Laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP) is different from conventional open hernia repair because of its unique surgical visual field and anatomical plane. Through personal experience with thousands of cases of laparoscopic inguinal herniorrhaphy, the authors extracted seven main essentials in TAPP approach and abbreviated them as “seven-step maneuver”. The “seven-step maneuver” is helpful for shortening surgery learning curve by fixing the surgery scenarios and simplifying the operation. It is recommended to be used in clinical practice.

Objective: To investigation the action and mechanism of macrophage migration inhibition factor (MIF) in drug resistance of colorectal cancer. Methods: The 5-fluorouracil (5-FU)-resistant human colon cancer LoVo/5-FU cells were established by stepwise exposure of human colon cancer LoVo cells to increasing concentrations of 5-FU. The studied parameters included the sensitivity of cells to 5-FU (IC50), MIF protein expression, glucose uptake ability of cells, lactic dehydrogenase (LDH) activity of cells and lactate production from cultured cells supernatant, which were detected by CCK-8 assay, Western blot analysis, 2-NBDG method, microporous assay and kit assay, respectively. The differences in above parameters between LoVo/5-FU cells and their parent LoVo cells were compared, and changes in these parameters in LoVo/5-FU cells before and after MIF interference and overexpression by siRNA and lentivirus transfection, or inhibition of aerobic glycolysis by PFKFB3 inhibitor PFK-15 were examined. Results: The LoVo/5-FU cells were successfully constructed, which showed significantly increased MIF protein expression, IC50 to 5-FU, glucose uptake, LDH activity and lactate production level compared with their parent LoVo cells (all P<0.05). In LoVo/5-FU cells, the IC50 to 5-FU, glucose uptake, LDH activity and lactate production level were significantly decreased after MIF interference by siRNA, while those above parameters were significantly increased after MIF overexpression (all P<0.05). After inhibition of aerobic glycolysis by PFK-15, the IC50 to 5-FU, glucose uptake and lactate production level in LoVo/5-FU cells were significantly decreased (all P<0.05), but the LDH activity showed no significant change (P>0.05), and the same effects were exerted by PFK-15 in LoVo/5-FU cells with MIF overexpression (all P<0.05). Conclusion: MIF enhanced the resistance of LoVo cells to 5-FU by increasing the aerobic glycolysis.

Background: The most common symptoms of upper gastrointestinal (UGI) diseases are epigastric pain and heartburn, nausea and vomiting, regurgitation and dysphagia. Endoscopic examination is the most reliable method for assessing UGI evaluation. Methods: Malignant tumors detected in UGI endoscopies performed between Dec 31, 2015 and Jan 1, 2011 were included in our study. Age, gender, indication for endoscopy, tumor site, tumor type, stage of disease and type of treatment data were recorded. Results: According to the analysis of five-year patient data; 39 (1.17%) of 3,309 cases had malignancy in the UGI endoscopy. The average age of malignancy detected cases were 63.4 years (range, 33–88 years). In the malignancy positive group; 35 (1%) cases had gastric and 4 (0.12%) cases had esophagus tumors. According to the gastric localization of tumors, 12 of cases were distal, 10 were proximal, 7 were middle and 4 were linitis plastica. Two of the cases had previous gastric surgery and the gastric malignancy of these cases was localized at the gastrojejunostomy site. The most frequent symptoms were abdominal pain, anemia, dyspepsia, bleeding, weight loss, obstruction and dysphagia in patients with gastric cancer. Two (5.7%) of the cases had previous gastrectomies because of benign causes. Malignant tumors were detected in the remnant tissue of these cases. The percentage of over 50-year-old patients was 89.7% in UGI malignancy detected patients. Three percent of gastric cancers were stage I, 18% of them were stage II, 25% of them were stage III and 53% of the cases were stage IV. Seventy-five percent of esophageal cancer cases had systemic metastases. Conclusions: Malignity is rarely detected among the patients from general surgery outpatient clinic, on whom UGI endoscopy is performed. But it is not different from the literature. Most of the malignancies are at advanced stage. In older age patients, endoscopy should be recommended even there are nonspecific symptoms. In the presence of alarm symptoms, UGI endoscopy should be recommended without considering the age.