Trocar puncture with modified sump drainage for duodenal stump fistula after radical gastrectomy for gastric cancer: A retrospective controlled study

Duodenal stump fistula (DSF) is a serious complication of radical gastrectomy for gastric cancer. Herein, we illustrated an innovative choice for treating duodenal stump fistulas by placing a modified sump drainage through trocar puncture into the DSF-related abscess (DSF-abscess) cavity. We retrospectively analyzed 974 consecutive patients who underwent gastrectomy for gastric cancer between 2011 and 2021. Of these patients, 34 who developed postoperative duodenal stump fistulas postoperatively were enrolled into our study, and their clinical data were retrospectively assessed. From January 2011 to December 2017, 15 patients received conventional treatments (percutaneous catheter drainage, PCD group) known as the traditional percutaneous method, and 19 patients from January 2018 to December 2021 received new treatments (Troca's SD group) consisting of conventional therapies and placement of a modified sump drainage through trocar puncture into DSF-abscess cavity. The demographics, clinical characteristics and treatment outcomes were compared between two groups. Compared with the PCD group, the rates of postoperative complications, duodenostomy creation, subsequent surgery, fistula healing rates of the DSF, and length of postoperative hospital stay were significantly decreased in the Troca SD group. However, there was no significant difference in the abscess recurrence rate and mortality rates. Trocar puncture with a modified sump drainage is an safe, effective, and technically feasible treatment for duodenal stump fistula after radical gastrectomy for gastric cancer. This novel technique should be further investigated using large-scale RCT research.

[Screening biomarkers for hypertensive heart disease: Analysis based on data from 7 medical institutions]

Objective: To screen the influencing factors of hypertensive heart disease (HHD), establish the predictive model of HHD, and provide early warning for the occurrence of HHD. Methods: Select the patients diagnosed as hypertensive heart disease or hypertensionfrom January 1, 2016 to December 31, 2019, in the medical data science academy of a medical school. Influencing factors were screened through single factor and multi-factor analysis, and R software was used to construct the logistics model, random forest (RF) model and extreme gradient boosting (XGBoost) model. Results: Univariate analysis screened 60 difference indicators, and multifactor analysis screened 18 difference indicators (P<0.05). The area under the curve (AUC) of Logistics model, RF model and XGBoost model are 0.979, 0.983 and 0.990, respectively. Conclusion: The results of the three HHD prediction models established in this paper are stable, and the XGBoost prediction model has a good diagnostic effect on the occurrence of HHD.

Lentivirus-Mediated Overexpression of SIVA-1 Reverses Cisplatin Resistance in Gastric Cancer in vitro

SIVA-1 plays a critical role in the induction of apoptosis in a number of different cell lines and participates in the mechanism of cisplatin (DDP)-mediated antitumor effects. However, the involvement of SIVA-1 in cisplatin resistance in gastric carcinoma has not been revealed. To explore the effect of SIVA-1 on DDP resistance, a recombinant pGV358-GFP-SIVA-1 lentiviral vector was constructed and transfected into human cisplatin-resistant MKN45/DDP gastric cancer cells. Subsequently, stable SIVA-1 overexpression was established in MKN45/DDP cells, which resulted in increased DDP sensitivity in MKN45/DDP cells in vitro. Flow cytometry demonstrated that SIVA-1 overexpression increased the percentage of apoptotic cells compared to that in the control. The colony formation assay clearly revealed that cell growth and proliferation were significantly suppressed following SIVA-1 overexpression. In addition, overexpression of SIVA-1 inhibited the migratory and invasive potential of MKN45/DDP cells in vitro. Western blot analysis indicated that SIVA-1 increased the expression levels of p53, p73, and p14ARF, whereas it reduced Bcl-2, MDM2, and Bcl-xL expression. In short, SIVA-1 upregulated the protein expression of p53, p73, and p14ARF and decreased that of Bcl-2, MDM2, and Bcl-xL in vitro and subsequently reversed cisplatin resistance in gastric cancer cells, suggesting that SIVA-1 serves as a valuable potential target for attenuating chemotherapy resistance.

Clinical significance of perioperative EMT-CTC in rectal cancer patients receiving open/laparoscopic surgery

The objective of this study was to explore the clinical significance of perioperative CTCs (circulating tumor cells) counts and EMT-CTCs (epithelial-mesenchymal transition-CTCs) in rectal cancer patients. A total of 30 patients with rectal cancer who underwent radical resection of rectal cancer at the Guangxi Zhuang Autonomous Region People's hospital were enrolled. Five ml peripheral blood was withdrawn from 30 patients with rectal cancer before the operation and seven days after the operation and at the corresponding time also from 20 healthy volunteers. CanPatrol™ CTC detection technique was used to enrich and identify CTCs and IER3 expression simultaneously. We found out that the preoperative total CTCs were correlated with lymph node metastasis (p=0.008) and tumor size, and mixed CTCs were closely correlated with lymph node metastasis (p=0.009). The number of IER3-positive total CTCs and mesenchymal CTCs were statistically associated with tumor size, p=0.034 and 0.043, respectively. The number of CTCs varied significantly before and after the operation in all patients (p=0.049). There were significant differences in CTCs variations between the open operation group and the laparoscopic operation group. In the laparoscopic operation group, the average number of single-cell CTCs was 6.9 before operation and 3.5 after the operation (p=0.013). In the open operation group, the average number of single-cell CTCs was 5.9 before operation and 4.2 after the operation. To conclude, surgery is associated with a decrease of CTCs in rectal cancer patients, especially in patients receiving laparoscopic surgery. The number of CTCs before the operation in rectal cancer patients is related to the size of tumors and regional lymph node metastasis. CTCs detection and characterization may be useful for clinical staging and lymph node dissection during operation.

Surgical-related risk factors associated with anastomotic leakage after resection for rectal cancer: a meta-analysis

OBJECTIVES

Anastomotic leakage (AL) after anterior resection always leads to longer hospital stays, decreased quality of life and even increased mortality. Despite extensive research, no consensus on the world well-concerned surgical-related risk factors exists. We therefore conducted a meta-analysis of the available published literature to identify the effects of surgical-related risk factors for AL after anterior resection for rectal cancer, hoping to provide more information and improved guidance for clinical workers managing patients with rectal cancer who are at a high risk for AL.

METHODS

In this study, the relevant articles were systematically searched from EMBASE, MEDLINE, PubMed, WangFang (Database of Chinese Ministry of Science & Technology), Chinese National Knowledge Infrastructure Database and China Biological Medicine Database. The pooled odds ratio (OR) with 95% confidence interval (95% CI) were calculated. Meta-analysis was performed using of RevMan 5.3 software.

RESULTS

A total of 26 studies met the inclusion criteria and comprised 34238 cases. Analysis of these 26 studies showed that no defunctioning stoma was highly correlated with AL (pooled OR = 1.28, 95%CI: 1.05-1.57, P = 0.01, random effect), and intraoperative blood transfusion was significantly associated with AL (pooled OR = 1.64, 95%CI: 1.34-2.02, P = 0.02, random effect). However, the AL was not associated with type of anastomosis, type of surgery, technique of anastomosis, level of inferior mesenteric artery ligation, operation time and splenic flexure mobilization.

CONCLUSIONS

Depend on this meta-analysis, no defunctioning stoma and intraoperative blood transfusion are the major surgical-related risk factors for AL after resection for rectal cancer. Because of the inherent limitations of the research, future prospective randomized controlled trials will need to confirm this conclusion.

[Occupational health investigate of 1-bromopropane used in a factory]

Objective: To investigate the occupational health survey of 1-brominepropane (1-BP) enterprises and understand the impact of 1-BP on the health of occupational exposure population. Methods: The occupational health data of 15 1-BP workers were collected from 3 time nodes in 0 months, June and December, and the effects of occupational exposure to 1-BP on health were analyzed. Results: In the workplace with pure 1-BP, the mean air concentration in the workplace was 26.8 mg/m(3), and the personal contact level was 29.7 to 63.4 mg/m(3). The occupational health monitoring data showed that white blood cell count (WBC) , red blood cell count (RBC) , aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were compared in 0 months, June, and 12 months, the difference was statistically significant (P<0.05) . Conclusion: During the 12 months observation period, the occupational exposure to 1-BP caused the number of peripheral blood erythrocyte and leukocyte count and the level of alanine transaminase in the workers, but it did not exceed the normal reference range.

Plasma disturbance of phospholipid metabolism in major depressive disorder by integration of proteomics and metabolomics

INTRODUCTION

Major depressive disorder (MDD) is a highly prevalent mental disorder affecting millions of people worldwide. However, a clear causative etiology of MDD remains unknown. In this study, we aimed to identify critical protein alterations in plasma from patients with MDD and integrate our proteomics and previous metabolomics data to reveal significantly perturbed pathways in MDD. An isobaric tag for relative and absolute quantification (iTRAQ)-based quantitative proteomics approach was conducted to compare plasma protein expression between patients with depression and healthy controls (CON).

METHODS

For integrative analysis, Ingenuity Pathway Analysis software was used to analyze proteomics and metabolomics data and identify potential relationships among the differential proteins and metabolites.

RESULTS

A total of 74 proteins were significantly changed in patients with depression compared with those in healthy CON. Bioinformatics analysis of differential proteins revealed significant alterations in lipid transport and metabolic function, including apolipoproteins (APOE, APOC4 and APOA5), and the serine protease inhibitor. According to canonical pathway analysis, the top five statistically significant pathways were related to lipid transport, inflammation and immunity.

CONCLUSION

Causal network analysis by integrating differential proteins and metabolites suggested that the disturbance of phospholipid metabolism might promote the inflammation in the central nervous system.

Sex differences in gut microbiota in patients with major depressive disorder

OBJECTIVE

Our previous studies found that disturbances in gut microbiota might have a causative role in the onset of major depressive disorder (MDD). The aim of this study was to investigate whether there were sex differences in gut microbiota in patients with MDD.

PATIENTS AND METHODS

First-episode drug-naïve MDD patients and healthy controls were included. 16S rRNA gene sequences extracted from the fecal samples of the included subjects were analyzed. Principal-coordinate analysis and partial least squares-discriminant analysis were used to assess whether there were sex-specific gut microbiota. A random forest algorithm was used to identify the differential operational taxonomic units. Linear discriminant-analysis effect size was further used to identify the dominant sex-specific phylotypes responsible for the differences between MDD patients and healthy controls.

RESULTS

In total, 57 and 74 differential operational taxonomic units responsible for separating female and male MDD patients from their healthy counterparts were identified. Compared with their healthy counterparts, increased Actinobacteria and decreased Bacteroidetes levels were found in female and male MDD patients, respectively. The most differentially abundant bacterial taxa in female and male MDD patients belonged to phyla Actinobacteria and Bacteroidia, respectively. Meanwhile, female and male MDD patients had different dominant phylotypes.

CONCLUSION

These results demonstrated that there were sex differences in gut microbiota in patients with MDD. The suitability of Actinobacteria and Bacteroidia as the sex-specific biomarkers for diagnosing MDD should be further explored.

Relationship between ncRNAs and gastric cancer: meta-analysis

OBJECTIVE

This study was designed to investigate the action and mechanism of cordyceps polysaccharide on rat acute liver failure (ALF).

METHODS

Sixty rats were randomly divided into five groups: normal group, model group, and cordyceps polysaccharide groups with high, middle and low doses (20, 10 and 5 mg/ml). Apoptosis was detected through TUNEL method. Protein expressions of caspase 1, IL-18, IL-10, VEGF, and SDF-1α in liver tissue are detected by Western Blot. PCNA and sIRPα1 contents were measured by PCR method. Rat ALF is modeled with a D-galactosamine induced by lipopolysaccharide (LPS).

RESULTS

The results after modelling showed tissue HE staining wiith typical manifestation of acute liver injury. Compared with the medicated group, serum ALT and AST, as well as hepatocyte apoptosis are significantly higher in the liver failure group, in a time-dependent way. This suggests that medication can effectively inhibit the expression of caspase 1, IL-18, and IL-10, while simultaneously increasing the expression of VEGF and SDF-1α, as well as of PCNA and sIRPα1. Cordyceps polysaccharide can alleviate the immune inflammatory response in acute liver failure, and may be specifically homing to the damaged liver, thus promoting the secretion of VEGF, proliferation of hepatocyte, regeneration of liver vessels, and repair of liver tissues.

CONCLUSION

Medication can reduce the IL-10 level, regulate the equilibrium of pro-inflammatory and anti-inflammatory factors, and decrease the level of caspase 1 and IL-18 (Tab. 2, Fig. 1, Ref. 18).

Value of 64-slice spiral CT triple-phase enhanced scanning for preoperative evaluation of lymph node dissection in patients with gastric cancer

AIM: To analyze the value of 64-slice spiral computed tomography (CT) triple-phase enhanced scanning for preoperative evaluation of lymph node dissection in patients with gastric cancer.

METHODS: Thirty-eight patients with gastric cancer underwent preoperative 64-slice spiral CT triple-phase enhanced scanning to comprehend the anatomic distribution of the celiac trunk, its three branches and their tributaries (common hepatic artery, right hepatic artery, left hepatic artery, splenic artery, and left gastric artery) through volume rendering and three dimensional vascular imaging. The lymph nodes were detected using group orientation method, and N staging was performed to compare with postoperative pathological results.

RESULTS: Surgical results verified that 64-slice spiral CT triple-phase enhanced scanning through volume rendering and three dimensional vascular imaging had an accuracy rate of 100% in preoperative evaluation of the distribution of the celiac trunk, its three branches and their tributaries. Compared to postoperative pathological results, the accuracy rate was 92.1% (35/38) in evaluating perigastric lymph node metastasis, and 71.4% (5/7), 62.5% (5/8), 81.82% (9/11), 75% (6/8), 25% (1/4) and 68.42% (26/38) in preoperatively evaluating stages N0-N3b and N gastric cancer, respectively.

CONCLUSION: Preoperative 64-slice spiral CT triple-phase enhanced scanning is an objective way to assess the distribution of the celiac artery trunk and related tributaries in patients with gastric cancer, and it allows to reliably judge whether there is perigastric lymph node metastasis and can guide intraoperative lymph node dissection and reduce intraoperative injury to the artery.

Advances in understanding the relationship between Helicobacter pylori infection and pathogenesis of gastric stump cancer

The incidence rate of gastric stump cancer has increased in recent years. The pathogenesis of gastric stump cancer is sophisticated and involves many factors, of which Helicobacter pylori infection is regarded as an important one. This article reviews the recent advances in understanding the relationship between Helicobacter pylori infection and pathogenesis of gastric stump cancer.

Selective tropism of liver stem cells to hepatocellular carcinoma in vivo

AIM: To investigate the selective tropism of liver stem cells to hepatocellular carcinoma (HCC) in an animal model and its feasibility as a vector to deliver therapeutic genes for targeted therapy of HCC.

METHODS: WB-F344, a kind of rat liver stem cell, was infected with recombinant virus to establish a cell line with stable, high-level expressing enhanced green fluorescent protein (EGFP). An animal model of HCC in Wistar rats was established by implanting HCC cells (CBRH7919) combined with an immunosuppressive drug. EGFP labeled liver stem cells were injected into caudal veins of the animals and distribution was observed at different time points after injection. SDF-1 and c-kit expression in non-tumor liver and tumor tissue were analysed by immunohistochemistry for the relationshiop between the expression and migration of liver stem cells. Furthermore, hepatic stem cells were injected via the portal vein, hepatic artery, caudal vein, or directly into the pericancerous liver tissue, respectively, and effects on migration, localization, and proliferation of the hepatic stem cells within the tumor tissue were observed and analyzed.

RESULTS: Recombinant adenovirus could deliver the EGFP gene to hepatic stem cells. A new stem cell line, named WB-EGFP, was established that stably expressed EGFP. WB-EGFP cells still showed selective tropism towards HCC and EGFP expression was stable in vivo. According to immunohistochemistry results, SDF-1 may not be related to the mechanisms of tropism of hepatic stem cells. Different application sites affected the distribution of liver stem cells. Injection via the portal vein was superior with regard to selective migration, localization, and proliferation of the hepatic stem cells within the tumor tissue.

CONCLUSION: Liver stem cells have the biological behavior of selective migration to HCC in vivo and they could localize and proliferate within HCC tissue stably expressing the target gene. Liver stem cells are a potential tool for a targeted gene therapy of HCC.

Clinicopathologic characteristics of high-grade colorectal intraepithelial neoplasia: analysis of 38 cases

AIM: To reveal the clinicopathological features of high-grade colorectal intraepithelial neoplasia and discuss treatment strategy.

METHODS: Thirty-eight cases of high-grade colorectal intraepithelial neoplasia diagnosed by colonoscopy biopsy were treated and followed up for 3 to 36 months. A retrospective review of clinical findings, endoscopic and histopathological features, and prognosis was used to determine appropriate treatment and follow-up for high-grade colorectal intraepithelial neoplasia.

RESULTS: Among the 38 patients, 17 underwent a preoperative endoscopic biopsy and agreed to a surgical operation; lesions in 19 cases were endoscopically resected, while the remaining 2 cases just agreed to being followed-up. Seventeen cases were diagnosed with a malignant carcinoma, and 21 eventually showed high-grade colorectal intraepithelial neoplasia. Pathological diagnosis pre- and post-treatment showed poor consistency; the Kappa value was 0.376, and in the cases of endoscopic clamping biopsy it was 0.580. Of the patients undergoing surgical or endoscopic treatment, one with malignant carcinoma had liver metastasis, and one suffered a recurrence 11 months later. One case with high-grade colorectal intraepithelial neoplasia was found to have an adenocarcinoma at a previous endoscopic resection site after 3 months. There were no new tumors in the other cases during 3 years of follow-up. In accordance with the characteristics of carcinoma cases, cancer risk appears related to tumor size, endoscopic features, severity of clinical symptoms, the villous morphology of biopsy pathology, and a high level of CEA or CA19-9.

CONCLUSION: Close attention needs to be paid when using the WHO's new diagnostic standards of high-grade intraepithelial neoplasia instead of the prestage of tumors of the digestive system. Clinicians should be careful when choosing treatment for high-grade intraepithelial neoplasia, especially in cases of endoscopic clamping biopsy.

Adenoviral-mediated efficiency expression of enhanced green fluorescence protein in adult liver stem cells of rats

AIM: To investigate the feasibility of adenoviral-mediated exogenous gene expression in adult liver stem cells of rats and to establish a cell line that stably and efficiently express enhanced green fluorescence protein (EGFP).

METHODS: A pAd-CMV-EGFP vector under the control of CMV promoter was constructed by homologous recombination in E.coilBJ 5 183, and the recombinant virus was Packaged in HEK 293 cell line. Hepatic adult stem cells cultured in vitro were infected with recombinant adenovirus. Expression of EGFP was observed by fluorescent microscopy and infection efficiency was analyzed. Adult liver stem cells were further cultured to estabilish a cell line that stably and efficiently expressed EGFP through cloning culture and the biological characteristics of the cell line were observed and analyzed by fluorescence microscopy, immunocytochemistry and differentiation-inducing experiment.

RESULTS: Adenovirus vector of pAd-CMV-EGFP was constructed and high titer recombinant virus were produced successfully. EGFP, mediated by adenovirus, could be transfected into hepatic adult stem cells with a high efficiency (about 40-70%). After cloning culture, WB-EGFP cell line was established, and it could stably express EGFP in 8-9 generations. Furthermore, biological characteristics such as marker of stem cells, proliferation speed and differentiation capability had not been affected.

CONCLUSION: Target gene can be efficiently transfected into hepatic adult stem cells through adeno-vector system. EGFP can be stably and long-term expressed in transfected cells and their offspring. It can serve as a tracker in the research of stem cells.