Objective To investigate the clinical effects and safety differences of open surgery and laparoscopy primary lesion resection combined with D2 lymph node dissection in the treatment of elderly patients with advanced gastric cancer. Methods One hundred and forty elderly patients with advanced gastric cancer were chosen and randomly divided into two group including open operative group (70 patients) with primary lesion resection combined with D2 lymph node dissection by open operation and laparoscopic surgery group (70 patients) with primary lesion resection combined with D2 lymph node dissection by laparoscopy; and the operative time, intraoperative bleeding amount, the levels of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of haemoglobin (Hb) after operation, the hospitalization time, the number of lymph node dissection, the survival rate with followed-up and postoperative complication incidence of both groups were compared. Results There was no significant difference in the operative time between 2 groups (P>0.05). The intraoperative bleeding amount, the level of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of Hb after operation and the hospitalization time of laparoscopic surgery group were significantly better than open operative group (P<0.05). The level of PaCO2 in operation of laparoscopic surgery group was significantly higher than open operative group (P<0.05). There were no significant difference in the gastric lymph node dissection number and the peripheral lymph node dissection number of gastric artery between 2 groups (P>0.05). There were no significant difference in the survival rates between the 2 groups after 3-year followed-up (P>0.05). The complication incidence after operation of laparoscopic surgery group was significantly lower than open operative group (P<0.05). The quality of life scores of patients in laparoscopic surgery group were significantly higher than those in open operative group on 7 days and in 3 months after operation, and the difference were statistically significant (P<0.05). Conclusion Compared with open operation, primary lesion resection combined with D2 lymph node dissection by laparoscopy in the treatment of elderly patients with advanced gastric cancer can efficiently possess the advantages including minimally invasive, shorter recovery time and less postoperative complications.
ObjectiveTo explore the effectiveness of the modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer (LABC) patients.MethodsBetween January 2016 and June 2019, 64 unilateral LABC patients were admitted. All patients were female with an average age of 41.3 years (range, 34-50 years). The disease duration ranged from 6 to 32 months (mean, 12.3 months). The diameter of primary tumor ranged from 4.8 to 14.2 cm (mean, 8.59 cm). The size of chest wall defect ranged from 16 cm×15 cm to 20 cm×20 cm after modified radical mastectomy/radical mastectomy. All defects were reconstructed with the modified designed bilobed latissimus dorsi myocutaneous flaps, including 34 cases with antegrade method and 30 cases with retrograde method. The size of skin paddle ranged from 13 cm×5 cm to 17 cm×6 cm. All the donor sites were closed directly.ResultsIn antegrade group, 2 flaps (5.8%, 2/34) showed partial necrosis; in retrograde group, 6 flaps (20%, 6/30) showed partial necrosis, 5 donor sites (16.7%, 5/30) showed partial necrosis; and all of them healed after dressing treatment. The other flaps survived successfully and incisions in donor sites healed by first intention. There was no significant difference in the incidence of partial necrosis between antegrade and retrograde groups (χ2=2.904, P=0.091). The difference in delayed healing rate of donor site between the two groups was significant (P=0.013). The patients were followed up 15-30 months, with an average of 23.1 months. The appearance and texture of the flaps were satisfactory, and only linear scar left in the donor site. No local recurrence was found in all patients. Four patients died of distant metastasis, including 2 cases of liver metastasis, 1 case of brain metastasis, and 1 case of lung metastasis. The average survival time was 22.6 months (range, 20-28 months).ConclusionThe modified designed bilobed latissimus dorsi myocutaneous flap can repair chest wall defect after LABC surgery. Antegrade design of the flap can ensure the blood supply of the flap and reduce the tension of the donor site, decrease the incidence of complications.
The traditional Kutler and Atasoy V-Y advancement flaps have minimal advancement degree, did not satisfy to repair large skin defect in fingers, hence, have no wide indications. The sensory function of the fingers to be influenced because of injury of sensory nerves and sear formation. Since 1985 to 1991, the V-Y advancement flaps pedicled by bilateral digital arteries and nerves have been used for reconstruction of 33 finger tip defect and 5 digital volar skin contraction. All of these cases obtained satisfactory function and excellent appearance.In this paper, the anatomical charactistics and principles of devicerecommended, the advantages and key points to success discussed.
Objective To summarize the effect of lenvatinib + transarterial chemoembolization (TACE) + programmed cell death protein-1 (PD-1) antibody in the treatment of hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. Methods In this study, we reported the clinical data of four patients with hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation who received conversion therapy with lenvatinib combined with TACE and PD-1 antibody in West China Hospital. Results Among the four patients, two patients achieved complete response and two achieved partial response; tumor markers were significantly decreased after combination treatment. However, all four patients failed to undergo hepatectomy. ConclusionsLenvatinib + TACE + PD-1 antibody is effective for hepatocellular carcinoma with main portal vein tumor thrombus and cavernous transformation. However, there are still many problems worthy of further discussion.
ObjectiveTo explore the feasibility and effectiveness of V-Y advanced sense-remained posterior tibial artery perforator flap in repairing wound around the ankle. MethodsBetween March 2012 and January 2015, 11 patients with wounds around the ankle were treated by V-Y advanced sense-remained posterior tibial artery perforator flap. There were 6 males and 5 females with a median age of 37 years (range, 21-56 years). The causes were traffic accident injury in 3 cases, thermal injury in 2 cases, burn in 2 cases, iatrogenic wounds in 2 cases, and local contusion in 2 cases. The disease duration ranged from 1 to 3 weeks (mean, 2 weeks). Injury was located at the medial malleolus in 4 cases, at the lateral malleolus in 3 cases, and at the heel in 4 cases. All had exposure of bone, tendon, or plate. The defect area ranged from 4 cm×2 cm to 5 cm×3 cm; the area of the flap ranged from 11 cm×4 cm to 15 cm×6 cm. ResultsNecrosis of distal flap occurred in 1 case after operation; re-operation to amputate the posterior tibial artery was given and the wound was repaired by proximal skin graft. Light necrosis of distal end was observed in 2 cases, and wound healed at 3 weeks after dressing. And other flaps successfully survived, and primary healing of wounds were obtained. The patients were followed up 6-24 months (mean, 11 months). The flaps were good in color, texture, and appearance. The ankle joint had normal activity. At last follow-up, 10 cases restored fine sense, and 1 case restored protective feeling with posterior tibial artery advanced flap after amputation. ConclusionV-Y advanced sense-remained posterior tibial artery perforator flap has the advantages of reliable blood supply, simple operation, good appearance, and sensory recovery. Therefore, it is an ideal method to repair wound around the ankle.
In 2014, the new concept of embolic stroke of undetermined source (ESUS) was first proposed by cryptogenic stroke/ESUS International Working Group. In the past 5 years, related clinical researches of ESUS have been deepened, and the results of many large clinical studies have been published. However, the guiding significance of this new concept to clinical practice is still controversial. By reviewing the background, diagnostic criteria, assessment, common emboli sources, anticoagulant therapy research advances and related limitations of ESUS, and analyzing the possible causes of negative anticoagulant therapy results, we explored the clinical value of this new classification.
Objective To evaluate clinical efficacy of mFOLFOX6 combined with aspirin in treatment of advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy. Methods One hundred and seven patients with advanced gastric cancer were assigned to observation group (57 cases) and control group (50 cases). The patients in the observation group received the mFOLFOX6 chemotherapy and regular intake of aspirin (100 mg/d) and the control group received the mFOLFOX6 chemotherapy alone. The recurrence or metastasis rate, rate of disease progress, toxicity, median survival time, and 3-year survival rate were compared between the observation group and the control group. Results ① There were no significant differences in the gender, age, pathological type, and so on between the observation group and the control group (P>0.05). ② The rates of toxicity such as the white blood cell reduction, granulocyte reduction, thrombocytopenia had no significant differences in these two groups (P>0.05). ③ The follow-up time was 4–45 months with an average 3.5 years, the rate of disease progress was lower (P=0.032), the median survival time was longer (P=0.043), the cumulative 3-year overall survival (P=0.015) and the cumulative 3-year disease-free survival (P=0.037) were better in the observation group as compared with the control group. Conclusion Preliminary results in this study show that mFOLFOX6 regimen combined with low-dose aspirin could significantly improve efficacy of advanced gastric cancer following perioperative period of laparoscopic distal subtotal gastrectomy, reduce rate of disease progress, and improve survival rate without increasing side effects.
Objective To assess and report on the current situation of the families of students, who were involved in the Wenchuan earthquake, to provide data for the government to make decisions that should help with recovery from the earthquake. Methods We selected 2 towns and 4 villages using stratified sampling to take account of different levels of destruction. We performed on-site surveys and secondary research. Results The psychological problems of the parents of the students were serious. These families’ economic situations were not good. Conclusion We should build ‘Mutual Aid’ organization and take the advantage of rural hospitals to promote the long-acting mechanism of the psychological intervention.
Surgery is the preferred treatment for resectable esophageal cancer, but in locally advanced esophageal cancer, the effect of surgery alone is not ideal, so surgery-based comprehensive treatment is the best option. Neoadjuvant therapy has become a standard treatment in the treatment of locally advanced resectable esophageal cancer. Neoadjuvant therapy includes neoadjuvant chemotherapy, radiochemotherapy, immunotherapy, targeted therapy, etc. With the significant efficacy and acceptable toxicity of immunotherapy in the first-line and second-line treatment of advanced esophageal cancer, neoadjuvant immunotherapy has become a research hotspot of locally advanced resectable esophageal cancer. This article reviews the latest research progress and some limitations of neoadjuvant immunotherapy in locally advanced resectable esophageal cancer.
Objective To explore the influence and mechanism of mechanistic target of rapamycin kinase (mTOR)/ receptor of advanced glycation end products (RAGE) pathway mediated-ferritinophagy on high glucose consumption promoting invasion and migration of colorectal cancer (CRC). Methods① Patients and tissue samples. Clinical data and tissues were collected from CRC patients underwent surgery and completed the dietary questionnaire in the Second Affiliated Hospital of Harbin Medical University from October 2022 to October 2023. Real-time quantitative reverse transcription PCR (qRT-PCR) was used to analyzed the expression of nuclear receptor coactivator 4 (NCOA4) and ferritin in CRC and para-carcinoma tissues. ② Cell culture and treatment. The HT29 and HCT116 cells were treated by RPMI1640 medium containing 0, 35, 70, 105, 140 mmol/L glucose, and cell counting kit-8 (CCK-8) and lactate dehydrogenase (LDH) activity analysis were performed to confirm 105 mmol/L glucose was the optimal concentration in the current study. Then the HT29 and HCT116 cells were randomly divided into: control group, glucose group; control group, glucose group, si-RAGE group, and glucose+si-RAGE group; control group, glucose group, rapamycin group, and glucose+rapamycin group. Untreated HT29 and HCT116 cells were considered as control group. The cells in glucose group were treated with 105 mmol/L glucose for 48 h. The CRC cells in the si-RAGE group were transfected with si-RAGE for 6 h. The CRC cells in the rapamycin group were treated with 10 nmol/L rapamycin for 48 h. The CRC cells in the glucose+si-RAGE group were treated with 105 mmol/L glucose for 48 h combination transfected with si-RAGE for 6 h. The CRC cells in the glucose+rapamycin group were treated with 105 mmol/L glucose for 48 h combination treated with 10 nmol/L rapamycin for 48 h. Then electron microscopy and Western blot, wound healing assay and transwell assay were exhibited, respectively. ③ Azoxymethane (AOM)-induced CRC rat model. The effects of glucose consumption on malignant behavior and ferritinophagy mediated by mTOR/RAGE pathway were evaluated in AOM-induced CRC rat models. A total of 16 rats were randomly divided into control group and glucose group, the CRC number was recorded and HE staining of CRC tissues was further performed. The expression of RAGE, mTOR, NCOA4, and ferritin in colorectal tissues of rats from each group was detected by RT-qPCR. Results① More lymphatic node metastasis and TNM Ⅲ/Ⅳ stages were observed in CRC patients from high glucose consumption group (P=0.004, P=0.004). Moreover, we confirmed that NCOA4 expression was significantly decreased (P<0.001) while ferritin was significantly increased (P<0.001) in CRC tissues especially in the CRC tissues from patients with positive lymph nodes metastasis. ② High glucose treatment significantly decreased autophagosomes in HT29 and HCT116 cells while si-RAGE transfection increased autophagic vacuoles compared to the control group. When compared with the glucose group, autophagosomes were increased in the glucose+si-RAGE group. Moreover, compared to the control group, the expressions of RAGE, p-mTOR, and ferritin were increased (P<0.001) while the expression of NCOA4 was decreased (P<0.001) in glucose group, but the expressions of RAGE, p-mTOR, and ferritin were decreased (P<0.001) while the expression of NCOA4 was increased (P<0.001) in the si-RAGE group; when compared with the glucose group, the expressions of RAGE, p-mTOR, and ferritin were downregulated (P<0.001) while the expression of NCOA4 was upregulated (P<0.001) in HT29 and HCT116 cells from the glucose+si-RAGE group. Compared to the control group, the HT29 and HCT116 cells in the glucose group performed enhanced wound scratch healing , migration and invasion viabilities (P<0.05); but the HT29 and HCT116 cells in the si-RAGE group performed impaired wound scratch healing, migration and invasion viabilities (P<0.05). When compared with the glucose group, the HT29 and HCT116 cells in the glucose+si-RAGE group performed impaired wound scratch healing, migration and invasion viabilities (P<0.05). ③ Rapamycin treatment significantly inhibited the expression of ferritin (P<0.05) but induced the expression of NCOA4 (P<0.05) compared to the control group. When compared with the glucose group, the expression of ferritin was downregulated (P<0.05) while the expression of NCOA4 was upregulated (P<0.05) in HT29 and HCT116 cells from the glucose+rapamycin group. Additionally, compared to the control group, rapamycin treatment performed inhibited effect on wound scratch healing, migration and invasion viabilities in the HT29 and HCT116 cells (P<0.05); while the HT29 and HCT116 cells in the glucose+rapamycin group performed impaired wound scratch healing, migration and invasion viabilities (P<0.05) when compared with the glucose group. ④ In the AOM induced CRC rat models, we found the more CRCs, aggravated cellular pleomorphism and upregulated expressions of RAGE, mTOR, ferritin (P<0.05) while downregulated expression of NCOA4 (P<0.05) in the glucose group than those of the control group. ConclusionHigh glucose consumption promote invasion and migration in CRC through suppressing ferritinophagy via activating the mTOR/RAGE pathway.