival (OS) and tumor-specific immune responses. Results: There were comparable baseline characteristics between the two groups. Tumor-specific immune responses increased significantly after gp96 vaccination. gp96 vaccination plus chemotherapy was well tolerated and there were no gp96-related serious adverse events. Patients who received gp96 vaccination had improved DFS compared with those who did not [p = 0.045; hazard ratio (HR): 0.47; 95% confidence interval (CI): 0.23-0.96]. The 2-year OS rates were 81.9% and 67.9% for the gp96 vaccination and chemotherapy alone group, respectively (p = 0.123; HR: 0.42; 95% CI: 0.15-1.24). Conclusion: gp96 vaccination elicits tumor-specific immune responses and can be safely used in adjuvant settings combined with chemotherapy. Patients with less-aggressive diseases might benefit from gp96 therapy.

Objective:To explore the expression of perioperative serum tumor necrosis factor-alpha (TNF-α),nitric oxide(NO),insulin-like growth factor Ⅱ(IGF-Ⅱ)in patients with gastric cancer and its clinical significance.Methods:117 patients with gastric cancer underwent radical gastrectomy (case group) and 60 healthy volunteers (control group) selected randomly in our hospital from August 2014 to August 2016 were collected.The TNF-α level of two groups was detected by the enzyme-linked immunosorbent assay(ELISA),the NO levels was detected by the nitrate reduction,the IGF-Ⅱlevel was detected by the double-antibody radioimmunoassay.Results:The serum TNF-α,IGF-Ⅱ levels of case group before operation were higher than those of control group,and the NO level was lower than that of control group,the differences were statistically significant(P＜0.05).The serum TNF-α,IGF-Ⅱ levels showed a declining trend at 3 d,7 d,10 d after operation,and which were lower than those before operation,the difference was statistically significant(P＜0.05).Compared with the control group,the serum levels of TNF-α,IGF-Ⅱ at 10 d after operation were not different (P＞0.05).And serum NO levels at 3 d,7 d,10 d after operation were gradually increased,which were higher than that before operation,the difference was statistically significant (P＜0.05),there was no difference in serum NO level between the control group and 10d after operation(P＞0.05).By the Pearson product-moment correlation analysis,a positive association between TNF-α and IGF-Ⅱ before operation was found(r=0.733,P＜0.05).There was a negative relationship between NO and TNF-α,IGF-Ⅱ.(r=-0.681,-0.716,P＜0.05).Conclusion:The serum TNF-α,IGF-IⅡpreoperative in patients with gastric cancer show high expression,and low expression of NO,with the extension of time,TNF-α,IGF-Ⅱ,NO gradually became normal.Combined detection of serum TNF-α,NO and IGF-in the perioperative period is helpful to evaluate the prognosis of gastric cancer.

Less invasive surgery is gaining popularity for the treatment of early gastric cancer (EGC), but there are no definitive guidelines for the use of less invasive surgery for the treatment of undifferentiated EGC. The aims of this meta-analysis were to identify potential predictive factors for lymph node metastasis (LNM) in undifferentiated EGC and to guide the personalized therapeutic modality for patients with undifferentiated EGC.

Background: Gastric carcinoma is the second leading cause of cancer death. microRNAs play vital roles in regulating expression of related oncogenes. microRNA-25 (miR-25) has been found to be up-regulated in gastric carcinoma. However, its roles in affecting cell apoptosis of gastric carcinoma and the related mechanism remain elusive. This study aimed to uncover the influences of miR-25 on gastric carcinoma cell apoptosis and the possible functional mechanisms involved.Material/Methods: Human gastric adenocarcinoma cell line AGS was used and transfected with lentivirus containing miR-25-specifc inhibitor sponge or expression vector to analyze the effects of miR-25.Results: miR-25 had higher expression in AGS than in human gastric epithelial cell line GES-1 (P<0.01). Inhibition of miR-25 by its sponge in AGS cells resulted in suppressed cell viability (P<0.01) and promoted cell apoptosis (P<0.01), while overexpression of miR-25 abrogated these effects (P<0.01 and P<0.05), indicating that miR-25 can promote cell viability and inhibit cell apoptosis in AGS cells. Expression analysis of related factors by Western blot showed that inhibiting miR-25 led to the up-regulation of F-box and WD repeat domain-containing 7 (FBXW7, P<0.01) and the down-regulation of FBXW7 substrates, cyclin E1 (CCNE1, P<0.01), and v-myc avian myelocyto-matosis viral oncogene homolog (MYC, P<0.001).Conclusions: These results indicate that miR-25 has anti-apoptosis roles in AGS cells, possibly via inhibiting FBXW7 and thus promoting oncogenes, such as CCNE1 and MYC. This study provides basic evidence for using miR-25 as a possible therapeutic target in treating gastric carcinoma.