Abstract:Objective: To assess the standardization of lymphadenectomy in hand-assisted laparoscopic radical gastrectomy for stomach cancer using nanocarbon particles as lymph node (LN) tracer. Methods: The clinical data of 40 patients with gastric cancer undergoing hand-assisted laparoscopic surgery for radical gastrectomy within a period of 8 months were retrospectively analyzed. Of the patients, 15 cases who received intraoperative nanocarbon suspension injection before LN clearance were designated as observation group, and another 25 cases served as control group. Results: Of the 15 patients in observation group, the LNs along the lesser curvature of the stomach were labeled in 12 cases (80.00%), No.8a or No.6 LNs staining were found in 8 cases each (53.33%), and the LNs staining were found in 3 cases each (20.00%) in the splenic hilum or greater curvature of the stomach. All the main surgical indexes that included the incision length [(6.90±0.28) cm vs. (6.82±0.38) cm], intraoperative blood loss [(286±168) mL vs. (235±98) mL], operative time [(182±31) min vs. (176±21) min], number of lymph nodes detected (16.8±6.71 vs. 14.9±3.90), and length of postoperative hospital stay [(10.1±3.8) d vs. (11.6±6.5) d], between the observation group and control group showed no statistical differences (all P>0.05). Conclusion: The application of LN tracer has certain adjunctive effects for improving the LN dissection during surgery. The use of tracer in hand-assisted laparoscopic radical gastrectomy can better reflect the standardization of LN dissection.

Abstract:Objective: To investigate the risk factors and prognosis for peritoneal metastasis in gastric cancer. Methods: The clinicopathologic data of 352 patients with gastric cancer were retrospectively analyzed. Results: The peritoneal metastasis rate of the entire group was 15.1% (53/352). Univariate analysis showed that gastric cancer peritoneal metastasis was related to the sex, histological types, depth of stomach wall invasion, lymph node metastasis, TNM stage, surgical procedure and local recurrence (all P<0.01). Multivariate analysis revealed that the depth of gastric wall invasion (P=0.016, 95%CI=0.570–0.945), TNM stage (P<0.001, 95%CI=2.414–4.027), lymph node metastasis (P=0.027, 95%CI=1.041–1.964), surgical procedure (P<0.001, 95%CI=1.203–1.870) and local recurrence (P<0.001, 95%CI=1.376–2.871) were risk factors for gastric cancer peritoneal metastases. The 1- and 2-year survival rates in patients with peritoneal metastasis were 44% and 10%, which in patients without peritoneal metastasis were 97.0% and 74.0% respectively, and the difference between the survival rates of the two groups had statistical significance (χ2=249.411, P<0.001). Conclusion: Gastric cancer with peritoneal metastasis predicts the high malignancy and poor diagnosis of the tumor. The depth of gastric wall invasion, TNM stage, lymph node metastasis, surgical procedure and local recurrence are independent significant risk factors for gastric cancer peritoneal metastasis.

Abstract:Objective: To evaluate the safety and short-term effectiveness of laparoscopic gastrectomy for gastric cancer in elderly patients. Methods: The clinical data of 87 elderly patients (≥70 years) with gastric cancer undergoing gastrectomy from July 2008 to December 2011 were retrospectively analyzed. Of the patients, 39 cases underwent laparoscopic gastrectomy (laparoscopic group) and the other 48 cases underwent traditional open gastrectomy (open surgery group). The general data, intraoperative variables, postoperative recovery and complications as well as therapeutic efficacy of the two groups were compared. Results: There were no significant differences between the two groups in sex distribution, median age, preoperative comorbidities, preoperative ASA score or disease profiles. Except for the average operative time (no difference was found between the two groups), the average intraoperative blood loss (73 mL vs. 309 mL), time for bowel function recovery (4.1 d vs. 5.5 d), time to liquid intake (4.2 d vs. 6 d), average length of hospital stay and incidence of postoperative cardiopulmonary complications (28.2% vs. 56.3%) were all significantly reduced in laparoscopic group compared with open surgery group (all P<0.05). The average length of follow-up was 29 months, and the survival rate of laparoscopic group and open surgery group was 57.1% and 65.9%, respectively (P>0.05). Conclusion: Laparoscopic gastrectomy for gastric cancer in elderly patients is safe and feasible, and can reduce intraoperative blood loss and postoperative cardiopulmonary complications, as well as promote the recovery of postoperative gastrointestinal function.

Abstract:Objective: To investigate the regularity of rectal lymph node metastasis and its relations with the clinicopathlogic factors. Methods: One hundred and five specimens from rectal cancer radical resection performed in the first affiliated hospital to Medical College of Xi’an Jiaotong University during one year were collected. The lymph nodes were dissected and collected in groups, and histopathological examination was performed in each resected lymph node. The metastatic rate of each group was calculated and the relationships between lymph node metastasis and clinicopathologic factors of the patients such as gender, age, tumor size, tumor location, differentiation degree, infiltration depth, gross tumor type and the distance from the anal verge were analyzed. Results: A total of 2 211 lymph nodes was detected from the 105 cases with an average of 21.06 lymph nodes per case. Positive lymph node metastasis was identified in 45 cases (42.86%), and the metastatic rate in perirectal lymph nodes, mesenteric lymph nodes and the lymph nodes at the root of inferior mesenteric artery was 38.10%, 28.85% and 15.79%, respectively. Rectal lymph node metastasis was related to the gross tumor type, differentiation degree, infiltration depth and distance from the anal verge (P<0.05). Conclusion: Rectal lymph node metastasis is associated with the gross tumor type, differentiation degree, infiltration depth and distance from the anal verge. Appropriate lymph node dissection range should be selected on the basis of the comprehensive analysis of the clinicopathologic factors when performing radical resection for rectal cancer.

Abstract:Objective: To identify the most suitable plane for division of the inferior mesenteric artery in laparoscopic-assisted radical resection of rectal cancer. Methods: The clinical data of rectal cancer patients from July 2008 to January 2012, who underwent laparoscopic-assisted radical resection with the division of the inferior mesenteric artery in different planes, were comparatively analyzed. Results: In patients with vascular division at the root of the inferior mesenteric artery during surgery (334 cases), the parameters that included the average operative time (7.8 min vs.12.6 min) and average blood loss (4.8 mL vs.12.5 mL) in management of the inferior mesenteric artery, and the average number of dissected lymph nodes around the inferior mesenteric artery and abdominal aorta (12.5 vs.10.9) were all significantly better than those in patients with vascular division at a point 2-4 cm distant from the root of the inferior mesenteric artery (153 cases), and all the differences had statistical significance (all P<0.01). There was no significant difference in the incidence of injury of inferior mesenteric plexus between the two procedures (P>0.05), and no intestinal ischemia occurred in any of the patients. Conclusion: Division at the root of the inferior mesenteric artery in performing laparoscopic-assisted radical resection of rectal cancer is safe and reliable. Moreover, it has the advantages of shorter operative time, less blood loss and adequate lymph node clearance.

Abstract:

Objective: To investigate the application of complete mesocolic excision (CME) in colon cancer surgery. Methods: The clinical data of 34 patients with colon cancer undergoing CME with central vascular ligation (CVL) between December 2009 and June 2012 were retrospectively analyzed. Results: The postoperative UICC pathological stages of the patients were stage I in 4 cases, stage II in 14 cases and stage III in 16 cases, respectively. The median number of lymph nodes dissected was 18 lymph nodes, and 18.8% (3/16) of the stage III patients had positive metastatic lymph nodes in the root of the mesocolon. There was no perioperative death or associated injury in the entire group. The operative time was 2.5-3.5 (median 2.75) h, intraoperative blood loss was 80-200 (median 110) mL, time to first passing of flatus and first defecation after surgery was 3-5 (median 4) d and 4-6 (median 5) d, respectively, and length of postoperative hospital stay was 11-20 (median 14) d. The postoperative complications included 3 cases of wound infection, and one case each of lung infection and chyle leakage. There was no anastomotic leak or bowel obstruction during the short postoperative period. The 34 patients were followed up for 6 months to 2 years during which no local recurrence occurred, but one case developed liver metastases 16 months after surgery and died 3 months later. Conclusion: CVL combined with CME for colon cancer is safe and feasible, and has favorable short-term efficacy. It can possibly become a standardized surgical technique for colon cancer.

Abstract:

Objective: To screen new tumor markers for colorectal cancer (CRC) through analyzing the differential protein expression profiles between CRC and normal mucosa by using two-dimensional fluorescence difference gel electrophoresis (2D-DIGE)-based proteomic techniques. Methods: The differentially expressed proteins were analyzed in six fresh CRC specimens and paired normal mucosa by 2D-DIGE and then identified by matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS), respectively. Thereafter, the proteins of interest were verified by immunohistochemical method in 46 cases of CRC and normal mucosal tissues. Results: 2D-DIGE analysis and MALDI-TOF-MS identification showed that the significantly up-regulated proteins in CRC tissues were ubiquinol cytochrome-c reductase core protein 1 (UQCRC1), 14-3-3 ζ and desmin etc., and the significantly down-regulated proteins were carbonic anhydrase (CA) I and CAII etc. (all P<0.05). The results of immunohistochemical staining revealed that the expression intensities of UQCRC1 and 14-3-3 ζ in CRC tissues were 2.43±0.81 and 1.41±1.07 respectively, which were significantly higher than those in normal mucosal tissues (1.80±0.96 and 0.67±0.94) (P<0.001), while the desmin expression had no significant difference between the two tissues (P>0.05); the expression intensities of CA I and CA II in CRC tissues were 1.67±0.52 and 1.18±0.84 respectively, which were significantly lower than those in normal mucosal tissues (2.93±0.25 and 2.80±0.50) (P<0.001). Conclusion: The 2D-DIGE-based proteomic techniques combined with immunohistochemical method are effective means to screen new tumor markers. UQCRC1, 14-3-3 ζ, CA I and CA II may potentially become the novel markers or therapeutic targets of CRC.

Abstract:Objective: To investigate the expression level of tumor suppressor gene WTX in colon cancer tissues and its significance. Methods: The specimens of cancerous tissues along with their adjacent and distant tissues from 50 patients with pathologically confirmed colon cancer were collected. The gene and protein expression levels of WTX in each tissue specimen were detected by using Real-time fluorescence quantitative PCR (qPCR) and Western blot analysis, respectively. Results: Relative to the value of the distant normal tissues (1.00±0.00), the WTX gene expression values in the tumor tissues and adjacent tissues were 0.36±0.17 and 0.91±0.34 respectively, and there were statistical differences among them (all P<0.05). The relative expression levels of WTX protein in the tumor tissues, adjacent and remote tissues were 0.27±0.11, 0.64±0.23 and 0.72±0.19 respectively, and all the differences among them had statistical significance (all P<0.05). Conclusion: The decreased expression of tumor suppressor gene WTX may be critically associated with the occurrence and development of colon cancer.

Abstract:Objective: To investigate K-ras gene mutation status and its relations with the clinicopathological characteristics in patients with colorectal cancer. Methods: The K-ras gene mutation status in the tumor tissues from 200 colorectal cancer patients were detected by Real-time fluorescence quantitative PCR (RT-qPCR) and direct sequencing, respectively. The results obtained by the two methods were compared and their significance was analyzed in conjunction with the main clinicopathological variables. Results: Of the 200 colorectal cancer specimens, 63 mutation cases were detected by RT-qPCR, and the mutation detection rate was 31.5%; 50 mutation cases were detected from the 169 specimens that were successfully sequenced by direct sequencing technique, and the mutation detection rate was 29.6%. The GGT→GAT at codon 12 was the most prevalent mutation and accounted for 34.9% (22/63) of the total mutation cases, followed by GGC→GAC at codon 13 that accounted for 28.6% (18/63) of the total mutation cases, while GGT→GCT at codon 12 was the rarest mutation that was not found in any case of the entire group (0/63). The concordance rate between two methods was 98%. K-ras gene mutation was significantly associated with the differentiation of the tumor (P<0.05), but not related to the sex, age, tumor location, lymph node metastasis or TNM stage of patients (all P>0.05). Conclusion: RT-qPCR is a rapid, sensitive and accurate method for detection of the K-ras gene mutation, and therefore provides reliable information for clinical applications of targeted therapy.

Abstract:Objective: To investigate the effect of ω-3 fatty acids on the proliferation and gene expressions of vascular endothelial growth factor (VEGF), syndecan-1 and Ki-67 of SW480 colon cancer stem cells. Methods: The CD133+/CD44+/ESA+ cell subgroups (SW480 colon cancer stem cells) in the SW480 colon cancer cells were sorted by flow cytometry. Then, the colon cancer cells were treated with serial concentrations (15, 30, 60 μg/μL) of EPA (eicosapentaenoic acid) or serial concentrations (15, 30, 60 μg/μL) of DHA (docose hexaenoie acid), or vehicle (control), and the cell proliferations of each cell group were determined by MTT assay. Furthermore, the gene expressions of VEGF, syndecan-1 and Ki-67 in colon cancer cells after treatment of EPA (60 μg/μL) or DHA (60 μg/μL) were analyzed by RT-PCR method. Results: Both low concentrations of EPA and DHA had no noticeable effect on the growth of colon cancer cells (both P<0.05), while either medium or high concentration (30 and 60 μg/μL) of EPA and DHA significantly inhibited the growth of colon cancer cells, which had statistical differences compared with control group (all P<0.05). Both EPA and DHA at a concentration of 60 μg/μL could significantly suppress the gene expression of syndecan-1 and Ki-67 (both P<0.05), but showed no evident effect on VEGF gene expression (both P>0.05). Conclusion: ω-3 fatty acids can inhibit the proliferation of SW480 colon cancer stem cells, and the mechanism is probably associated with its suppression of syndecan-1and Ki-67 expression.

Abstract:Objective: To investigate the effects of interleukin 1α (IL-1α) and its receptor antagonist (IL-1ra) on the proliferation and invasion of human colon cancer cells with different metastatic potentials as well as the role of IL-1α and IL-1ra in metastatic process. Methods: The colonic carcinoma cell lines with high liver metastatic potential (WiDr) and low liver metastatic potential (Caco-2 and Colo-320) were used. The gene and protein expressions of IL-1α and its type I receptor (IL-1R I) were determined by RT-PCR and ELSIA assay, respectively. After exposure to different concentrations of the exogenous IL-1α and IL-1ra, the cell proliferation of the three cell lines was measured by WST-1 assay and the invasive ability of WiDr and Caco-2 cells was assessed by using Transwell chamber. Results: The RT-PCR results showed that the IL-1α mRNA was only expressed in the WiDr cells of high liver metastatic potential but not in Caco-2 and Colo-320 cells of low liver metastatic potential, while the IL-1R I gene was expressed in all the three types of cells. The concentration of IL-1α protein detected in WiDr cells by ELISA assay was (7.85±0.52) pg/mL but was not detected in Caco-2 and Colo-320 cells. The exogenous IL-1α significantly increased the proliferative ability of Caco-2 and Colo-320 cells (all P<0.05), but had no effect on that of WiDr cells (P>0.05), while the exogenous IL-1ra markedly inhibited the proliferation of WiDr cells (P<0.05). The exogenous IL-1α significantly enhanced the invasive ability of Caco-2 cells (P<0.05), but had no influence on that of WiDr cells (P>0.05); the exogenous IL-1ra significantly inhibited the invasiveness of WiDr cells (P<0.05), but had no effect on Caco-2 cells (P>0.05). Conclusion: The liver metastatic potential of colon cancer is related to its IL-1α expression, and exogenous IL-1ra can inhibit the proliferative and invasive ability of colon cancer cells.

Abstract:Objective: To investigate the miR-155 expression in gastric cancer tissues and its clinical relevance. Methods: The surgical specimens of 52 cases of stomach cancer and their adjacent normal tissues were collected. The miR-155 expression level in gastric cancer and adjacent normal tissues were determined by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) technique, and the relations of miR-155 expression with the clinicopathologic factors of gastric cancer were analyzed. Results: The RT-PCR results showed that the miR-155 expression value in gastric cancer tissues (0.84±2.27) was significantly higher than that in their paired adjacent normal tissues (0.28±0.56) (P<0.05). The miR-155 expression level was associated with the lymph node metastases in gastric cancer patients, the miR-155 expression in patients with the lymph node metastases was higher than that in those without lymph node metastases (P<0.05). The miR-155 expression level was irrelevant to the sex, age, tumor size, depth of invasion, and all the differences between the groups on these factors had no statistical significance (all P>0.05). Conclusion: miR-155 has high expression level in gastric cancer tissues, and it may be relevant to gastric cancer lymph node metastasis.

Abstract:Objective: To investigate the effect of gastric bypass procedure on hepatic lipid metabolism in spontaneous diabetic Goto-Kakizaki (GK) rats and its significance. Methods: Forty male GK rats were equally randomized into experimental group and control group. Rats in experimental group underwent Roux-en-Y gastric bypass operation while rats in control group underwent antroduodenal transaction and then, reanastomosis in situ. The fasting glucose and 2-h oral glucose tolerance test (2-h OGTT) glucose value of the two groups were measured before and 1 week, 2 and 4 weeks after surgery respectively, and the fasting blood levels of free fatty acids (FFA), total cholesterol (Tch) and triglyceride (TG) of rats before and 4 weeks after surgery were also measured. In addition, liver tissues of rats obtained intraoperatively and 4 weeks after surgery were used for immunohistochemical oil red O staining to observe the TG deposits in the liver. Results: Compared with those before surgery, the values of both fasting glucose and 2-h OGTT glucose showed a gradually declining trend after surgery in experimental group, which decreased significantly at 2 and 4 weeks after surgery (all P<0.05); in experimental group, the blood FFA level significantly decreased (P<0.05), while there were no significant changes in the TG and Tch level (both P>0.05), but the TG accumulation in the liver tissue section was markedly reduced. All of the above parameters and measurements in control group showed no obvious changes after surgery compared with preoperative values (all P>0.05). Conclusion: The blood sugar-lowering effect of gastric bypass procedure may be probably associated with its improving hepatic lipid metabolism and decreasing FFA concentration, thereby ameliorating the insulin resistance.

Abstract:Objective: To investigate the effect of gastric bypass procedure (GBP) on the secretion of the hormone of the “enteroinsular axis” and dipeptidyl peptidase-IV (DPP-IV) during exertion of its blood sugar-lowering action in rats with type 2 diabetes mellitus (T2DM). Methods: Twenty-four male spontaneous non-obese diabetic Goto-Kakizaki (GK) rats were equally randomized to undergo either gastric bypass surgery (GBP group) or sham operation (sham operation group). The body weight, fasting blood glucose, and the levels of DPP-IV and “enteroinsular axis” hormone glucagons-like peptide 1 (GLP-1) before and 1 week, 2, 4, 8, 12, 24 and 48 weeks after surgery of the two groups were recorded and compared. Results: The recorded parameters between the two groups had no obvious differences before operation (all P>0.05). The body weights of rats in both groups decreased significantly within the first week after surgery and then recovered gradually, but at each predefined time point, there were no significant differences between the two groups (all P>0.05). Compared with those before surgery, the levels of fasting blood glucose, and plasma DPP-IV and GLP-1 in sham operation group did not change after surgery (all P<0.01); while the fasting blood sugar and plasma DPP-IV significantly decreased and GLP-1 level significantly increased in GBP group (all P<0.01). In addition, the levels of fasting blood glucose, DPP-IV and GLP-1 between the two groups had statistical significance at each observation time point after surgery (all P<0.01). Conclusion: The blood sugar control effect of GBP may be associated with its increasing the GLP-1 level of the “enteroinsular axis” through inhibiting the DPP-IV activity.

Abstract:Objective: To investigate the blood sugar lowering effects of different gastric bypass procedures in type 2 diabetic (T2DM) rats and the mechanisms involved. Methods: Fifty SD rats with T2DM induced by streptozotocin were equally randomized into 5 groups: Group A (sham operation control), group B (gastric bypass with exclusion of the duodenum), group C (gastric bypass with the exclusion of the proximal jejunum), group D (gastric bypass with the exclusion of the duodenum and proximal jejunum) and group E (gastrojejunal diversion without intestinal exclusion), respectively. The body weight gain and levels of fasting blood glucose (FBG), glucose-dependent insulin-releasing peptide (GIP) and glucagon-like peptide-1 (GLP-1) in rats of each group were determined before and 1 week, 3, 6 and 12 weeks after operation. Twelve weeks later, rats in group E underwent a second laparotomy to exclude the duodenum and proximal jejunum by occluding the duodenum distal to the gastric antrum, and the levels of FBG, GIP and GLP-1 were determined 1 week, 3 and 6 weeks after the second operation. Results: Compared with the preoperative values, the body weight of the rats in each group showed no obvious change one week after surgery (all P>0.05), which in group A, B and C still had no noticeable change 3 and 6 weeks after surgery (all P>0.05), but significantly increased 12 weeks after surgery and was most marked in group A (all P<0.05), but in group D and E were somewhat decreased 3 and 6 weeks after surgery (all P<0.05) and close to the preoperative levels 12 weeks after surgery (both P>0.05). The levels of FBG, GIP and GLP-1 in group A showed no obvious alterations at each postoperative time point compared with those before surgery (all P>0.05). The FBG levels decreased significantly and gradually from one week after surgery in group D, and decreased significantly and gradually from 3 weeks after surgery in group B, C and E (all P<0.05), which was most evident in group D and least in group E (all P<0.05), and had no difference between group B and C at the same time points after surgery (all P>0.05). The GIP values decreased significantly and gradually from one week after surgery in group B, C and D, which was most evident in group D (all P<0.05), and had no difference between group B and C at the same time points after surgery (all P>0.05). The GIP values showed no significant difference at each time point after surgery compared with preoperative value in group E. The GLP-1 values increased significantly and gradually from one week after surgery in group D and E, and increased significantly and gradually from 3 weeks after surgery in group B and C, which were significantly higher in group D and E than those in group B and C at the same time points after surgery (all P<0.05). Compared with the values before the second operation, the values of FBG and GIP significantly decreased (all P<0.05), while the GLP-1 values showed no significant differences (all P>0.05) in group E after the second operation. Conclusion: Gastric bypass with duodenal-jejunal exclusion has excellent blood glucose lowering effect in diabetic rats, and the mechanisms are associated with the low GIP secretion due to the food bypassing the duodenum and proximal jejunum, and high GLP-1 secretion due to the early and rapid passage of food into the distal jejunum and ileum.

Abstract:

Objective: To investigate the hepatoprotective effect of hypothermic infusion of self-prepared hepatic protective solution during portal vein occlusion (PVO) in rats with obstructive jaundice. Methods: Seventy-two rats underwent common bile duct ligation, and one week later were equally randomized into control group (recanalization of bile duct and only portal vein isolation), portal vein obstruction (PVO) group (recanalization of bile duct and PVO for 1.5 h), lactated Ringer’s solution infusion group (recanalization of bile duct and portal vein infusion with 4 ℃ lactated Ringer’s solution during PVO) and self-prepared hepatic protective solution infusion group (recanalization of bile duct and portal vein infusion with 4 ℃ self-prepared hepatic protective solution during PVO). The specimens of rats’ livers from each group were harvested at 0, 6 and 24 h respectively after surgery, and then the expressions of bcl-2, Bax and caspase-3 protein in liver tissues were detected by Western blot analysis, and the liver cell apoptosis rates were measured by TUNEL assay. Results: Compared with control group, the bcl-2 expression in the liver tissues of PVO group increased slightly at each time point after surgery, but all the differences had no statistical significance (all P>0.05), while the bcl-2 expressions in the liver tissues of the two solution infusion groups were significantly increased at 6 and 24 h after surgery (all P<0.05), which were more evident in self-prepared hepatic protective solution infusion group (all P<0.05); the expressions of Bax and caspase-3 protein in the liver tissues as well as liver cell apoptosis rates of PVO group significantly increased at 6 and 24 h after surgery (all P<0.05), and the two infusion solutions significantly inhibited the elevation of Bax and caspase-3 protein expression and reduced the liver cell apoptosis rate (all P<0.05), and these effects were more pronounced in self-prepared hepatic protective solution infusion group (all P<0.05). Conclusion: Self-prepared hepatic protective solution has hepatoprotective effect during PVO in rats with obstructive jaundice, and the mechanism is related to the inhibition of liver cell apoptosis of mitochondrial pathway.

Abstract:Objective: To analyze the clinical characteristics and treatment approaches of radiation enteritis with acute bowel obstruction. Methods: The clinical data of 25 patients with radiation enteritis complicated by acute bowel obstruction admitted from October 2006 to March 2011 were retrospectively analyzed. Results: All patients underwent conservative treatment such as catheter intestinal decompression and aggressive nutritional support, and once their emergency conditions were alleviated, selective gastrografin contrast examination of the small bowel was performed via the decompression catherer to reveal the pathologic changes causing obstruction. Of the entire group, 24 cases underwent surgical treatment. Intraoperative findings showed that most radiation injuries occurred in the pelvic cavity or ileum, and there were indistinct borders between intestinal loops as well as abdominal organs, which were even adhered together in a frozen-like state. Thirteen patients underwent resection of obstructing lesion with anastomosis, 10 patients underwent ileocolic bypass anastomosis, right hemicolectomy was performed in one patient, and small intestine intubation and plication techniques were synchronously used in 21 cases. The bowel obstruction was resolved in one patient with nonsurgical treatment. Except for one patient who died of intra-abdominal and lung infection after surgery, 24 of 25 patients (96.0%) were cured. Twenty-three patients were followed up for 6 to 24 months, and the long-term efficacy rate was 95.7% (22/23). Conclusion: Proper conservative treatment can change emergent operation to a scheduled or elective operation for radiation enteritis associated acute bowel obstruction. Resection of obstructing lesion with anastomosis or entero-enteric bypass anastomosis combined with small intestine intubation is the preferred procedure for surgical treatment of this condition.

Abstract:

Objective: To investigate the clinicopathological diagnosis and management of gastrointestinal stromal tumors (GISTs). Methods: The clinicopathological data of 100 GISTs patients were retrospectively analyzed. Results: All patients had a single lesion on CT scan, of whom 79 cases had a benign lesion that presented as soft tissue mass with uniform density, and 21 cases had malignant tumor that showed a lobulated mass with low-density necrotic areas of variable sizes inside. The dual-phase contrast-enhanced CT scan demonstrated that there were ulcers of varying sizes in the tumor cavity, and the ulcers in 7 cases of malignant tumor were large and deep. The masses were heterogeneously enhanced under contrast-enhanced CT scan, and no enhancement was seen in the cystic necrotic area. The lesions of 56 cases were located in the stomach, 26 cases in the duodenum, 10 cases in the small bowel, 6 cases in the colon and rectum, and 2 cases in the mesentery. The pathological examination of the surgical specimens showed cell nests composed of spindle-shaped tumor cells with the typical arrangement of GISTs. All patients underwent complete resection, no lymph node metastasis was found and no intraoperative or postoperative death occurred. The average length of hospitalization was 15.2 d. The follow-up period ranged from 6 months to 24 months, during which time 5 malignant GIST patients died and all the the deaths were due to liver metastases; tumor recurrence occurred in 28 patients (28%), of whom 12 cases were borderline tumors and 16 cases were malignant tumors; 16 cases had local recurrence and 12 cases had peritoneal recurrence. All of the recurrent cases were alive during the 3-month follow-up period after a second resection. Conclusion: The diagnosis of GISTs depends on the clinical manifestations, CT scan findings and pathological examination, and GISTs may have better outcomes after early surgical resection.

Abstract:

Investigations reveal thymidine phosphorylase has the effects of promoting tumor angiogenesis and inhibiting cell apoptosis, and is closely related to the prognosis and outcome of the cancer patients. Meanwhile, it is also the key converting enzyme for the prodrugs of 5-fluorouracil such as 5'-deoxy-5-fluorouridine. This paper reviews the advances in the investigation of thymidine phosphorylase, including its expression and function in colorectal cancer tissue, converting effect on 5'-deoxy-5-fluorouridine and therapeutic potential.

Abstract:With the deepening of the investigations, the critical role of microRNA (miRNAs) in the occurrence and development of colorectal cancer has been established. This paper overviews the relations of up- and down-regulation of miRNAs with colorectal cancer, the influences of the alterations of miRNAs on the diagnosis and staging of colorectal cancer, and the prospects of their possible application in the future.

Abstract:CpG island methylation can lead to epigenetic transcription inactivation of the tumor suppressor gene, and in some circumstances it may be the only mechanism of tumor suppressor gene inactivation, which directly results in the occurrence of the tumors. This paper overviews the relations of the CpG island methylation of the tumor suppressor gene such as Syk, and of p15 with colorectal cancer, and also presents related problems and future considerations.

Abstract:With the in-depth investigations in recent years, new progresses have been achieved in understanding the prognostic significance of vascular and perineural invasion in colorectal cancer. This paper addresses the issues of these concerns.

Abstract:

FLJ10261 (TEME16A) is a recently defined gene that is closely related to gastrointestinal stromal tumors (GISTs). The DOG1 protein encoded by this gene is specifically expressed in GISTs, and its positive expression is more extensive and specific than the expressions of KIT and PDGFRA as proved by immunohistochemistry and in situ hybridization. Thus, it may become an alternative therapeutic target for GISTs. This paper reviews the recent advances in the relationship between DOG1 and GISTs.