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Abstract:Objective: To investigate the association between rs2275913 site polymorphism of IL-17 gene and the risk of gastric cancer. Methods: The case-control studies on relationship between the IL-17 rs2275913 G>A polymorphism and gastric cancer susceptibility were collected by searching several national and international databases. After literature screening, data extraction and quality assessment, Meta-analysis was performed by STATA 12.1 software. Results: Ten case-control studies were finally included, with 4 371 patients in case group and 5 345 subjects in control group. Meta-analysis results showed that among the rs2275913 site polymorphisms of IL-17 gene, the risk of gastric cancer was increased under allele-contrast model (A vs. G) (OR=1.22, 95% CI=1.10–1.37) and additive model (AA vs. GG) (OR=1.58, 95% CI=1.23–2.04), and was decreased under dominant model (AG+GG vs. AA) (OR=0.63, 95% CI=0.48–0.84) and recessive model (GG vs. AG+AA) (OR=0.86, 95% CI=0.78–0.94), but had no obvious change under codominant model (AG vs. AA+GG) (OR=0.91, 95% CI=0.78–1.07). Conclusion: IL-17 rs2275913 polymorphism is closely related to gastric cancer susceptibility.

Abstract:Objective: To investigate the influence of preoperative ASA classification and scope of surgical operation on the prognosis of gastric cancer after radical operation in patients of different ages. Methods: The clinical data of 188 gastric cancer patients who underwent primary radical resection were retrospectively analyzed. According to the ASA classification, scope of surgical operation and age, the patients were distinguished into high ASA score (score≥3) and low ASA score (score<3) patients, total gastrectomy group and partial gastrectomy patients, and young, middle-aged (<60 years of age) and old-aged (≥60 years of age) patients, respectively. The postoperative survival time between patients grouped by above factors was compared. Results: Survival analysis showed that the postoperative survival time in patients with high ASA score was shorter than that in patients with low ASA score (P<0.05); the postoperative survival time in patients undergoing partial gastrectomy was longer than that in those undergoing total gastrectomy among the young, middle-aged (P<0.05), while there was no significant difference among the old-aged (P>0.05); the postoperative survival time had no significant difference between patients undergoing partial gastrectomy and total gastrectomy among those with high ASA score (P>0.05), but which was longer in the former than that in the latter among those with low ASA score (P<0.05). Conclusion: ASA classification can be used to estimate the prognosis of gastric cancer patients after radical operation. The scope of surgical operation should be strictly controlled in young patients and patients with low preoperative ASA score, and unnecessarily extended operation should be avoided.

Abstract:Objective: To investigate the distribution profiles of the ABO blood group in gastric cancer patients and their relations with the occurrence of gastric cancer. Methods: The clinicopathologic data of 1 744 gastric cancer patients treated in Cancer Hospital affiliated to Harbin Medical University during 2010 to 2011 were retrospectively analyzed. The difference of distribution patterns of ABO blood types between gastric cancer patients and healthy population (496 447 cases) was compared, and the relations of blood types with clinicopathologic features of gastric cancer patients were determined. Results: Of the 1 744 gastric cancer patients, 554 cases (31.77%) were A blood type, 524 cases (30.05%) were B blood type, 468 cases (26.83%) were O blood type, and 198 cases (11.35%) were AB blood type, respectively. The distribution of ABO blood types in gastric cancer patients was statistically different to that in healthy population (χ2=38.384, P=0.000); the risk of gastric cancer in cases with A blood type was higher than in non-A individuals (OR=1.174, 95% CI=1.061–1.299), in cases with AB blood type was higher than that in non-AB individuals (OR=1.282, 95% CI=1.106–1.487), while in those with O blood type was lower than that in non-O individuals (OR=0.738, 95% CI=0.664–0.821). There was significant difference in tumor location between patients with O and B blood type (P<0.05), lymph node metastasis in patients with A blood type was higher than that in those with B blood type (72.77% vs. 65.57%, P<0.05), and distant metastasis of in patients with blood type A or O was higher than that in those with blood type AB (16.02% vs. 9.14%; 15.25% vs. 9.14%, both P<0.05). Conclusion: The distribution of ABO blood types in gastric cancer patients is different from that in healthy population. The risk of gastric cancer may increase in individuals with A or AB blood type, but decrease in those with O blood type, and blood types might be one of the risk factors for gastric cancer, and also be associated with the biological behavior of gastric cancer.

Abstract:Objective: To compare the effective difference between preoperative and postoperative use of somatostatin in reducing the degree of pancreatic injury caused by laparoscopic radical gastrectomy. Methods: Fifty patients scheduled to undergo laparoscopic radical gastrectomy were equally randomized into observational group (somatostatin treatment started 12–24 h before operation and continued during and after operation) or control group (somatostatin treatment started after operation), and 22 cases in observational group and 23 cases in control group were finally included due to 5 cases that dropped out of the study before completion. The relevant clinical variables between the two groups were compared. Results: There was no significant difference in general conditions and preoperative infectious and nutritional factors between the two groups (all P>0.05). In observational group compared with control group, the postoperative day-1 drainage volume was significantly lower than that in control group (P=0.05), but the total drainage volume showed no significant difference (P=0.016). No significant difference was noted between the two groups in respects of perioperative serum amylase level, drainage fluid amylase level, postoperative infectious and nutritional factors, time to drainage tube removal, time to gastrointestinal recovery, and incidence of complications (all P>0.05). Conclusion: Preoperative use of somatostatin has no obvious superiority compared with postoperative somatostatin treatment in alleviating pancreatic injury caused by laparoscopic radical gastrectomy.

Abstract:Objective: To investigate the clinical value of totally laparoscopic total gastrectomy in treatment of cancer of the upper stomach. Methods: The clinical data of 66 patients with cancer of the upper stomach undergoing laparoscopic total gastrectomy from May 2013 to September 2014 were retrospectively analyzed. Of the patients, 16 cases underwent totally laparoscopic total gastrectomy (total-laparoscopic group) and 50 cases were subjected to laparoscopically-assisted total gastrectomy (laparoscopic-assisted group). The preoperative data, intraoperative variables, and postoperative conditions between the two groups of patients were compared. Results: The preoperative data between the two groups were comparable. In total-laparoscopic group compared with laparoscopic-assisted group, the operative time was prolonged, and hospitalization cost was increased (both P<0.05), but it was superior in respects of the length of surgical incision, postoperative pain, time for postoperative recovery, length of postoperative hospital stay and incidence of postoperative complications (all P<0.05). There was no significant difference in intraoperative blood loss, distance from proximal and distal margins of resection, and number of lymph nodes dissected between the two groups (all P>0.05). Conclusion: Totally laparoscopic total gastrectomy is safe and feasible, which provides a treatment choice for gastric cancer and a future direction for the development of the concept of minimal invasiveness.

Abstract:Objective: To investigate the clinical features, diagnosis and treatment methods as well as prognosis of the giant gastrointestinal stromal tumor (GIST). Methods: The clinical data of 179 patients with GIST treated in the Affiliated Hospital of North Sichuan Medical College from January 2012 to April 2015 were retrospectively analyzed, of whom 39 cases had giant GIST (diameter equal to or larger than 10 cm). Results: Of the 39 patients with giant GIST, the tumors occurred in the stomach in 14 cases (35.6%), extra-gastrointestinal locations (mesentery, omentum and peritoneum) in 10 cases (25.6%), ileum in 7 cases (17.9%), jejunum in 4 cases (10.3%), duodenum in 3 cases (7.7%), and rectum in 1 case (2.6%). In patients with giant GIST compared with those with common GIST (diameter less than 10 cm), the proportion of mitotic figures, capsule rupture, multiple lesions, extra-gastrointestinal GIST, preoperative anemia and complications were significantly increased (all P<0.05). Of the 39 patients, 8 cases (20.5%) underwent simple tumor resection, 30 cases (76.9%) had synchronous partial resection of gastrointestinal and other organs, and tumor removal was unsuccessful in one case (2.6%); all cases were high risk GIST. A valid follow-up was conducted in 32 patients, of whom 4 cases (10.3%) had postoperative imatinib therapy; the 1- and 2-year progression-free survival rate was 92.8% and 79.6%, respectively. Conclusion: Giant GIST can be diagnosed according to clinical manifestations and results of imaging and pathological examinations, and a relatively high risk is suggested by its clinical features. Complete tumor excision combined with partial resection of gastrointestinal and other organs as well as standardized pre- and postoperative targeted therapy may be the effective approach to improve the outcome of these patients.

Abstract:Objective: To systematically analyze the expression of autophagy-related protein Beclin 1 (BECN1) in gastric cancer tissue and the correlation between BECN1 expression and clinicopathologic features of gastric cancer patients. Methods: The studies investigating BECN1 expression in gastric cancer tissues and its clinical significance published up to February 2015 were collected by searching the national and international databases. After data extraction, a meta-analysis was performed by using RevMan 5.3 and Stata12.0 software. Results: Nine studies were finally included, involving 1 620 gastric cancer patients. The results of this meta-analysis showed that the positive expression rate of BECN1 in gastric cancer tissues was significantly lower than that in non-gastric cancer tissues (OR=0.11, 95% CI=0.02–0.62, P=0.01), in well differentiated gastric cancer tissues was significantly higher than that in moderately-poorly differentiated gastric cancer tissues (OR=14.30, 95% CI=5.94–34.4, P=0.000), and in gastric cancer tissues without distant metastasis was significantly higher than that in those with distant metastasis (OR=0.39, 95% CI=0.22–0.70, P=0.001), but no significant relationship was noted between BECN1 expression and gender, age, tumor infiltration depth, lymph node metastasis and TNM stage of gastric cancer patients (all P>0.05). Conclusion: BECN1 may play a crucial role in gastric cancer carcinogenesis and differentiation of gastric cancer cells, and may also participate in the regulation of the metastasis ability of gastric cancer cells.

Abstract:Objective: To investigate the effect of diallyl disulfide (DADS) on NADPH oxidase activity in gastric cancer cells and the mechanism. Methods: In gastric cancer AGS cells after exposure to DADS, the NADPH oxidase activity and miR-34a expression as well as the status of Src-Gab1-Shp2 pathway in the cells were detected. Meanwhile, several interventions were made to investigate the relationship among NADPH oxidase, miR-34a, and Src-Gab1-Shp2 pathway. Results: The NADPH oxidase activity and miR-34a in AGS cells were significantly increased after DADS treatment (both P<0.05), and the NADPH oxidase activity increasing effect of DADS was abolished by Src inhibitor PP2 addition. The mRNA expressions of Src, Gab1 and Shp2 were all significantly decreased after DADS or miR-34a mimics treatment, moreover, the expression levels of phosphorylated Src, Gab1 and Shp2 proteins were all significantly down-regulated after DADS treatment (all P<0.05). Conclusion: DADS can increase NADPH oxidase activity in gastric cancer cells, and this effect may probably be associated with its increasing miR-34a expression and thereby, inhibiting the activity of Src-Gab1-Shp2 pathway.

Abstract:Objective: To investigate the inhibitory effect of thioridazine on growth of gastric cancer cells in vitro and the mechanism. Methods: Gastric cancer SGC-7901 cells were exposed to different concentrations of thioridazine for 24 hours, and then the proliferation and apoptosis of the gastric cells were detected by MTT assay and flow cytometry, and the expressions of apoptosis-related proteins that included bax, bcl-2 and caspase-3 were measured by Western blot analysis, respectively. Results: In SGC-7901 cells after exposure to thioridazine, the proliferation was decreased, apoptosis was increased significantly, the expression of antiapoptotic protein bcl-2 was down-regulated, and proapoptotic protein bax as well as caspase-3 was up-regulated significantly, and all effects showed a concentration-dependent manner (all P<0.05). Conclusion: Thioridazine has evident inhibitory effect on human gastric cancer in vitro, which may possibly be associated with its activating the caspase-3-dependent apoptotic pathway.

Abstract:Objective: To investigate the CDH17 expression in gastric cancer cells and its influence on the invasiveness of gastric cancer cells. Methods: The invasion ability and expressions of CDH17, epithelial marker E-cadherin and mesenchymal marker N-cadherin in normal gastric mucosal GES-1 cells, and gastric cancer MGC803 and BGC823 cells were examined by Transwell migration assay, immunofluorescence staining and Western blot analysis, respectively, and the changes in above parameters in the two types of gastric cancer cells after transfection with CDH17siRNA were also determined. Results: No invading cells or CDH17 and N-cadherin expression, but evident E-cadherin expression was seen in normal gastric mucosal GES-1 cells. In either MGC803 or BGC823 cells compared with GES-1 cells, there was considerable number of invading cells as well as marked CDH17 and N-cadherin expressions, but significantly reduced E-cadherin expression (all P<0.05), and further, the changes in these parameters in highly invasive MGC803 cells were more evident than those in less invasive BGC823 cells. After CDH17siRNA transfection, the changes in above parameters in both types of gastric cells were significantly weakened compared with those before transfection, and the differences of which between the two types of cells were decreased (all P>0.05). Conclusion: High CDH17 expression can promote invasion ability of gastric cancer cells, probably via epithelial-mesenchymal transition.

Abstract:Objective: To investigate the expression of vesicle-associated membrane protein 8 (VAMP8) in colon cancer tissue and its clinical significance. Methods: The specimens of colon cancer along with normal adjacent tissue from 42 patients were collected, in which the positive expression rate of VAMP8 protein was detected by immunohistochemical staining, and then the relations of VAMP8 expression with clinicopathologic characteristics of the patients were analyzed. Further, 12 pairs of the specimens were selected, and then the VAMP8 mRNA and protein expression levels were determined by qRT-PCR and Western blot, respectively. Results: Results of qRT-PCR and Western blot analysis showed that the VAMP8 mRNA and protein expression levels in colon cancer tissue were significantly higher than those in their matched adjacent tissue in 9 pairs of specimens (both P<0.05). Results of immunohistochemical staining demonstrated that the positive expression rate of VAMP8 protein in colon cancer tissues was significantly higher than that in adjacent non-tumorous tissues (73.8% vs. 42.9%; χ2=8.28, P<0.01), and the VAMP8 expression was significant associated with histopathological grade, Dukes’ stage and lymph node metastasis (all P<0.05). Conclusion: VAMP8 expression is increased in colon cancer tissue, which suggests that VAMP8 may promote the progression and metastasis of colon cancer through regulating the autophagy-lysosome pathway. Key words Colonic Neoplasms; Vesicle-Associated Membrane Protein 8; Autophagy; Neoplasm Invasiveness

Abstract:

Objective: To investigate the expression of transforming growth factor β-activated kinase 1 (TAK1) in colon cancer and the clinical significance.
Methods: Surgical specimens from 141 patients with colon cancer were collected. The TAK1 expression in colon cancer tissues and their adjacent normal tissues were determined by immunohistochemical staining, and the relations of TAK1 expression with clinicopathologic factors as well as prognosis of the patients were analyzed. Meanwhile, the K-ras gene mutation in the colon cancer tissues was detected, and the relationship between TAK1 expression and K-ras gene mutation was examined. 
Results: The positive expression rate of TAK1 in colon cancer tissues was significantly higher than that in adjacent normal tissues (68.8% vs. 16.3%, P<0.05). The positive TAK1 expression was significantly associated with Dukes stage, degree of tumor differentiation and lymph node metastasis (P<0.05), and the 5-year survival rate in patients with TAK1 positive tumor was significantly lower than in those with its low expression(P<0.05). The incidence of K-ras gene mutation in TAK1 positive colon cancer tissues was significantly higher than that in those with TAK1 negative expression (52.6% vs. 13.6%, P<0.05).
Conclusion: TAK1 may be involved in malignant progression of colon cancer, and its expression is probably related to K-ras gene mutation.

Abstract:Objective: To investigate the feasibility and short-term efficacy of new purse-string technique in totally laparoscopic radical resection for lower rectal cancer. Methods: The data of 6 patients with low rectal cancer undergoing totally laparoscopic radical resection with new purse-string technique were analyzed. In these patients, after totally laparoscopic total mesorectal excision, the anvil of the circular-stapling device secured with a suture needle was inserted into the lumen of the sigmoid colon through an incision on the sigmoid colon wall close to the proximal transection margin, and then the accompanying needle was advanced through colonic wall and pulled out so that the center rod of the anvil penetrated the colonic wall, following which the colon was transected by a linear cutter stapler near the site to secure the anvil. Next, the distal tumor-bearing rectosigmoid colon was everted and pulled transanally outside the body, staple-closure and transection of the distal rectum was done under direct vision, and then anastomosis was performed. Results: The operative procedures were successfully completed in all the 6 patients, and there was no conversion to laparotomy. The operative time was (165±21) min and intraoperative blood loss was (55±12) mL. No anastomotic leakage occurred, and no local recurrence or distant metastasis was found in any of the patients during follow-up. Conclusion: Using new purse-string technique in totally laparoscopic lower rectal cancer resection has high safety and significant short-term results, but the long-term results require further evaluation.

Abstract:Objective: To evaluate the influence of laparoscopic total mesorectal excision (TME) on postoperative urinary function. Methods: One-hundred and sixty-eight patients undergoing TME procedure were reviewed. Of the patients, 112 cases underwent laparoscopic TME (laparoscopic group), and 56 cases were subjected to open TME (laparotomy group), and the postoperative urinary function of the patients were assessed through several aspects that included the urethral catheter indwelling time, incidence of urinary retention within 30 d after operation, urodynamic parameters on postoperative day 7 to 10, and international prostate symptom score (IPSS) at 3 months after operation. Results: The general preoperative data of the two groups were comparable. The postoperative urethral catheter indwelling time in laparoscopic group was shorter than that in laparotomy group (P<0.05). The urodynomic tests showed that peak urine flow rate and maximum detrusor pressure in laparoscopic group were higher than those in laparotomy group (both P<0.05); the voided volume of the two groups had no significant difference (P>0.05); the postvoid residual urine volume in laparoscopic group was less than that in laparotomy group (P<0.05). There was no significant difference in postoperative 3-month IPSS scores between the two groups (P>0.05). Conclusion: With a mastery of intraoperative essentials, the influence of TME on urinary function during short-term postoperative period is significantly milder after laparoscopic procedure than that exerted by laparotomy operation.

Abstract:Objective: To assess the efficacy and safety of neoadjuvant imatinib therapy followed by transanal endoscopic microsurgery (TEM) for local excision of gastrointestinal stromal tumor (GIST) of the rectum. Methods: A group of thirteen patients with rectal GIST received imatinib therapy for 30-90 d and, after tumor regression, underwent TEM local excision of the tumor. The preoperative clinicopathologic profiles, response to neoadjuvant therapy, and relevant surgical variables of the patients were analyzed. Results: Remission was achieved in all patients within 3 months of neoadjuvant imatinib therapy, and significant tumor down-staging was seen. All patients, except one case that was converted to laparoscopic local rectal excision, received TEM local excision, of which 9 cases (70%) received operation after less than 2 months of neoadjuvant imatinib therapy. The average operative time was 45 min, and length of postoperative hospital stay was 6.7 d. The intraoperative blood loss in 11 patients (85%) was less than 20 mL, and no severe postoperative blood loss or infection occurred in any of the patients. No treatment-related death or other severe adverse reaction occurred. During follow-up, no recurrence or death occurred in the 12 patients undergoing TEM local excision. Conclusion: For some cases with locally progressive rectal GIST, preoperative imatinib therapy followed by TEM treatment can achieve favorable outcomes with high safety and minimal trauma, so it can be considered as a treatment option.

Abstract:

Objective: To compare the clinical effects between preventive transverse colostomy and terminal ileostomy in low anterior rectal cancer resection. Methods: The clinical data of 79 patients with low rectal cancer undergoing low anus-preserving operation with preventive enterostomy were retrospectively analyzed. Of the patients, 33 cases received preventive transverse colostomy, and 46 cases received preventive terminal ileostomy. Between the two groups of patients, the incidence of postoperative anastomotic leakage and stoma-related complications as well as the serum levels of inflammatory factors were compared. Results: The preoperative data of the two groups of patients were comparable. Anastomotic leakage occurred in 2 cases (6.06%) in transverse colostomy group, and in 4 cases (8.70%) in terminal ileostomy group, and the difference between the two groups had no statistical significance (P>0.05). The incidence of wound infection in in transverse colostomy group was higher than that in terminal ileostomy group (P<0.05), but the incidences of all other stoma-related complications showed no significant difference between the two groups (all P>0.05). The serum levels C-RP and IL-6 levels in transverse colostomy group at 24, 48 and 72 h after operation were all higher than those in terminal ileostomy group (all P<0.05). Conclusion: Preventive transverse colostomy has similar effect as preventive terminal ileostomy in avoiding postoperative anastomotic leakage in low anterior rectal cancer resection, but terminal ileostomy is superior to transverse colostomy in terms of reducing postoperative trauma and stress responses, and complications.

Abstract:

Gastric intestinal metaplasia (IM) is generally believed an intermediate stage in the multistep process of gastric adenocarcinoma, and considered as precancerous lesion. IM has multiple pathogenic factors, and many molecules have been found involved in the mechanisms for its occurrence. Epidemiological evidence showed the possibility of reversibility in IM, but it is still controversial at present. The authors address, in this paper, the research progress in respects of causes, molecular mechanism and reversibility of IM.

Abstract:The regulatory T cells (Tregs) are important immunoregulatory cells and the forkhead box P3 (Foxp3) is essential for the production and normal function of Tregs. It is generally believed that Foxp3+ Treg cells reduce immune response to tumor cells via inhibiting the function of T cells, and are closely associated with the genesis and development of tumors. These cells mainly pertain to Foxp3+ Treg cells in tumor infiltrating lymphocytes (TIL), but the exact mechanism for their peritumor accumulation remains unclear. On the contrary, others insist that Foxp3+ Treg cells inhibit tumor growth, and high expression of Foxp3 in tumor is correlative to favorable prognosis of diseases. After literature review, the authors analyzed that the causes of the disagreement might be related to the distinct types of gastric cancer and antibody for detecting Foxp3 and the subpopulation of Foxp3+ Treg cells. Therefore, more reliable data can be obtained only by identifying the true subtypes of Foxp3+ Treg cells and verifying their relations with the various types of gastric cancer.

Abstract:The inflammatory microenvironment that is enriched with inflammatory cells, cytokines and chemokines can induce cell proliferation and mutation, and thereby provides possibility of growth, migration and immune evasion for tumors. Interleukin-6 (IL-6) is a multifunctional inflammatory factor produced by immune cells, which plays an important role in the inflammatory reactions, immune responses and hematopoietic regulation. More and more studies have found that IL-6 plays a key role in the development and progression of many cancers. In this paper, the authors address the recent progress concerning the relationship between IL-6 and digestive tract tumors.

Abstract:Neonatal necrotizing enterocolitis (NEC), characterized by rapid onset, difficult early diagnosis, high mortality and many postoperative complications, is a common pediatric surgical acute abdomen. Current clinical debates mainly center around two issues: firstly, the surgical timing and procedure selection; secondly, how to preserve the length of small bowel as adequately as possible and prevent the occurrence of short bowel syndrome. The authors, in this paper, address the current research progress in surgical treatment of NEC, with the prospect of seeking enlightenment and solutions.