Red ginseng polysaccharide promotes ferroptosis in gastric cancer cells by inhibiting PI3K/Akt pathway through down-regulation of AQP3

OBJECTIVE

This study aims to investigate the effect of red ginseng polysaccharide (RGP) on gastric cancer (GC) development and explore its mechanism.

METHODS

GC cell lines AGS were treated with varying concentrations of RGP (50, 100, and 200 μg/mL). AGS cells treated with 200 μg/mL RGP were transfected with aquaporin 3 (AQP3) overexpression vector. Cell proliferation, viability, and apoptosis were evaluated by MTT, colony formation assay, and flow cytometry, respectively. Real-time quantitative reverse transcription PCR (qRT-PCR) was used to detect the expression of AQP3. The levels of Fe2+, malondialdehyde, and lactate dehydrogenase were measured using their respective detection kits, and the reactive oxygen species levels was determined by probe 2',7'-dichlorodihydrofluorescein diacetate. The expression of ferroptosis-related protein and PI3K/Akt pathway-related protein were assessed by western blot. In vivo experiments in nude mice were performed and the mice were divided into four groups (n = 5/group) which gavage administrated with 150 mg/kg normal saline, and 75, 150, 300 mg/kg RGP, respectively. Their tumor weight and volume were recorded.

RESULTS

RGP treatment effectively inhibited the proliferation and viability of AGS cells in a dosage-dependent manner and induced apoptosis. It induced ferroptosis in AGS cells, as well as inhibiting the expression of PI3K/Akt-related proteins. AQP3 overexpression could reversed the effect of RGP treatment on ferroptosis. Confirmatory in vivo experiments showed that RGP could reduce the growth of implanted tumor, with increased RGP concentration resulting in greater tumor inhibitory effects.

CONCLUSION

RGP might have therapeutic potential against GC, effectively inhibiting the proliferation and viability of AGS cells.

Preoperative controlling nutritional status as an optimal prognostic nutritional index to predict the outcome for colorectal cancer

BACKGROUND

The controlling nutritional status (CONUT) score effectively reflects a patient's nutritional status, which is closely related to cancer prognosis. This study investigated the relationship between the CONUT score and prognosis after radical surgery for colorectal cancer, and compared the predictive ability of the CONUT score with other indexes.

AIM

To analyze the predictive performance of the CONUT score for the survival rate of colorectal cancer patients who underwent potentially curative resection.

METHODS

This retrospective analysis included 217 patients with newly diagnosed colorectal. The CONUT score was calculated based on the serum albumin level, total lymphocyte count, and total cholesterol level. The cutoff value of the CONUT score for predicting prognosis was 4 according to the Youden Index by the receiver operating characteristic curve. The associations between the CONUT score and the prognosis were performed using Kaplan-Meier curves and Cox regression analysis.

RESULTS

Using the cutoff value of the CONUT score, patients were stratified into CONUT low (n = 189) and CONUT high groups (n = 28). The CONUT high group had worse overall survival (OS) (P = 0.013) and relapse-free survival (RFS) (P = 0.015). The predictive performance of CONUT was superior to the modified Glasgow prognostic score, the prognostic nutritional index, and the neutrophil-to-lymphocyte ratio. Meanwhile, the predictive performances of CONUT + tumor node metastasis (TNM) stage for 3-year OS [area under the receiver operating characteristics curve (AUC) = 0.803] and 3-year RFS (AUC = 0.752) were no less than skeletal muscle mass index (SMI) + TNM stage. The CONUT score was negatively correlated with SMI (P < 0.01).

CONCLUSION

As a nutritional indicator, the CONUT score could predict long-term outcomes after radical surgery for colorectal cancer, and its predictive ability was superior to other indexes. The correlation between the CONUT score and skeletal muscle may be one of the factors that play a predictive role.

[Skip metastasis at the esophageal resection margin in radical gastrectomy: clinical characteristics of 30 cases]

Objective: To summarize the clinical characteristics of patients with skip metastasis at esophageal resection margin during radical gastrectomy. Methods: This is a descriptive study of case series. Relevant data from 2006 to 2022 were collected from two major gastric cancer consultation and treatment centers: Nanjing Drum Tower Hospital and Jinling Hospital.Characteristics, surgical approach, number of dissected lymph nodes, immunohistochemical staining, and pathological staging were summarized and analyzed. The distribution of residual tumor cells at the esophageal margins was further analyzed at the cellular and tissue levels. Skip metastasis at the esophageal resection margin was defined as a negative esophageal margin with a positive margin in the cephalad donut. Results: Thirty (0.33%, 30/8972) eligible patients, 24 (80.0%) of whom were male, were identified in the two centers. The mean age was 63.9±11.0 years. Seventeen (56.7%) of these patients had papillary or tubular adenocarcinomas, including 13 (43.3%) poorly- and four (13.3%) moderately-differentiated tumors; four (13.3%) had signet-ring cell carcinomas; four (13.3%) mucinous adenocarcinomas; three (10.0%) mixed adenocarcinomas, including two with poorly-differentiated tubular adenocarcinomas mixed with signet-ring cell carcinoma and mucinous adenocarcinoma; and one had a poorly differentiated tubular adenocarcinoma mixed with signet-ring cell carcinoma. Two patients (6.7%) had other types of cancer, namely adenosquamous carcinoma in one patient and undifferentiated carcinoma in the other one. The predominant tumor sites were the lesser curvature (n=26, 86.7%) and the cardia (n=24, 80.0%). The mean tumor diameter was 6.6 cm, mean distance between tumor and esophageal resection margin was 1.5 cm, and proportions of tumor invasion into the dentate line, nerves, and vessels were 80.0% (24/30), 86.7%(26/30), and 93.3% (28/30), respectively. The mean number of lymph nodes resected was 20.4±8.9. The pathological stage was mainly T4 (n=18, 60.0%) and N3 (n=21, 70.0%), the median Ki67 was 52.7%, and the rates of positivity for HER2, EGFR, VEGFR, E-cadherin and PD-L1 were 40.0% (12/30), 46.7% (14/30), 80.0% (24/30), 86.7% (26/30) and 16.7% (5/30), respectively. At the cellular level, cancer cells were mainly distributed in small focal areas, as cell masses, or as tumor thrombi; large numbers of widely distributed atypic cells were seldom observed. At the tissue level, cancer cells were located in the mucosal layer in seven patients (23.3%), in the submucosal layer in 18 (60.0%), and in the muscular layer in five (16.7%); no cancer cells were identified in the outer membrane. Five of the seven tumors were located in the lamina propria, two in the muscularis mucosae, and none in the mucosal epithelium. Conclusion: Patients with skip metastasis at the esophageal resection margin at radical gastrectomy have unfavorable tumor biology and a high proliferation index, are at a late pathological stage, and the residual cancer is mostly located in the submucosa.

[Toxic retinopathy caused by veterinary antiparasitic closantel: a case report]

A 32-year-old female patient presented with bilateral vision loss for 2 months following her intake of various antiparasitic drugs, including closantel, a veterinary drug, for a self-perceived intraocular parasitic infection. Swept-source optical coherence tomography revealed diffuse hyperreflectivity between the outer nuclear layer and the retinal pigment epithelium, as well as the largely indistinguishable outer retinal layers. This case was clinically diagnosed with veterinary closantel-induced toxic retinopathy and had a poor visual prognosis after nerve nutrition and circulation improvement therapy due to the long duration of the disease.

Forkhead Box S1 mediates epithelial-mesenchymal transition through the Wnt/β-catenin signaling pathway to regulate colorectal cancer progression

Background

Recent studies have shown that the fox family plays a vital role in tumorigenesis and progression. Forkhead Box S1 (FOXS1), as a newly identified subfamily of the FOX family, is overexpressed in certain types of malignant tumors and closely associated with patient's prognosis. However, the role and mechanism of the FOXS1 in colorectal cancer (CRC) remain unclear.

Method

FOXS1 level in CRC tissues and cell lines was analyzed by western blot and quantitative real-time polymerase chain reaction (qRT-PCR). Immunohistochemistry (IHC) was used to detect the relationship between FOXS1 expression and clinicopathological features in 136 patients in our unit. The expression of FOXS1 was knocked down in CRC cells using small interfering RNA (siRNA) technology. Cell proliferation was assessed by CCK8 assay, colony formation, and 5-Ethynyl-20-deoxyuridine (EdU) incorporation assay. Flow cytometry detected apoptosis and wound healing, and Transwell assays determined cell migration and invasion. Western blotting was used to detect the levels of proteins associated with the Wnt/β-catenin signaling pathway. Then, we used short hairpin RNA (shRNA) to knock down FOXS1 to see the effect of FOXS1 on the proliferation, migration, invasion, and metastasis of CRC cells in vivo. Finally, we investigated the impact of Wnt activator LiCl on the proliferation, migration, invasion, and metastasis of CRC cells after FOXS1 knockdown.

Result

Compared to those in normal groups, FOXS1 overexpressed in CRC tissues and CRC cells (P < 0.05). Upregulation of FOXS1 association with poor prognosis of CRC patients. si-FOXS1 induced apoptosis and inhibited proliferation, migration, invasion, the epithelial-mesenchymal transition (EMT), and the Wnt/β-catenin signaling pathway in vitro; sh-FOXS1 inhibited the volume and weight of subcutaneous xenografts and the number of lung metastases in vivo. LiCl, an activator of Wnt signaling, partially reversed the effect of FOXS1 overexpression on CRC cells.

Conclusion

FOXS1 could function as an oncogene and promote CRC cell proliferation, migration, invasion and metastasis through the Wnt/βcatenin signaling pathway, FOXS1 may be a potential target for CRC treatment.

A multicenter clinical study: personalized medication for advanced gastrointestinal carcinomas with the guidance of patient-derived tumor xenograft (PDTX)

BACKGROUND

Establish patient-derived tumor xenograft (PDTX) from advanced GICs and assess the clinical value and applicability of PDTX for the treatment of advanced gastrointestinal cancers.

METHODS

Patients with advanced GICs were enrolled in a registered multi-center clinical study (ChiCTR-OOC-17012731). The performance of PDTX was evaluated by analyzing factors that affect the engraftment rate, comparing the histological consistency between primary tumors and tumorgrafts, examining the concordance between the drug effectiveness in PDTXs and clinical responses, and identifying genetic variants and other factors associated with prognosis.

RESULTS

Thirty-three patients were enrolled in the study with the engraftment rate of 75.8% (25/33). The success of engraftment was independent of age, cancer types, pathological stages of tumors, and particularly sampling methods. Tumorgrafts retained the same histopathological characteristics as primary tumors. Forty-nine regimens involving 28 drugs were tested in seventeen tumorgrafts. The median time for drug testing was 134.5 days. Follow-up information was obtained about 10 regimens from 9 patients. The concordance of drug effectiveness between PDTXs and clinical responses was 100%. The tumor mutation burden (TMB) was correlated with the effectiveness of single drug regimens, while the outgrowth time of tumorgrafts was associated with the effectiveness of combined regimens.

CONCLUSION

The engraftment rate in advanced GICs was higher than that of other cancers and meets the acceptable standard for applying personalized therapeutic strategies. Tumorgrafts from PDTX kept attributes of the primary tumor. Predictions from PDTX modeling closely agreed with clinical drug responses. PDTX may already be clinically applicable for personalized medication in advanced GICs.

[Mechanism of gut-microbiota-liver axis in the pathogenesis of intestinal failure-associated liver disease]

Intestinal failure (IF) is defined as the critical reduction of functional intestines below the minimum needed to absorb nutrients and fluids, so that intravenous supplementation with parenteral nutrition (PN) is required to maintain health and/or growth. Although the benefits are evident, patients receiving PN can suffer from serious cholestasis due to lack of enteral feeding and small intestinal bacterial overgrowth (SIBO). One such complication that may arise is intestinal failure-associated liver disease (IFALD). Evidences from recent studies suggest that alterations in the intestinal microbiota, as well as intraluminal bile acid driven signaling, may play a critical role in both hepatic and intestinal injury. Since Marshall first proposed the concept of the gut-liver axis in 1998, the role of gut-liver axis disorders in the development of IFALD has received considerable attention. The conversation between gut and liver is the key to maintain liver metabolism and intestinal homeostasis, which influences each other and is reciprocal causation. However, as a "forgotten organ" , intestinal microbiota on the pathogenesis of IFALD has not been well reflected. As such, we propose, for the first time, the concept of gut-microbiota-liver axis to emphasize the importance of intestinal microbiota in the interaction of gut-liver axis. Analysis and research on gut-microbiota-liver axis will be of great significance for understanding the pathogenesis of IFALD and improving the prevention and treatment measures.

Flurbiprofen axetil for postoperative analgesia in upper abdominal surgery: a randomized, parallel controlled, double-blind, multicenter clinical study

PURPOSE

To investigate the efficacy and safety of flurbiprofen axetil in postoperative analgesia in upper abdominal surgery.

METHODS

This was a multicenter, randomized, positive drug parallel controlled double-blind clinical study. Patients undergoing upper abdominal surgery were randomly divided to receive flurbiprofen axetil or tramadol. The VAS pain scores at rest and on coughing (pulmonary function training) were assessed immediately before drug usage (T1) to evaluate the efficacy of postoperative analgesia. Repeat assessment of the VAS was performed after T1. The timing of the recovery of the gastrointestinal function and the preoperative and postoperative IL-6, cortisol, and blood glucose levels were recorded as secondary endpoints. Vital signs and the occurrence of adverse reactions were evaluated for the assessment of safety.

RESULTS

A total of 240 patients were enrolled in the current study; 119 used flurbiprofen axetil for postoperative analgesia. The VAS scores at rest and on coughing did not differ between the two groups to a statistically significant extent (P > 0.05). However, the reduction of the VAS score at rest in the flurbiprofen axetil group was greater than that in the tramadol group at 4-24 h after T1. The reduction of the VAS score on coughing at 8 h after T1 was greater in the flurbiprofen axetil group. The incidence of adverse reactions was significantly lower in the flurbiprofen axetil group, with only one adverse reaction recorded. In contrast, 18 adverse reactions were reported in the tramadol group.

CONCLUSION

Flurbiprofen axetil showed superior efficacy to tramadol in early postoperative analgesia after upper abdominal surgery. Flurbiprofen axetil was associated with a significantly lower incidence of adverse reactions in comparison to tramadol.

[Analysis of Related Factors in Elderly Patients with Strangulated Small Bowel Obstruction]

Objective To investigate the surgery-related factors of strangulated small bowel obstruction in the elderly patients. Methods The clinical data of 261 elderly patients with acute small bowel obstruction treated between July 2010 and September 2016 were analyzed retrospectively. Differences of clinical data,laboratory Results ,and CT findings were compared between the elderly strangulation group(ESt group,n=139)and the elderly simple group (ESi group,n=122). The surgery-related factors of strangulated small bowel obstruction in the elderly were analyzed by univariate and multivariate Logistic regression analysis. Results The ESt group and the ESi group showed significant differences in factors including muscle guarding (χ²=102.331,P=0.000),American Society of Anesthesiologists(ASA) score≥3 (χ²=69.748,P=0.000),leukocyte count (t=7.453,P=0.000),C-reactive protein (t=2.128,P=0.034),segmental mesenteric fluid (χ²=78.655,P=0.000),thick-walled small bowel (χ²=100.806,P=0.000),intestinal wall of hyperattenuation (χ²=69.068,P=0.000),ascites (χ²=89.299,P=0.000),mesenteric fat stranding (χ²=80.255,P=0.000),bird's beak sign (χ²=84.451,P=0.000),and stranding sign (χ²=98.635,P=0.000). Univariate regression analysis indicated the above 11 factors were the surgery-related factors in elderly patients with strangulated small bowel obstruction. Multivariate Logistic regression analysis showed that the surgery-related factors included segmental mesenteric fluid (OR=3.576,95%CI:1.043-12.261,P=0.043),ASA score≥3 (OR=3.463,95%CI:1.149-10.441,P=0.027),muscle guarding (OR=3.288,95%CI:1.010-10.707,P=0.048),thick-walled small bowel (OR=3.046,95%CI:1.074-8.638,P=0.036),and increased leukocyte count (OR=1.307,95%CI:1.170-1.458,P=0.000). Conclusion Muscle guarding,ASA score≥3,segmental mesenteric fluid,thick-walled small bowel,and increased leukocyte count are the surgery-related factors of strangulated small bowel obstruction in the elderly patients.

Dexamethasone-Induced Myeloid-Derived Suppressor Cells Prolong Allo Cardiac Graft Survival through iNOS- and Glucocorticoid Receptor-Dependent Mechanism

How to induce immune tolerance without long-term need for immunosuppressive drugs has always been a central problem in solid organ transplantation. Modulating immunoregulatory cells represents a potential target to resolve this problem. Myeloid-derived suppressor cells (MDSCs) are novel key immunoregulatory cells in the context of tumor development or transplantation, and can be generated in vitro. However, none of current systems for in vitro differentiation of MDSCs have successfully achieved long-term immune tolerance. Herein, we combined dexamethasone (Dex), which is a classic immune regulatory drug in the clinic, with common MDSCs inducing cytokine granulocyte macrophage colony stimulating factor (GM-CSF) to generate MDSCs in vitro. Addition of Dex into GM-CSF system specifically increased the number of CD11b⁺ Gr-1^int/low MDSCs with an enhanced immunosuppressive function in vitro. Adoptive transfer of these MDSCs significantly prolonged heart allograft survival and also favored the expansion of regulatory T cells in vivo. Mechanistic studies showed that inducible nitric oxide sythase (iNOS) signaling was required for MDSCs in the control of T-cell response and glucocorticoid receptor (GR) signaling played a critical role in the recruitment of transferred MDSCs into allograft through upregulating CXCR2 expression on MDSCs. Blockade of GR signaling with its specific inhibitor or genetic deletion of iNOS reversed the protective effect of Dex-induced MDSCs on allograft rejection. Together, our results indicated that co-application of Dex and GM-CSF may be a new and important strategy for the induction of potent MDSCs to achieve immune tolerance in organ transplantation.

A retrospective study of 34 patients with unicentric and multicentric Castleman's disease: Experience from a single institution

The aim of the present study was to share the experience of a single institute in the diagnosis, use of accessory examinations and treatment strategies of Castleman's disease (CD). The present study analyzed 34 patients (13 males and 21 females) with CD who were hospitalized between January 2006 and September 2014. The patients were divided into two groups based on the anatomical distribution of the disease: Unicentric CD (UCD) and multicentric CD (MCD). Histological data was obtained from lymph node biopsies. All clinical data were acquired by reviewing patients' medical records and contacting patients by telephone. A total of 27 patients had UCD and 7 patients had MCD. All 27 patients with UCD with benign symptoms underwent complete diagnostic surgical resection and survived, with the exception of 1 patient who succumbed to pancreatic head carcinoma 13 months after surgery. A total of 7 patients with MCD presented with systemic symptoms and 2 of these patients declined treatment following the definite diagnosis of CD. The remaining 5 patients were treated with various strategies, including surgical resection and further glucocorticoid treatment, intravenous siltuximab, rituximab in combination with cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy or hematopoietic stem cell transplantation. A total of 3 patients with MCD survived, with a median follow-up period of 69 months. The present study indicates that complete surgical resection is currently the standard treatment for UCD. Perioperative use of multidetector computed tomography and the laparoscopic approach have certain advantages in UCD. Molecular target therapy is effective in patients with stable MCD, and hematopoietic stem cell transplantation may be beneficial in certain patients with MCD and disease progression.

Tumor-associated macrophages correlate with phenomenon of epithelial-mesenchymal transition and contribute to poor prognosis in triple-negative breast cancer patients

BACKGROUND

Tumor-associated macrophages (TAMs) are associated with poor outcomes in multiple solid cancers and play important roles in cancer progression. Epithelial-mesenchymal transition (EMT) may account for metastasis and recurrence. However, the association between TAMs and EMT is not clarified in triple-negative breast cancer (TNBC). The aim of this study was to investigate the effects of TAMs on EMT in TNBC.

MATERIAL AND METHODS

We studied specimens from 278 patients with TNBC. TAMs marker cluster of differentiation 163 and EMT-related marker E-cadherin were detected by immunohistochemistry in TNBC tissues, and their clinical significance was evaluated from the patients' medical records.

RESULTS

TNBC patients with polarized cluster of differentiation 163⁺ TAMs infiltration and low level of E-cadherin had a significantly higher risk of aggressive features, including recurrence, histologic differentiation, and lymph node metastasis. Infiltration of TAMs was also negatively correlated with E-cadherin in TNBC tissues. Multivariate analysis indicated that infiltration of TAMs and low expression of E-cadherin were independent prognostic factors of overall survival and disease-free survival in TNBC patients.

CONCLUSIONS

High infiltration of TAMs was associated with low expression of E-cadherin and could be used as an unfavorable prognostic factor for patients with TNBC.

Wip1 Deficiency Promotes Neutrophil Recruitment to the Infection Site and Improves Sepsis Outcome

Sepsis is defined as an uncontrolled host response to infection, and no specific therapy or drugs have been used in clinical trials currently. Discovering new therapeutic targets for sepsis treatment has always been a central problem in the field of sepsis research. Neutrophils stand at the first line in controlling infection and have been identified to be dysregulated with impaired migration and antimicrobial function during sepsis. Based on our previous results on demonstrating wild-type p53-induced phosphatase 1 in controlling neutrophil development, we explored the possible relationship among Wip1, neutrophils, and sepsis in the present study. Wip1-deficient mice exhibited improved outcomes in cecal ligation and puncture (CLP)-induced sepsis model with enhanced bacterial clearance and less multi-organ damage. The protection seen in Wip1 KO mice was mainly due to an increased accumulation of neutrophils in the primary infectious locus mediated by the decreased internalization of CXCR2, as well as by an increased antimicrobial function. Additionally, we also identified a negative correlation between CXCR2 and Wip1 in human neutrophils during sepsis. Pharmacological inhibition of Wip1 with its inhibitor can also prevent the internalization of CXCR2 on human neutrophils treated with lipopolysaccharides in vitro and significantly improve the outcome in CLP-induced sepsis model. Taken together, our results demonstrate that Wip1 can negatively regulate neutrophil migration and antimicrobial immunity during sepsis and inhibition of Wip1 can be a potential therapeutic target for sepsis treatment.

Postoperative decrease of serum albumin predicts short-term complications in patients undergoing gastric cancer resection

AIM

To find an accurate and simple predictor for postoperative short-term complications after gastrectomy.

METHODS

Two hundred and twenty-three patients undergoing gastric cancer resection between October 1, 2015 and September 30, 2016 were enrolled in this study. Univariate and multivariate analyses were used to identify risk factors for complications after gastrectomy. The cutoff values and diagnostic accuracy were examined by receiver operating characteristic curves.

RESULTS

Sixty-two (27.8%) patients had short-term complications after gastric cancer resection. The postoperative decrease in serum albumin (∆ALB) was an independent risk factor for complications (OR = 17.957, 95%CI: 6.073-53.095, P < 0.001). The cutoff value was 14.0% and the area under the curve was higher than that of C-reactive protein on postoperative day 3 (area under the curve: 0.806 vs 0.709). Patients with ∆ALB ≥ 14.0% were more likely to have short-term complications after gastrectomy (46.7% vs 5.0%, P < 0.001), prolonged hospital stay (17.2 ± 10.8 d vs 14.1 ± 4.2 d, P = 0.007) and higher comprehensive complication index (P < 0.001) than those with ∆ALB < 14.0%.

CONCLUSION

Postoperative ∆ALB with a cutoff of 14.0% can be used to recognize patients who have high risk of short-term complications following gastric cancer resection.

Hypoxia-inducible factor-1 alpha Correlates with Tumor-Associated Macrophages Infiltration, Influences Survival of Gastric Cancer Patients

Background: Hypoxia was a common feature for accelerating tumor metastasis by both inducting epithelial-mesenchymal transition (EMT) of tumor cells and polarization of tumor-associated macrophages (TAMs). The association and roles between hypoxia, EMT and TAMs in the biological behavior of gastric cancer (GC) for the time being recurrence is unclear. Material and methods: hypoixa by expression of hypoxia-inducible factor-1 alpha (HIF-1α), polarized functional status of infiltrated TAMs by immunohistochemical staining of CD68 and CD163, and the expression of E-cadherin as EMT property had been evaluated in 236 patients consecutive with histologically confirmed GC. Clinical significance was assessed for all these patients. Results: High expression of HIF-1α was found in patients with aggressive features, especially for recurrent patients. High infiltration of TAMs and abnormal expression of EMT-marker were also related to aggressive characteristics and predicted poor prognosis in GC. Meanwwhile, there existed a significant correlation among expression of HIF-1α, infiltration of TAMs and EMT marker in GC tissues. Multivariate Cox analysis revealed that high expression of HIF-1α combined TAMs infiltration were independent prognostic factors for disease-specific survival rate. Conclusion: HIF-1α is an unfavorable indicator for prognosis, may promote tumor progression through the induction of EMT and establishment of a pro-tumor immunosuppressive microenvironment. Further investigation into the therapeutic effects of blocking hypoxia is possible a potential strategy for GC treatment.

Effect of Clostridium perfringens enterotoxin on gastric cancer cells SGC7901 which highly expressed claudin-4 protein

AIM

To investigate the effects of Clostridium perfringens enterotoxin (CPE) on gastric cancer cells which highly expressed claudin-4 (CL4) protein.

METHODS

In this study, we detected expression of CL4 protein in different gastric cancer cell lines. Then, we investigated the effects of CPE on SGC7901 cells which highly expressed CL4 protein and the effects of CPE on subcutaneous tumor in nude mice models.

RESULTS

CL4 are highly expressed in SGC7901 cells. CPE expressed significant cytotoxicity in SGC7901 cells. Suppression of CL4 expression significantly decreased CPE-mediated cytotoxicity. CPE also inhibited tumor growth in subcutaneous tumor xenograft models.

CONCLUSION

CPE showed CL4 mediated cytotoxicity on gastric cancer cells SGC7901 and inhibited tumor growth in nude mice models.

Neutrophil dysregulation during sepsis: an overview and update

Sepsis remains a leading cause of death worldwide, despite advances in critical care, and understanding of the pathophysiology and treatment strategies. No specific therapy or drugs are available for sepsis. Neutrophils play a critical role in controlling infection under normal conditions, and it is suggested that their migration and antimicrobial activity are impaired during sepsis which contribute to the dysregulation of immune responses. Recent studies further demonstrated that interruption or reversal of the impaired migration and antimicrobial function of neutrophils improves the outcome of sepsis in animal models. In this review, we provide an overview of the associated mediators and signal pathways involved which govern the survival, migration and antimicrobial function of neutrophils in sepsis, and discuss the potential of neutrophils as a target to specifically diagnose and/or predict the outcome of sepsis.

High Infiltration of Polarized CD163+ Tumor-Associated Macrophages Correlates with Aberrant Expressions of CSCs Markers, and Predicts Prognosis in Patients with Recurrent Gastric Cancer

Background: As the most predominant tumor-infiltrating immune cells, tumor-associated macrophages (TAMs) are associated with poor outcome in multiple solid cancers and play important roles in cancer progression. Cancer stem cells (CSCs) may account for metastasis and recurrence after cancer therapy. However, the association between TAMs and CSCs is not clarified in gastric cancer (GC). The aim of the present study was to evaluate the effects of TAMs on CSCs in GC and find out the risk factors to predict recurrence and prognosis.

Material and methods: This study included consecutive 236 patients with histologically confirmed primary GC. TAMs marker CD163 and CSCs-related proteins were detected by immunohistochemistry (IHC) in GC tissues and their prognostic values were all investigated.

Results: High expression of CD163⁺ TAMs was found in patents with aggressive characteristics, especially for patents with recurrence. There existed a significant correlation between high expression of CD163 and CSCs-related markers in GC tissues. In patients with recurrence, high-expression of CD163 TAMs was an independent worse prognostic factor.

Conclusion: High infiltration of TAMs was related to aggressive behavior, associated with aberrant expression of CSC markers, and an independent worse prognostic factor in GC. Targeting TAMs may be a potential treatment strategy for GC, including patients with recurrence.

Phosphatase Wip1 in Immunity: An Overview and Update

Wild-type p53-induced phosphatase 1 (Wip1) is a newly identified serine/threonine phosphatase, which belongs to the PP2C family. Due to its involvement in stress-induced networks and overexpression in human tumors, primary studies have mainly focused on the role of Wip1 in tumorigenesis. It now has also been implicated in regulating several other physiological processes such as organism aging and neurogenesis. Recent evidence highlights a new role of Wip1 in controlling immune response through regulating immune cell development and function, as well as through the interplay with inflammatory signaling pathways such NF-κB and p38 mitogen-activated protein kinase. In this short review, we will give an overview of Wip1 in immunity to better understand this important phosphatase.

Donor-Specific Regulatory T Cells Acquired from Tolerant Mice Bearing Cardiac Allograft Promote Mixed Chimerism and Prolong Intestinal Allograft Survival

The induction of donor-specific transplant tolerance has always been a central problem for small bowel transplantation (SBT), which is thought to be the best therapy for end-stage bowel failure. With the development of new tolerance-inducing strategies, mixed chimerism induced by co-stimulation blockade has become most potent for tolerance of allografts, such as skin, kidney, and heart. However, a lack of clinically available co-stimulation blockers has hindered efficient application in humans. Furthermore, unlike those for other types of solid organ transplantation, strategies to induce robust mixed chimerism for intestinal allografts have not been fully developed. To improve current mixed chimerism induction protocols for future clinical application, we developed a new protocol using donor-specific regulatory T (Treg) cells from mice with heart allograft tolerance, immunosuppressive drugs which could be used clinically and low doses of irradiation. Our results demonstrated that donor-specific Treg cells acquired from tolerant mice after in vitro expansion generate stable chimerism and lead to acceptance of intestinal allograft. Increased intragraft Treg cells and clonal deletion contribute to the development of SBT tolerance.

Small bowel volvulus with jejunal diverticulum: Primary or secondary?

Small bowel volvulus, which is torsion of the small bowel and its mesentery, is a medical emergency, and is categorized as primary or secondary type. Primary type often occurs without any apparent intrinsic anatomical anomalies, while the secondary type is common clinically and could be caused by numerous factors including postoperative adhesions, intestinal diverticulum, and/or tumors. Here, we report a rare case of a 60-year-old man diagnosed with small bowel volvulus using multidetector computed tomography (MDCT) angiography. Further discovery by laparotomy showed one jejunal diverticulum, longer corresponding mesentery with a narrower insertion, and a lack of mesenteric fat. This case report includes several etiological factors of small bowel volvulus, and we discuss the possible cause of small bowel volvulus in this patient. We also highlight the importance of MDCT angiography in the diagnosis of volvulus and share our experience in treating this disease.

Esophagojejunostomy after laparoscopic total gastrectomy by OrVilTM or hemi-double stapling technique

AIM: To investigate the feasibility, advantages and disadvantages of two types of anvil insertion techniques for esophagojejunostomy after laparoscopic total gastrectomy.

METHODS: This was an open-label prospective cohort study. Laparoscopy-assisted radical total gastrectomy with D2 lymph node dissection was performed in 84 patients with primary non-metastatic gastric cancer confirmed by pre-operative histological examination. Overweight patients were excluded, as well as patients with peritoneal dissemination and invasion of adjacent organs. After total gastrectomy, all patients were randomized into two groups. Patients in Group I underwent esophagojejunostomy using a transorally-inserted anvil (OrVil^TM), while patients in Group II underwent esophagojejunostomy using the hemi-double stapling technique (HDST). Both types of esophagojejunostomy were performed under laparoscopy. Patients’ baseline characteristics, preoperative characteristics, perioperative characteristics, short-term postoperative outcomes and operation cost were compared between the two groups. The primary endpoint was evaluation of the surgical outcome (operating time, time of digestive tract reconstruction and time of anvil insertion) and the medical cost of each operation (operation cost and total cost of hospitalization). The secondary endpoints were time to solid diet, post-surgical hospitalization time, time to defecation, time to ambulation and intra-operative blood loss. In addition, complications were assessed and compared.

RESULTS: Laparoscopic total gastrectomy and esophagojejunostomy were successfully performed in all 84 patients, without conversion to laparotomy. There were no significant differences in the operative time and time for total gastrectomy between the two groups (287.8 ± 38.4 min vs 271.8 ± 46.1 min, P = 0.09, and 147.7 ± 31.6 min vs 159.8 ± 33.8 min, P = 0.09, respectively). The time for digestive tract reconstruction and for anvil insertion were significantly decreased in Group II compared with Group I (47.8 ± 12.1 min vs 55.4 ± 15.7 min, P = 0.01, and 12.6 ± 4.7 min vs 18.7 ± 7.5 min, P = 0.001, respectively). Intra-operative blood loss (96.4 ± 32.7 mL vs 88.2 ± 36.9 mL, P = 0.28), time to defecation (3.5 ± 0.9 d vs 3.2 ± 1.1 d, P = 0.12), time to ambulation (3.9 ± 0.7 d vs 3.6 ± 1.1 d, P = 0.12), time to solid diet (7.6 ± 1.4 d vs 8.0 ± 2.7 d, P = 0.31) and total hospitalization (10.6 ± 2.6 d vs 10.8 ± 3.5 d, P = 0.80) were similar between the two groups. In addition, the total costs of hospitalization were similar between the two groups (73848.7 ± 11781.0 RMB vs 70870.3 ± 14003.5 RMB, P = 0.296), but operation cost was significantly higher in Group I compared with Group II (32401.9 ± 1981.6 RMB vs 26961.9 ± 2293.8 RMB, P < 0.001).

CONCLUSION: Anvil insertion was faster and easier using the HDST technique compared with OrVil^TM, and was more cost-effective. There was no significant difference in safety.

Laparoscopic assisted extraperitoneal hernia sac high ligation vs traditional surgery for inguinal hernia in preschool children

AIM: To compare the clinical effects of laparoscopic assisted extraperitoneal hernia sac high ligation with traditional surgery in the management of inguinal hernia in preschool children.

METHODS: Preschool children with inguinal hernia treated at Suqian People's Hospital from March 2013 to January 2015 were divided into two groups to receive either laparoscopic assisted extraperitoneal hernia sac high ligation (observation group, n = 53) or traditional surgery (control group, n = 49). Operative time, hospital stay, and postoperative complications were compared for the two groups.

RESULTS: All surgical procedures were successful in the two groups. The mean operation time and hospital stay were significantly better in the observation group than in the control group (15.35 min ± 2.11 min vs 20.45 min ± 3.74, 2.0 d vs 3.5 d, P < 0. 05). The postoperative follow-up duration was 6 mo, during which no postoperative recurrence was observed in the observation group. One case of contralateral hernia developed in patients with unilateral inguinal hernia in the observation group. In the control group, 7 cases of contralateral hernia appeared.

CONCLUSION: Laparoscopic assisted extraperitoneal hernia sac high ligation treatment of inguinal hernia in preschool children is feasible and convenient, with shorter hospital stay and fewer postoperative complications.

C-reactive protein is a predictive factor of anastomotic leakage after laparoscopic colorectal cancer surgery

AIM: To evaluate the potential predictive role of C-reactive protein (CRP) in assessing anastomotic leakage after laparoscopic colorectal cancer surgery.

METHODS: We reviewed pre- and postoperative serum CRP in 124 patients who underwent laparoscopic surgery for colorectal cancer between January 2013 and January 2014. Patients with anastomotic leakage (group A, n = 17) were compared to those without (group B, n = 107). Patients with ongoing infections before surgery or with acquired infections other than leakage were excluded. Mean pre- and postoperative values of CRP were compared.

RESULTS: The average values of serum CRP were significantly higher in group A than in group B starting from the 2nd postoperative day (POD) until the diagnosis of leakage (P < 0.001). The cut-off value of 80 mg/L on the 3rd POD maximized the sensitivity (77%) and specificity (98%) of serum CRP in assessing the risk of leakage.

CONCLUSION: According to these results, an early and persistent elevation of CRP after laparoscopic surgery for colorectal cancer is a marker of anastomotic leakage. A cut-off value > 80 mg/L on POD3 maximizes sensitivity and specificity.

Surgical approach does not influence the outcome of incidental gallbladder carcinoma

Several reports claim that there is a risk that laparoscopic cholecystectomy (LC) might worsen the prognosis of unsuspected gallbladder cancer. The aim of this study was to evaluate whether the surgical approach influence the outcome in patients with incidental gallbladder carcinoma.

METHODS

A retrospective study was done of 28 patients who were diagnosed with unsuspected gallbladder carcinoma who had undergone cholecystectomy for benign gallbladder disease at our institution between 1999 and 2007. 20 patients (4 men and 16 women, aged from 37 to 81 years) undergoing LC (group A) and 8 patients (6 men and 2 women, aged from 43 to 88 years) undergoing open cholecystectomy (OC) (group B) with incidental diagnosed GC. We evaluated the outcome in the two groups correlating the cumulative survival rates with tumor stage and surgical technique (LC or OC), time of diagnosis (after or during cholecystectomy).

RESULTS

nine patients (69.2 %) in group A and four patients (30.8%) in group B had recurrence. Survival rate was statistically correlated to tumor stage (P<0.0001) Survival rate was statistically correlated with tumor stage but neither with the surgical approach used to perform cholecystectomy, nor with time of diagnosis (intra- or post-operatively).

CONCLUSION

These results would seem to lend support to the opinion that LC does not worsen the prognosis for incidental GC, regardless of whether the tumor was detected during or after cholecystectomy.

[Application and development of quantum dots in the imaging of lymph node metastasis]

Quantum dots(QDs) are semiconductor nanocrystals composed of element from the periodic groups of II(-IIIIII( or III(-IIIII(, which possess wide excitation spectra and narrow emission spectra. The maximum emission wavelength of QDs can be controlled in a relatively simple manner by variation of particle size and composition. QDs can be tuned at a variety of precise wavelengths from ultraviolet(UV) to near infrared(NIR). QDs can be conjugated to a wide range of biological targets, including monoclonal antibodies, proteins, polymers and nucleic acid probes. These characteristics make it not only for revealing interaction of nucleic acids, proteins and other biological macromolecules, by biological imaging but also for detection of lymph node metastasis through preoperative and introperative lymphatic imaging. Along with the continuously improvement of observation techniques and quantum dot structure optimization in recent years, the research on lymph node imaging is ongoing.

Multiple early gastric carcinoma: Report of one case

Multiple early gastric carcinoma is a relatively rare clinical entity and is easy to be misdiagnosed for missing tumor lesions. Here we report such a case in a patient who was diagnosed with this rare disease by postoperative pathology after two surgeries. Major causes of misdiagnosis of this disease include the lack of experience with multiple early gastric carcinoma, limitations of medical examinations, and poor patient compliance. To increase the detection rate of multiple early gastric carcinoma, clinicians should increase knowledge about this disease to raise awareness. Chromoendoscopy and magnifying endoscopy should be used when conventional endoscopy is not enough to help establish a diagnosis. Careful intraoperative examination should also be guaranteed. Moreover, pathological examination of continuous sections of surgical specimens is necessary for a definite diagnosis.

Retroperitoneal alveolar soft-part sarcoma: A case report

Alveolar soft-part sarcoma is a rare type of malignant soft tissue tumor that usually presents as a painless, slow-growing mass and is easily misdiagnosed as paraganglioma, alveolar rhabdomyosarcoma, clear cell renal cell carcinoma, or granular cell tumor. Alveolar soft-part sarcoma of the retroperitoneum is extremely rare. Here we report a case of retroperitoneal alveolar soft-part sarcoma that was correctly diagnosed based on a combination of imaging, clinical and pathological features and the use of immunohistochemical and gene detection techniques. A literature review was performed to further raise the awareness of this rare disease.

Inhibition of STAT3 by RNA interference suppresses angiogenesis in colorectal carcinoma

In order to investigate signal transduction and activation of transcription 3 (STAT3) signaling on angiogenesis in colorectal carcinoma (CRC) after inhibiting STAT3 expression, we constructed the HT-29-shSTAT3 cell line by lentivirus-mediated RNAi. Cell growth was assessed with MTT and the cell cycle distribution by flow cytometry. CRC nude mouse models were established and tumor growth was monitored periodically. On day 30, all mice were killed and tumor tissues were removed. Microvessel density (MVD) was determined according to CD34-positive staining. The expression of vascular endothelial growth factor A (VEGFA), matrix metalloproteinase-2 (MMP2) and basic fibroblast growth factor (FGF2) was monitored by quantitative real-time PCR and Western blot analysis. Knockdown of STAT3 expression significantly inhibited cell growth in HT-29 cells, with a significantly higher proportion of cells at G0/G1 (P < 0.01). Consistently, in vivo data also demonstrated that tumor growth was significantly inhibited in mice injected with HT-29-shSTAT3 cells. MVD was 9.80 ± 3.02 in the HT-29-shSTAT3 group, significantly less than that of the control group (P < 0.01). mRNA and protein levels of VEGFA and MMP2 in the HT-29-shSTAT3 group were significantly lower than in the control group (P < 0.05), but no significant difference was observed in the mRNA or protein level of FGF2 (P > 0.05). Taken together, these results demonstrate that STAT3 signaling is important to the growth of CRC and promotes angiogenesis by regulating VEGFA and MMP2 expression.

Protective effects of mannitol against small bowel ischemia and reperfusion injury after transplantation in rats

AIM: To investigate the effect of mannitol on small bowel ischemia and reperfusion (I/R) injury after transplantation and its possible mechanism.

METHODS: Rat models of small bowel I/R injury after transplantation were established in male rats. All the rats were randomly divided into sham operation group, I/R group and mannitol-treated group. After 0.5, 1 and 1.5 hours of I/R, intestinal tissues were collected for histopathological examination. The content of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) in the intestinal tissues.

RESULTS: The height and thickness of intestinal intestinal villi were significantly lower in I/R group than those in sham operation group (P < 0.01) and mannitol-treated group (P < 0.05). At different time points, the content of MDA was markedly higher in I/R group (16.24 ± 4.56, 18.50 ± 2.89, 19.42 ± 2.21) than that in sham operation group (10.26 ± 1.72, P < 0.01) and mannitol-treated group (11.24 ± 1.51, 14.03 ± 3.12, 16.06 ± 3.62; P < 0.05), but the activity of SOD was notably higher (398.36 ±1 8.81, 363.16 ± 16.29, 325.66 ±1 4.58 vs 447.97 ± 16.94; 422.30 ±1 7.41, 385.09 ± 19.11, 346.15 ± 14.10; P < 0.01 or P < 0.05).

CONCLUSION: Mannitol has protective effect against small bowel I/R injury after transplantation in rats by eliminating free radicals.

Effect of p27(KIP1) on cell cycle and apoptosis in gastric cancer cells

AIM

To elucidate the effect of p27(KIP1) on cell cycle and apoptosis regulation in gastric carcinoma cells.

METHODS

The whole length of p27(KIP1) cDNA was transfected into human gastric cancer cell line SCG7901 by lipofectamine. Expression of p27(KIP1) protein or mRNA was analyzed by Western blot and RNA dot blotting, respectively. Effect of p27(KIP1) on cell growth was observed by MTT assay and anchorage-independent growth in soft agar. Tumorigenicity in nude mice was used to assess the in vivo biological effect of p27(KIP1). Flow cytometry, TUNEL, and electron microscopy were used to assess the effect of p27(KIP1) on cell cycle and apoptosis.

RESULTS

Expression of p27(KIP1) protein or mRNA increased evidently in SCG7901 cells transfected with p27(KIP1). The cell growth was reduced by 31% at 48 h after induction with zinc determined by cell viability assay. The alteration of cell malignant phenotype was evidently indicated by the loss of anchorage-independent growth ability in soft agar. The tumorigenicity in nude mice was reduced evidently (0.55+/-0.14 cm vs 1.36+/-0.13 cm, P<0.01). p27(KIP1) overexpression caused cell arrest with 36% increase (from 33.7% to 69.3%, P<0.01) in G1 population. Prolonged p27(KIP1) expression induced apoptotic cell death reflected by pre-G1 peak in the histogram of FACS, which was also confirmed by TUNEL assay and electron microscopy.

CONCLUSION

p27(KIP1) can prolong cell cycle in G1 phase and lead to apoptosis. p27(KIP1) may be a good candidate for cancer gene therapy.

Overexpression of Bax induces apoptosis and enhances drug sensitivity of hepatocellular cancer-9204 cells

AIM: To investigate the role of overexpression of Bax in apoptotic pathways and the response of human hepatocellular cancer (HCC)-9204 cells to cell death induced by adriamycin.

METHODS: The whole length of Bax cDNA was transfected into human HCC-9204 cells by the method of lipofectamine transfection. An inducible MT-II regulatory system was constructed, which allowed controlled expression of protein upon addition of ZnSO₄ (100 μmol/L) as an external inducer. Stable transfecting inducible expression vector containing Bax gene was performed. Expression of Bax in protein was analyzed by immunohistochemistry and Western blotting. TUNEL and flow cytometry were used to assess the effect of Bax on apoptosis. Colony assay and tetrazolium blue (MTT) assay were used to evaluate the difference in drug sensitivity of HCC-9204 cells after Bax-transfection.

RESULTS: Immunohistochemistry and Western blotting demonstrated that the expression of Bax protein markedly increased in Bax-transfected cells 4 h after the addition of ZnSO₄. Bax positive signal was frequently found on the cytoplasm and perinuclear region of HCC-9404 cells, and there was ectopic expression in cells with marked condensation of chromatin and cytoplasm (apoptotic cells). Apoptotic index significantly increased in Bax-transfected HCC-9204/Bax cells (3.6 vs 27.2, 4.2 vs 32.3, P<0.05). Flow cytometry analysis showed a significant sub-G1 peak and apoptosis in 15.4% HCC-9204/Bax cells 24 h after treatment. Furthermore, colony survival rate decreased from 66% (HCC-9204/pMD) to 45% (HCC-9204/Bax) 2 d after ADR withdrawal. MTT assay result showed that the effects of Bax on cell viability following ADR exposure were significant as compared to the vehicle-transfected HCC-9204/pMD cells (21% vs 44%, P<0.01).

CONCLUSION: Overexpression of Bax not only induces apoptosis, but also sensitizes HCC-9204 cells to cell death induced by adriamycin.

Effect of ischemic preconditioning on ischemia reperfusion injury of graft after pancreas transplantation and correlations with apoptosis in rat

AIM: To investigate the effect of ischemic preconditioning on ischemia reperfusion injury of the pancreas graft in rat, and to analyze the possible mechanism.

METHODS: Six normal SD rats in the control group received sham operation. Twenty-four SD rats with steptozozin-induced diabetes were randomly assigned to 2 groups: Group I/R consisted of 6 diabetic rats which received pancreas transplantation; Group IPC consisted of 18 diabetic rats which received pancreas transplantation and were exposed to 5 min ischemia and 5 min reperfusion once (IPC₁, n = 6), twice (IPC₂, n = 6) or thrice (IPC₃, n = 6) before ablating donors. Blood glucose, serum NO and TNF-α, MDA, SOD, MPO, TUNEL cells, and the expression of Bcl-2 and Bax pretien (Western Blot) in graft were monitored.

RESULTS: The mean blood glucose levels in Group IPC1 (14.3 ± 1.1 vs 12.1 ± 0.9 mmol/L, P<0.05), Group IPC₂ (12.1 ± 0.9 vs 16.5 ± 1.4 mmol/L, P<0.01) and Group IPC₃(14.7 ± 1.3 vs 12.1 ± 0.9 mmol/L, P<0.05) were lower than that in Group I/R, and the glucose level in Group IPC₂ was lower than those in IPC1(12.1 ± 0.9 vs 14.3 ± 1.1 mmol/L, P<0.05)and IPC₃ (12.1 ± 0.9 vs 14.7 ± 1.3 mmol/L, P<0.05) 2 hours after reperfusion. The mean NO (13.13 ± 2.87 vs 8.91 ± 1.23 μg/L, P<0.05, 18.79 ± 2.39 vs 8.91 ± 1.23 μg/L, P<0.01, 14.36 ± 1.78 vs 8.91 ± 1.23 μg/L, P<0.05) and SOD (179.82 ± 19.54 vs 153.47 ± 17.67 mU/g, P<0.05, 213.64 ± 22.97 vs 153.47 ± 17.67 mU/g, P<0.01, 181.68 ± 20.32 vs 153.47 ± 17.67 mU/g, P<0.05) levels in Group IPC₁, IPC₂ and IPC₃ were higher than that in Group I/R, and the levels in Group IPC₂ were higher than those in Group IPC₁ and Group IPC₃ 2 hours after reperfusion (18.79 ± 2.39 vs 13.13 ± 2.87 μg/L, 18.79 ± 2.39 vs 14.36 ± 1.78 μg/L, 213.64 ± 22.97 vs 179.82 ± 19.54 mU/g, 213.64 ± 22.97 vs 181.68 ± 20.32 mU/g, P<0.05). The mean levels of TNF-α (1.41 ± 0.17 vs 1.79 ± 0.25 kU/L, P<0.05, 1.05 ± 0.16 vs 1.79 ± 0.25 kU/L, P<0.01, 1.43 ± 0.20 vs 1.79 ± 0.25 kU/L, P<0.05, MDA (0.70 ± 0.26 vs 0.87 ± 0.31 mmol/g, P<0.05, 0.46 ± 0.18 vs 0.87 ± 0.31 mmol/g, P<0.01; 0.67 ± 0.15 vs 0.87 ± 0.31 mmol/g, P<0.05) and MPO (0.81 ± 0.23 vs 0.96 ± 0.34 A/g, P<0.05, 0.51 ± 0.16 vs 0.96 ± 0.34 A/g, P<0.01, 0.78 ± 0.22 vs 0.96 ± 0.34 A/g, P<0.05) in Group IPC₁, IPC₂ and IPC₃ were lower than those in Group I/R, and those in Group IPC₂ were lower than in IPC₁ and IPC₃ 2 hours after reperfusion (1.05 ± 0.16 vs 1.41 ± 0.17 kU/L, 1.05 ± 0.16 vs 1.43 ± 0.20 kU/L, 0.46 ± 0.18 vs 0.70 ± 0.26 mmol/g, 0.46 ± 0.18 vs 10.67 ± 0.15 mmol/g, 0.51 ± 0.16 vs 0.81 ± 0.23 A/g, 0.51 ± 0.16 vs 0.78 ± 0.22 A/g, P<0.05). The apoptotic indexes in IPC1 (25.21 ± 3.47 vs 35.65 ± 4.78%, P<0.01), IPC₂ (15.47 ± 2.09 vs 35.65 ± 4.78%, P<0.01) and IPC₃ (24.89 ± 3.56 vs 35.65 ± 4.78%, P<0.01) were lower than Group I/R, and that in Group IPC₂ was lower than IPC₁ (15.47 ± 2.09 vs 25.21 ± 3.47%, P<0.01) and IPC₃ (15.47 ± 2.09 vs 24.89 ± 3.56%, P<0.01) 2 hours after reperfusion. The expression of the Bax protein in Group I/R was higher than that in Group IPC, while that in Group IPC₂ was the lowest. The expression of Bcl-2 protein in Group IPC was higher than in Group I/R, and that in Group IPC2 was the highest. The expression of the Bax protein in Group IPC was lower than Group I/R, and that in Group IPC₂ was the lowest.

CONCLUSION: Ischemic preconditioning can protect pancreas graft from I/R injury. The possible mechanism may be related to the increased production of serum NO and tissue SOD, reduced conglutination and aggregation of PMNs in pancreas and diminished synthesis TNF-α. Ischemic preconditioning can reduce apopotosis of the graft, which may be resulted from alleviated conglutination and aggregation of PMNs, increased oxygen radical, increased Bcl-2 protein and reduced P53 protein expression. Five min ischemia and five min reperfusion twice is the best way to induce ischemic preconditioning in rat pancreas transplantation.

Argon supper-cryosurgery for patients with middle and late stage liver cancer

OBJECTIVE

To assess the value of argon supper-cryosurgery for 42 patients with middle and late stage liver cancer.

METHODS

Forty-two patients who had received argon supper-cryosurgery were analyzed retrospectively in terms of their clinical characteristics as well as the performance of argon supper-cryosurgery.

RESULTS

All patients were ameliorated in symptoms shortly after the operation, including pain alleviation, psyche straightening up, alpha-fetoprotein descending or recovery. Jaundice occurred in 1 patient and intraabdominal hemorrhage in 2. The levels of aspartate transaminase and alanine transaminase in all patients were elevated 1 month after the operation, and normalized after protective therapy of the liver. No operative death was noted.

CONCLUSIONS

Cold and heat reversed therapy of argon supper-cryosurgery can drastically destroy tumor tissue, especially the tumors which are too large to resect or close to the large vessels. It is applicable to increase the operative rate, decrease the operative death rate, and enlarge the therapeutic scope.

Expression of NGF family and their receptors in gastric carcinoma: A cDNA microarray study

AIM: To investigate the expression of NGF family and their receptors in gastric carcinoma and normal gastric mucosa, and to elucidate their effects on gastric carcinoma.

METHODS: RNA of gastric cancer tissues and normal gastric tissues was respectively isolated and mRNA was purified. Probes of both mRNA reverse transcription product cDNAs labled with α-³³P dATP were respectively hybridized with Atlas Array membrane where NGF and their family genes were spotted on. Hybridized signal images were scanned on phosphor screen with ImageQuant 5.1 software after hybridization. Normalized values on spots were analyzed with ArrayVersion 5.0 software. Differential expression of NGF family and their receptors mRNA was confirmed between hybridized Atlas Array membranes of gastric cancer tissues and normal gastric mucosa, then their effects on gastric carcinoma were investigated.

RESULTS: Hybridization signal images on Atlas Array membrane appeared in a lower level of nonspecific hybridization. Both of NGF family and their receptors Trk family mRNA were expressed in gastric cancer and normal gastric mucosa. But adversely up-regulated expression in other tissues and organs. NGF, BDGF, NT-3, NT-4/5, NT-6 and TrkA, B and C were down-regulated simultaneously in gastric carcinoma in comparison with normal gastric mucosa. Degrees of down-regulation in NGF family were greater than those in their receptors Trk family. Down-regulation of NT-3 and BDGF was the most significant, and TrkC down-regulation level was the lowest in receptors Trk family.

CONCLUSION: Down-regulated expression of NGF family and their receptors Trk family mRNA in gastric cancer is confirmed. NGF family and their receptors Trk family probably play a unique role in gastric cancer cell apoptosis by a novel Ras or Raf signal transduction pathway. Their synchronous effects are closely associated with occurrence and development of gastric carcinoma induced by reduction of signal transduction of programmed cell death.

cDNA suppression subtraction library for screening down-regulated genes in gastric carcinoma

AIM: To establish cDNA suppression subtraction library with a high subtraction efficiency by counterpart normal gastric mucosa mixture mRNA subtracting gastric cancer cells mixture mRNA for screening down-regulated genes in gastric carcinoma.

METHODS: RNA of gastric cancer tissues and counterpart normal gastric mucosa were respectively isolated in five patients with gastric cancer, and their mRNA was purified. cDNA suppression subtraction library was established by counterpart normal gastric mucosa mixture mRNA (tester) subtracting gastric cancer tissues mixture mRNA (driver) of five patients with gastric carcinoma. The library plasmids were transformed into competent bacteria DH5a after ligation of the library cDNA fragments with T vectors. Library plasmids were extracted after picking colonies and shaking bacteria overnight. Its subtraction efficiency was confirmed by PCR and reverse hybridization of a nylon filter onto which the colonies of bacteria were transfered with probes of reverse transcription products cDNA of gastric cancer tissues mRNA and counterpart normal gastric mucosa mRNA labeled with α-³²P dCTP.

RESULTS: mRNA purified from total RNA of gastric cancer tissues and counterpart normal gastric mucosa in five patients with gastric carcinoma revealed a good quality. cDNA suppression subtraction library constructed for screening down-regulated genes in gastric carcinoma represented a high subtraction efficiency. 86% of differential expression in down-regulated genes between counterpart normal gastric mucosa and gastric carcinoma was confirmed.

CONCLUSION: cDNA suppression subtraction library with a high subtraction efficiency for screening down-regulated genes in gastric carcinoma is successfully established.

[Clinical application of the medial fasciocutaneous flap of arm]

OBJECTIVE

To study the clinical application of the medial arm fasciocutaneous flap based on the medial septocutaneous branches of the brachial vessel.

METHODS

Since 1994, the medial arm fasciocutaneous flap based on the medial septocutaneous branches of the branchial vessel has been used to cure scar contracture of axillary and elbow joint, radiated ulcer of the chest wall. Eighteen clinical cases were reported. Among them, there were 14 males and 4 females, aged from 6 to 48 years old. The flaps, of which 3 were proximally based and 15 distally based, were designed 23 cm x 11 cm as maximal size and 10 cm x 6 cm as minimal size.

RESULTS

All the flaps survived and the excellent function and cosmetic result were achieved.

CONCLUSION

The medial arm fasciocutaneous flap is thin, soft and relatively hairless, so it is suitable for repairing the soft tissue defect of the axillary or elbow joint. There are consistently present perforators at both ends that allow one to rotate long flaps around pivoting points immediate to the areas needing coverage. Moreover, this flap is characterized by the simplicity of the surgical techniques and circulatory reliability.

[Functional evaluation of electrical-injury nerve using somatosensory evoked potential technique]

OBJECTIVE

To investigate the characteristics and the pathologic classification of electrical-injury nerve using somatosensory evoked potential(SEP) technique.

METHODS

SEP were detected and evaluated in 12 cases with electrical-injury nerve during operation, electrical stimulation was commenced from distal side of nerve where the structure of nerve looks normal under operating microscope, up to proximal side until evoking out a stable SEP predeterminate virtual value. Pathological examination and the following functional evaluation were compared with the values of SEP.

RESULTS

At the site of nerve looking normal under operating microscope, perineurium appears normal or slightly thicken. But there are obvious fibrosis and fibrotic proliferation between fascicular and intrafascicular. Vessel plexus is not seen. At SEP stabilizely evoked site, nervous construction is normal, there are visible interfascicular vessel plexus and connective tissue appears loose. Comparing SEP values with pathological section, amplitude and latency of SEP is positively correlative with the quality of nerve. Eight cases repaired with SEP technique to select the anastomosis site for nerve transplantation were followed up, two-point discrimination reached grade III (America hand surgery association criterion) within 62.5% cases.

CONCLUSION

SEP technique is valuable method for functional evaluation of electrical- injury nerve which has a complicated pathology. The pathology of electrical-injury nerve can be classified into 4 types, type A: fibrosis of nerve; type B: nerve looking normal under operation microscope, perineurium appears thicken, and there are obvious fibrosis and fibrotic proliferation between fascicular and intrafascicular, vessel plexus is rarely to see; type C: nerve looks normal, lymphocyte infiltration exists and it is obvious that there are many physalis-like, retrogressive construction in the section; type D: nervous construction is normal, there are visible interfascicular vessel plexus, and connective tissue appears loose, SEP always can be stably evoked.

Microsurgical replantation of the avulsed scalp: report of six cases

This article reports the successful microsurgical replantation of six scalps avulsed for over 3 to 11 hr, after trauma and before repair, including five total and one partial avulsion. The authors believe that one key to successful replantation is effective vessel anastomoses. In the reported series, three scalps were reconstructed with two superficial temporal vessels and in five cases, with a 1:1 ratio between arteries and veins. The partially avulsed scalp was replanted successfully with only one artery and one vein. The management of postoperative complications is discussed.

Reconstruction of postburn female breast deformity

Postburn breast deformity is a sequelae of severe scar contraction of the burned chest. During the past four years, 6 female patients with such a deformity required reconstruction, and the surgery was performed in our department. Three different types of breast reconstruction were undertaken, each one achieving a satisfactory aesthetic result.

A new method for treating postburn talipes equinovarus

Postburn talipes equinovarus has long been a challenging problem for plastic surgeons, who usually replace the overlying scar in multistaged flap or tube transfer operations before lengthening the shortened Achilles tendon. This always requires long hospitalization and causes much discomfort for the patient because of postural immobilization. In 1975, I designed a new and simple procedure by Z-lengthening the scar tissue and the Achilles tendon as a whole in one stage. To date, the operative result in 10 cases has been excellent, without failure or recurrence.

Reversed island forearm fascial flap in hand surgery

We present a technique using a reversed island forearm fascial flap based on the distal portion of the radial artery and veins, with a skin graft on top, to repair a soft tissue defect of the hand. Good results were obtained in a total of 18 operations in 17 postburn cases. The operation can be completed in one stage even when it involves the excision of scar tissue, correction of the secondary deformities of deep structures, and repair of the soft tissue defect of the hand. The advantages and disadvantages of the method and key points of the technique are discussed.