Search

PURPOSE To ascertain if preoperative short-term radiotherapy followed by chemotherapy is not inferior to a standard schedule of long-term chemoradiotherapy in patients with locally advanced rectal cancer. MATERIALS AND METHODS Patients with distal or middle-third, clinical primary tumor stage 3-4 and/or regional lymph node–positive rectal cancer were randomly assigned (1:1) to short-term radiotherapy (25 Gy in five fractions over 1 week) followed by four cycles of chemotherapy (total neoadjuvant therapy [TNT]) or chemoradiotherapy (50 Gy in 25 fractions over 5 weeks, concurrently with capecitabine [chemoradiotherapy; CRT]). Total mesorectal excision was undertaken 6-8 weeks after preoperative treatment, with two additional cycles of CAPOX (intravenous oxaliplatin [130 mg/m2, once a day] on day 1 and capecitabine [1,000 mg/m2, twice a day] from days 1 to 14) in the TNT group and six cycles of CAPOX in the CRT group. The primary end point was 3-year disease-free survival (DFS). RESULTS Between August 2015 and August 2018, a total of 599 patients were randomly assigned to receive TNT (n = 302) or CRT (n = 297). At a median follow-up of 35.0 months, 3-year DFS was 64.5% and 62.3% in TNT and CRT groups, respectively (hazard ratio, 0.883; one-sided 95% CI, not applicable to 1.11; P < .001 for noninferiority). There was no significant difference in metastasis-free survival or locoregional recurrence, but the TNT group had better 3-year overall survival than the CRT group (86.5% v 75.1%; P = .033). Treatment effects on DFS and overall survival were similar regardless of prognostic factors. The prevalence of acute grade III-V toxicities during preoperative treatment was 26.5% in the TNT group versus 12.6% in the CRT group ( P < .001). CONCLUSION Short-term radiotherapy with preoperative chemotherapy followed by surgery was efficacious with acceptable toxicity and could be used as an alternative to CRT for locally advanced rectal cancer.

Purpose The safety of an MRI simulation-guided boost after short-course preoperative radiotherapy (SCPRT) for unresectable rectal cancer is assessed with a planned interim analysis. Methods and materials Patients diagnosed with clinical stage T3-4 or regional lymph node-positive disease with positive mesorectal fascia or T4b disease evaluated by pelvic MRI were randomly assigned to the SCPRT-boost group (25 Gy in 5 fractions plus 4 Gy delivered to the gross tumor volume, followed by four cycles of chemotherapy) or preoperative chemoradiotherapy group (50 Gy in 25 fractions with concurrent chemotherapy). Then, patients received total mesorectal excision surgery after preoperative treatment. The primary endpoint was the R0 resection rate. The interim analysis was performed when 42 patients completed their assigned treatments. Results From October 2018 to November 2019, a total of 43 patients were enrolled, and 42 patients were included in the interim analysis. During preoperative therapy, grade 3 or above toxicities were observed in 10/21 (47.6%) patients in the experimental group, and 4/21 (19.0%) patients in the control group. A total of 17 (81.0%) and 13 (61.9%) patients in the experimental group and control group underwent surgery, respectively. Overall, 65.1% of the patients achieved R0 resection in the intention-to-treat analysis. Surgery-related adverse complications were observed in 2 patients (11.8%) in the experimental group and 1 patient (7.7%) in the control group. Conclusion Our results show that the toxicity of an MRI simulation-guided boost after SCPRT for unresectable rectal cancer is acceptable. Thus, this clinical trial will be continued as planned.

BACKGROUND/PURPOSE To explore the risk factors of splenic vessel preservation in laparoscopic distal pancreatectomy (LDP) and to guide with the appropriate selection of surgical methods through three-dimensional (3D) reconstruction. METHODS Patients suffering from benign or low-grade malignant tumors of pancreatic body and tail having undergone LDP in Ningbo Medical Center Lihuili Hospital from January 2014 to September 2019 were selected for quantitative analysis of the anatomical data of patients' pancreas, tumors, splenic vessels and spleens by 3D reconstruction. According to the final surgical methods, the patients were divided into the laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation (lap-SVP) group and the non-lap-SVP group. Clinical data of the two groups were compared to assess the risk factors for surgical failure of lap-SVP and logistic regression model was applied to predict the choice of surgical methods. RESULTS A total of 218 patients were included in the study, including 144 in the lap-SVP group and 74 in the non-lap-SVP group. Multivariate analysis confirms that large tumor volume, large contact area between the pancreas to be resected and the splenic vein, and large maximum ratio of the circumference of the splenic vessel embedded in the pancreas to be resected to the circumference of the splenic vessel are independent risk factors for surgical failure of lap-SVP (OR > 1, P

Basic helix-loop-helix family member e40 (BHLHE40) is located in 3p26.1 and acts as a transcriptional repressor of the circadian rhythm by suppressing the expression of the clock genes and clock-controlled genes. Recent research indicated that BHLHE40 may be involved in regulating tumor cell progression. However the mechanism by which BHLHE40 regulates the invasion and metastasis of tumor cells is unclear. Our in vitro assays showed that BHLHE40 promoted tumor cell invasion while BHLHE40 silencing by siRNA suppressed tumor cell invasion of MCF-7 cells. BHLHE40 suppressed the mRNA and protein expression of CLDN1 CLDN4 and CDH1 and promoted the expression of SNAI1 and SNAI2. Reporter assays demonstrated that BHLHE40 suppressed CLDN1 transcription but not through direct binding to the E-box motifs in the CLDN1 promoter. Further studies demonstrated BHLHE40 suppressed CLDN1 transcription by preventing the interaction between SP1 and a specific motif within the promoter region of CLDN1. BHLHE40 could not further suppress CLDN1 transactivation after SP1 siRNA transfection that is, BHLHE40-induced suppression of CLDN1 relied on SP1. Furthermore our data indicated that SP1 was a major regulator of CLDN1 transcription by binding to a specific motif that was located at -233 to -61 bp upstream of the transcription start site. Immunoprecipitation and co-localization data revealed an interaction between BHLHE40 and SP1. By constructing deletion mutants we found that the BHLH and Orange regions are both essential for the BHLHE40-SP1 interaction. BHLHE40 probably acts as an inhibitory nuclear cofactor or perhaps recruits other inhibitory cofactors to inhibit the SP1-mediated CLDN1 transactivation. These results suggest that BHLHE40 facilitates cell invasion and may be used as a novel target for breast cancer prevention and treatment.

To explore the safety and feasibility of intraoperative, intraperitoneal perfusion chemotherapy with lobaplatin for colorectal cancer (CRC).From November 1, 2016 to January 15, 2017, a total of 100 patients with CRC in Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, who had undergone radical surgery, were randomized into two groups as follows: the lobaplatin group (50 patients) and the control group (50 patients). The time of recovery of postoperative intestinal functions, hematotoxicity, hepatic-renal toxicity, and postoperative complications were observed and analyzed, with the goal of exploring the safety and feasibility of the drug administration.The time to first gas exhaust in lobaplatin and the control group was 3.08 days and 3.20 days, respectively (p=0.392). The time of defecation in lobaplatin and the control group was 4.38 days and 4.50 days, respectively (p=0.524). There was no statistically significant difference between them in terms of the time of gas exhaust and defecation. One case with intra-abdominal hemorrhage, 1 case with anastomotic leakage, 3 cases with incision complication, 1 case with adhesive intestinal obstruction, and 1 case with pulmonary infection occurred in lobaplatin group compared to 1 case with anastomotic bleeding, 1 case with anastomotic leakage, 2 cases with incision complication, 2 cases with adhesive intestinal obstruction, 2 cases with pulmonary infection, and 1 case with lymphatic fistulas occurred in control group. There was no statistically significant difference between the groups in terms of the total incidence of postoperative complications (p=0.790). No statistically significant difference was observed between the groups in terms of leukocyte and platelet levels on the first, third, and fifth postoperative day. There was also no statistically significant difference in terms of platelet level 2 weeks after surgery. Both the lobaplatin and control group had 2 cases with postoperative abnormal hepatic-renal function. A total of 6 cases in the lobaplatin group and 7 cases in the control group developed gastrointestinal reactions, showing no statistically significant difference (p=0.766).Intraoperative intraperitoneal perfusion chemotherapy with lobaplatin showed no effect on short-term recovery in patients with CRC.

To compare the potency of recipient-derived, antigen-specific regulatory T cells induced by different dendritic cells (DCs; iTregs) and freshly isolated natural regulatory T cells (nTregs) in preventing mouse graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation (BMT). CD4+ T cells from recipient BALB/c mice were stimulated with DCs from recipient BALB/c (syn-DCs), donor B6 (allo-DCs), and third-party C3H (third-party-DCs) mice to induce different iTregs. In parallel, nTregs were isolated from spleen cells of recipient BALB/c (syn-nTregs) and donor B6 (allo-nTregs) mice using magnetic-activated cell sorting. Mixed lymphocyte reaction (MLR) assays were performed to evaluate the suppressive ability of these various regulatory T cells (Tregs). Both the iTregs and nTregs were transfused to GVHD mice on Days 0, 1, 3, and 5. Body weight, GVHD score, and survival time were monitored. Peripheral Tregs were subsequently examined on Days 7, 14, 21, and 28 after BMT, while chimerism was evaluated on Days 14 and 60. Histopathology of colon, liver, and spleen were also performed. DCs markedly induced CD25+ and Foxp3+ expression on CD4+ T cells. The allo-DC-induced Tregs (allo-iTregs) suppressed the proliferation of alloreactive T cells better than the other iTregs/nTregs in MLR assays (P < 0.05). Meanwhile, transfusion of the allo-iTregs reduced the severity of GVHD (P < 0.05), increased survival time compared with the GVHD group (P < 0.05), and enhanced the chimerism proportion. On Day 28 after BMT, the allo-iTregs group had the highest frequency of peripheral Tregs (P < 0.05). Recipient-derived allo-iTregs induced by donor DCs included predominant clones that specifically recognized donor antigens. These allo-iTregs not only prevented GVHD by suppressing the proliferation of donor-alloreactive T cells, but also promoted engraftment, and prolonged the survival of GVHD mice. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc. Anat Rec, 302:825-836, 2019. © 2018 Wiley Periodicals, Inc.

Acute pulmonary embolism (APE) is a serious disease which is life-threatening. Since it is crucial for APE patients to assess the changes of cardiac function safely and timely, the imaging research of cardiac morphology and function is becoming more and more important. The correlation of computed tomography (CT) measured cardiac parameters and pulmonary obstruction index (POI) was analyzed to discuss the morphological changes of the heart of APE patients in order to provide a new method to evaluate cardiac functions accurately and effectively. 118 APE patients confirmed with CT pulmonary angiography (CTPA) were divided into high-risk group (47 cases, POI ≥ 20) and low-risk group (71 cases, POI

Much research effort has been devoted to identifying prognostic factors for esophageal squamous cell carcinoma (ESCC) by immunohistochemistry; however, no conclusive findings have been reached thus far. We hypothesized that certain molecules identified in previous studies might serve as useful prognostic markers for ESCC. Therefore, the aim of the current study was to validate the most relevant markers showing potential for ESCC prognosis in our prospective esophageal cancer database. A literature search was performed using the PubMed database for papers published between 1980 and 2015 using the following key words: 'esophageal cancer,' 'prognosis,' and 'immunohistochemistry.' Literature selection criteria were established to identify the most widely studied markers, and we further validated the selected markers in a cohort from our single-surgeon team, including 153 esophageal cancer patients treated from 2000 to 2010. A total of 1799 articles were identified, 82 of which met the selection criteria. Twelve markers were found to be the most widely studied, and the validation results indicated that only P21, COX-2, and E-cadherin were independent prognostic factors for ESCC patients in this series. The systemic review and cohort validation suggest that P21, COX-2, and E-cadherin are potential prognostic factors for ESCC, paving the way for more targeted prospective validation in the future.

To investigate the difference of procalcitonin (PCT) level between uninfected diabetic nephropathy patients and healthy volunteers.This study enrolled 76 patients with diabetes only [DM group, 24 h urinary micro albumin (mALB)30 mg/24 h], 81 patients with early DN (EDN group, mALB 30-300 mg/24 h), 87 DN patients (DN group, mALBor = 300 mg/24 h), and 82 age- and sex-matched healthy volunteers. All the patients were free of systemic infection. PCT levels and various laboratory parameters including metabolic and kidney functions as well as inflammatory element profiles were assessed.The PCT level of DN group was significantly higher than that of healthy control group, DM group and EDN group (P0.001 or P0.05). Spearman's test showed a significant positive correlation between PCT and serum lactate dehydrogenase (LDH, r = 0.541, P0.01), Urine acid (UA) (r = 0. 320, P0.01), Urea (r = 0.324, P0.01), creatinine (Cr) (r= 0.403, P0.01), alpha-hydroxybutyrate dehydrogenase (alpha-HBD) (r = 0.791, P0.01) and C-reactive protein (CRP) (r = 0.694, P0.001) in diabetic nephropathy patients respectively.Serum PCT level of patients with diabetic nephropathy is higher than that of healthy volunteers, which may be associated with minimal inflammation and kidney function damage.

The aim of this study was to evaluate the effect of a longer interval between long-course neoadjuvant chemoradiotherapy and surgery on surgical and oncologic outcome.A total of 233 consecutive patients with clinical stage II and III rectal cancer were divided into 2 groups according to the neoadjuvant-surgery interval: short-interval group (≤ 7 weeks, n = 111), and long-interval group (7 weeks, n = 122). Data on neoadjuvant-surgery interval, operative time, perioperative complications, final pathology, disease recurrence, and mortality were prospectively collected and analyzed.The two groups were comparable in terms of demographics, tumor, and treatment characteristics. Operative time and perioperative complications were not influenced by a longer interval. Patients in the long-interval group had a significantly higher pathologic complete response (pCR) rate (27.1% vs. 15.3%, P = 0.029), and a decreased rate of circumferential resection margin involvement (1.6% vs. 8.1%, P = 0.020). After a median follow-up of 42 months (range 6-90 months), the 3-year local recurrence rate was 12.9% in the short-interval group versus 4.8% in the long-interval group (P = 0.025).A neoadjuvant-surgery interval7 weeks is safe and is associated with a higher rate of pCR and R0 resection, and decreased local recurrence.

Background At present no objective parameters to identify the risk of liver metastasis after surgery have been established in rectal cancer. Objective To identify the chromosomal aberrations that are correlated with liver metastasis of rectal cancer. Methods Primary tumor tissues of rectal carcinoma were analyzed by array-based comparative genomic hybridization (array-CGH). Genomic aberrations were identified by Genomic Workbench and MD-SeeGH. Results The most frequent gains in rectal cancer were at 20q11.21-q13.33, 8q11.21-q24.3, 13q12.11-q14.2 and losses in 5q13.2, 8p23.3-p22, 17p13.3-p13.2 and 18q11.2-q23. Seven amplifications at 6p21.1, 8q24.21, 8q24.3, 13q13.2 and 20q13.2-q13.32 and nine homozygous deletions at 1q31.3, 4q12-q13.1, 4q32.3-q33, 5q13.2, 8p23.2, 8q11.23, 16p13.2, 19p13.11 and 19q13.41 were identified. Both frequency plot comparison and SAM (Significance analysis of microarray) methods indicated that losses at 1p35.3, 4p14, 14q23.1-q32.11 and 18p11.32-p11.21 were more frequent in patients without liver metastasis. Conclusions These liver metastasis associated genomic changes may be useful to reveal the mechanism of metastasis and identify candidate biomarkers.

To evaluate the feasibility, safety and short-term outcomes of total laparoscopic rectosigmoid cancer surgery with transanal natural orifice specimen extraction.From July 2012 to February 2013, 21 patients underwent total laparoscopic surgery with transanal natural orifice specimen extraction. There were 12 males and 9 females with a median age of 53 (48-77) years.Rectal cancer (n = 11) and sigmoid cancer (n = 10) were diagnosed. The clinical data such as bowel function recovery time, number of lymph nodes harvested and an incidence of anastomotic leakage was collected and retrospectively analyzed to assess the value of this technique.Operation was successfully accomplished without conversion into open surgery or conventional laparoscopic-assisted surgery. The median operative duration was 105 (80-165) min, the median volume of blood loss 50 (20-300) ml, the median number of lymph nodes harvested 16(8-29) and the time of first bowl movement was 48 (24-72) h. The postoperative hospitalization stay was 9 (6-12) d. There were abdominal hemorrhage (n = 1) and anastomotic leakage (n = 1).Total laparoscopic rectosigmoid cancer surgery with transanal natural orifice specimen extraction appears to be feasible, and oncologically acceptable for selected patients.

This study was aimed to explore the change characteristics of cell differentiation antigen (CD) on bone marrow (BM) granulocytes in patients,with megaloblastic anemia (MA). In combination with BM cell morphology, hemogram, level of blood serum folic acid, level of Vit B(12), cell genetics and biological examination data, the BM granulocytes differentiation antigens in 13 patients with MA were detected by flow cyto metry and analyzed retrospectively, in order to summarize the variation characteristics of CD13, CD33 and CD15 expressed on myeloid cells in patient with MA, including forward scatter light (FSC) and side scatter light (SSC) signal intensity, then these findings were compared with that in normal healthy persons. The results showed that the expression rates of CD13, CD15 and CD33 on granulocytic in patients with MA and normal healthy persons were (44.53 ± 16)%, (96.16 ± 2.67)%, (80.81 ± 14.71)% and (62.33 ± 11.02)%, (99.53 ± 0.46)%, (70.00 ± 7.81)% respectively, in which the expression rate of CD13 and CD15 in patients with MA decreased (P0.01), while the expression rate of CD33 increased (P0.01). The mean fluorescence intensity (MFI) of CD13, CD15, CD33, SSC and FSC in MA patients and normal healthy persons were 3.39 ± 1.41, 14.29 ± 6.59, 1.95 ± 0.94, 478.78 ± 70.43, 633.46 ± 75.53 and 5.12 ± 1.15, 20.67 ± 5.13, 1.04 ± 0.17, 332.00 ± 38.16, 537.00 ± 16.70 respectively, in which the MFI of CD13 and CD15 on granulocytes in MA patients decreased (P0.01),while the MFI of FSC,SSC and CD33 increased (P0.01 and P0.05). It is concluded that not only the morphology of BM granulocytes in patents with MA shows dysmaturity, but the expressing feature of differentiation antigens on BM granulocytes in MA patients also displays dysmaturity.These findings will contribute to the clinical diagnosis of MA patients.

To analyze the outcomes of simultaneous liver resection for patients who have primary colorectal cancer with synchronous hepatic metastases to see if there is any advantage for doing so.We retrospectively analyzed the medical records (1999 - 2009) of 53 consecutive patients with synchronously recognized primary colorectal carcinoma and hepatic metastases who underwent simultaneous (40 patients) or two-stage (13 patients) colonic and hepatic resections performed at our hospital.There was no thirty-day mortality in both groups. The two groups had significant differences in mean operation duration [(212.9 ± 72.3) min vs. (326.5 ± 140.2) min, P = 0.014], mean blood loss [(337.5 ± 298.0) ml vs. (594.6 ± 430.5) ml, P = 0.020], post-operative hospital stay [(16.2 ± 8.1) day vs. (25.8 ± 8.5) day, P = 0.001]. The incidence rates of post-operative complications were 25.0% (10/40) and 53.8% (7/13), respectively, in the two groups (P = 0.053). The 1-, 3-, 5-year survival rates in the simultaneous resection group were 95.0%, 57.0% and 37.4%, respectively, with a median overall survival of 40.0 months and median disease-free survival of 14.0 months. The 1-, 3-, 5-year survival rates in the two-stage resection group were 92.3%, 58.7% and 36.7%, respectively, with a median overall survival of 38.0 months and median disease-free survival of 13.0 months. There were no significant differences between the two groups in respect of their survivals (P0.05).Simultaneous colectomy and hepatectomy are safe and efficient for colorectal cancer patients who have synchronous colorectal liver metastases, with less complications and blood loss, and shorter hospital stay compared with the two-stage resection.

There has been a history of 30 years in the study of CD4(+)CD25(+) T regulatory cells (Treg) which primarily play a role of immune suppression in vivo. Many autoimmune diseases are related to the decrease and the disorder of these cells, such as multiple sclerosis, non-obese diabet (NOD) and lupus erythematosus. In the field of transplantation tolerance, the role played by Treg is also very important. All of these features have drawn the attention to the prevention of autoimmune diseases and the rejection of transplantation. However, the low frequency of Treg in vivo affected their use and study. Currently, many techniques about expansion of Treg in vitro have been established so as to overcome the problem of their limited cell numbers in vivo. Recent studies suggest that antigen-specific T regulator cells (sTreg) expanded by dentritic cells (DC) showed a superior immunosuppression in comparison with polyclonal Treg expanded by anti-CD3/CD28Ab, which is the focus of current studies. This article mainly reviews and compares the expansion techniques and the mechanism of regulatory T cells.

To investigate the influence of combined hepatectomy with splenectomy on safety of operation for hepatocellular carcinoma patients complied with cirrhosis and hypersplenism and the best peri-operative treatment of these patients.Clinical data of 177 hepatocellular carcinoma patients complied with cirrhosis and hypersplenism admitted from January 1999 to December 2009 were analyzed retrospectively. Among which, 71 patients received concomitant splenectomy with hepatectomy (splenectomy group), 106 patients only receive a hepatectomy (non-splenectomy group). The safety of operation, complications, liver function and WBC and PLT counts were compared between the two groups.There was no significant difference of general conditions, counts of WBC and PLT between the two groups before operation. The counts of PLT at 1, 10, 30 day after operation were (88.4 ± 23.6) × 10⁹/L, (345.3 ± 98.2) × 10⁹/L and (210.8 ± 92.2) × 10⁹/L respectively in splenectomy group, which were significantly higher than that of non-splenectomy group (P0.05). The operation time of splenectomy group was (216 ± 105) min, which was longer than that of non splenectomy group (P0.05), but the blood loss and transfusion rate had not significantly difference between the two groups. The complication rates of splenectomy group and non-splenectomy group were 11.3% and 6.6% respectively, there was no significant difference between the two groups.Combined hepatectomy with splenectomy will be safe for hepatocellular carcinoma patients complied with cirrhosis and hypersplenism as if the operative indication and increase the ability of peri-operative treatment are strictly obeyed.

Anorectal malignant melanoma was a rare disease with extremely poor prognosis. The aim of this study was to explore the clinical characteristic, diagnosis and treatment strategies of anorectal malignant melanoma.The data of 57 patients with anorectal malignant melanoma was collected and retrospectively analyzed.Rectal bleeding and anal mass were found to be common symptoms of anorectal malignant melanoma. The preoperative diagnosis rate of anorectal malignant melanoma was 48.6%. The overall 3-year and 5-year survival rate was 38.0% and 21.3% respectively. The 3-year survival rates of stage I and II patients were 63.0% and 16.7% respectively (P = 0.000), and the 5-year survival rates were 33.3% and 11.1% (P = 0.001), which both had significant statistic differences. The 3-year survival rate of patients undergone abdmoninoperineal resection and patients undergone wide local excision were 36.7% and 53.0% respectively (P = 0.280), while the 5-year survival rate were 24.1% and 23.1% (P = 0.642), which both had no significant statistic differences.This study identified no survival advantage to abdominoperineal resection in treatment of anorectal malignant melanoma, and we propose that wide local excision could be considered as the initial treatment of choice.

To explore the diagnosis, treatment, and prognostic factors of liver sarcoma.The clinical data of 16 liver sarcoma patients, 9 males and 7 females, aged 46.7 (12-73), treated 1980-2005, were analyzed retrospectively.The most common symptoms were right upper quadrant pain (56.3%) and mass in the right upper abdomen (56.3%). Alpha fetoprotein (AFP) was negative in all the patients. None was correctly diagnosed by imaging examination preoperatively. Fifteen patients underwent surgical treatment, including radical operation in 7 patients (46.7%) and palliative resection/biopsy in 8 patients. 1 patient took transcatheter hepatic arterial chemo-embolization rather than operation because of multifocal tumor. Pathological analysis diagnosed 6 patients (37.5%) as with leiomyosarcoma, 5 patients (31.25%) with angiosarcoma, 2 patients (12.5%) with fibrosarcoma, 1 patient (12.5%) with epithelioid hemangioendothelioma, 1 patient (12.5%) with myxoid liposarcoma, and 1 patient (12.5%) with undifferentiated embryonal sarcoma. The 1-year, 3-year, and 5-year survival rates were 71.4%, 41.7%, and 33.3% respectively. The 1-year, 3-year, and 5-year survival rates of the patients who received R0 were 100.0%, 83.3%, and 66.7% respectively, all significantly higher than those of the patients who did not receive R0 (all P = 0.011). The 1-year, 3-year, and 5-year survival rates of the patients with the tumor size5 cm were 100%, 100%, and 75% respectively, all higher than those of the patients with the tumor size5 cm, however, not significantly (all P = 0.084).Liver sarcoma is difficult to be diagnosed preoperatively. Surgical resection is the mainstay of the treatment of liver sarcoma. R0 and tumor size are of prognostic values.

To explore the clinical characteristics, diagnosis and treatment regimens for the primary gastric lymphoma (PGL).The data of 98 PGL patients treated from January 1994 to December 2006 were collected and analyzed retrospectively.Abdominal pain was the common symptom of PGL. All the patients were at stage I or stage II, and the preoperative diagnosis rate was 56.5%. The overall 1-, 3- and 5-year survival rates were 95.1%, 86.0% and 73.0% respectively. The 5-year survival rates of stage I and stage II patients were 89.5% and 66.7% respectively, and the difference was significant. The 5-year survival rate of patients received operations was 77.2% and that without operation was 75.0%, the difference was not significant.The therapy based on chemotherapy is preferred for the treatment of PGL. In the cases of serious gastrointestinal complications, indefinite pathological diagnosis or non-effective chemotherapy, operations should be considered.

To evaluate the veracity of the C1 lateral mass screw insertion in the atlantoaxial fixation using plate and screw method without A-P fluoroscopic guiding.In the atlantoaxial fixation, without A-P fluoroscopic guiding, we probe lateral mass edge and identify the entrance point of C1 lateral mass screw indirectly. 159 patients treated with atlantoaxial fixation using plate and screw method were studied. Postoperative CT was used for analysis, and the position of the lateral mass screws in atlas was identified by coronary and axial CT scan. Three areas were delimited in and around the lateral mass of atlas in the axial CT scan, so as to analyze the location of screws: area A (inside the joint face), area B (outside the joint face but still in lateral mass), and area C (outside the lateral mass).Among the 318 screws, 308 (96.9%) were located in area A, 5 in area B (1.6%), and 5 in area C (1.6%). All cases got atlantoaxial union at 4 months after operation.Probing lateral mass edge and identifying the lateral mass indirectly is reliable for identifying the path of screw in atlas.

Study Design. A retrospective study of surgical outcome of 33 patients with irreducible atlantoaxial dislocation (IAAD). Objective. To evaluate the safety efficacy of one stage anterior release and posterior fixation and fusion to reduce and stabilize IAAD. Summary of Background Data. The traditional treatment of symptomatic IAAD is ventral decompression by transoral approach. This procedure is accompanied with high morbidity and mortality. It does not correct the swan neck deformity, which could precipitate the degenerative changes in the lower cervical spine. Our hypotheses were that it is the contraction of the muscles, ligaments, and capsules of atlantoaxial joint that prevent reduction, and that most of IAADs might be reduced by anterior atlantoaxial joint release without the odontoid resection, and that further reduction and stabilization might be achieved by special posterior fixation. Methods. A consecutive series of 33 patients with IAAD were surgically treated. Dislocation or reduction was assessed before surgery, immediately after surgery, and at the final follow-up. Etiology, instrumentation, levels fused, and complications were documented. All patients were assessed clinically for neurologic recovery by Odom's method. Results. The mean age was 32 years (range, 7–63 years). The pathology included os odontoideum in 8 patients, occipitalization of C1 in 19 patients, malunion of odontoid fracture in 5, and relaxation of transverse ligament of atlas in 1. Twenty five patients presented neurologic signs and symptoms. Anterior release was performed without odontoid resection in all cases. Four patients underwent transarticular C1–C2 screw fixation, 3 had C1–C2 pedicle screw and plate fixation, and 26 required occipitocervical fixation. Twenty-five cases resulted in an anatomic reduction, 8 had partial reduction. Complication included one dysphagia and two nasal phonations. The mean follow-up period was 33.7 months (range, 24–55 months). There was no pseudarthrosis, and all but 1 of the patients with neurologic deficit showed improvement. Conclusion. This series has demonstrated the safety and efficacy of the transoral anterior atlantoaxial release in the reduction of IAAD. Most of the so-called irreducible/fixed AAD could become reducible after anterior release without odontoid resection. The posterior short-segment atlantoaxial or occipitocervical fixation, especially the plate screw instrumentation, could achieve further reduction and provide immediate stabilization. One-stage anterior release and posterior instrumentation and fusion are a safe and reliable operation in experienced hands.

To evaluate the accuracy and reliability of atlantoaxial transarticular screw insertion (Magerl's technique) in atlas under lateral fluoroscopic monitoring without anteroposterior view.Seventy-five consecutive patients with atlantoaxial instability, 48 males and 27 females, aged 35.1, were treated by Magerl's technique. The screw path in atlas was achieved by direct probing the isthmus of axial vertebrae then identifying its position through the atlantoaxial joint correlation. Postoperative transoral X ray and CT film were used for analysis of the position of the 150 screws in the mass of atlas. Three areas were delimitated in and around the lateral mass of atlas: area A (inside the joint face), area: B (outside the joint face but still in lateral mass), and area C area (outside the lateral mass) so as to analyze the location of screws.Among the 150 screws 139 (92.7%) were located in area A, 8 in area B(1) and 3 in area B(2) (7.3%), and none in area C. All cases got atlantoaxial union 3 months after operation.The method of "direct probing" is reliable for identifying the path of screw in atlas.

AIM: To study the effect of inhibited E-cadherin expression on invasion of cancer cells. METHODS: We designed the nucleotide sequence of siRNA corresponding to 5’ non-coding and coding sequence of E-cadherin. 21-nucleotide dssiRNA was synthesized by in vitro transcription with Ambion Silencer TM siRNA Construction Kit. siRNA was transfected into gastric cancer MKN45 using TransMessenger transfection Kit. RT-PCR and immunofluorescent assay were used to investigate the inhibition of the expression of mutated E-cadherin. Invasive ability of cancer cells was determined by Transwell assay. RESULTS: The synthesis of E-cadherin mRNA rather than protein expression was suppressed dramatically 7 d after interference. Decreased protein expression was observed on d 10 after interference. On d 11, invasion ability was enhanced significantly. CONCLUSION: siRNA targeted at non-coding and coding sequence of E-cadherin showed significant inhibition on mRNA and protein expression. Inhibited E-cadherin expression results in increased invasion ability of cancer cells.

To observe the clinical effect of a occipitocervical fixation systems using C(2) pedicle screws and plates.An occipitocervical fixation system was designed. Since June 2001 to March 2003, 38 patients with instability of atlantoaxial joint underwent reconstructive surgery using this systems. Twenty-four patients were associated with congenital occipitalization. The pedicle screws were inserted into C(2) pedicles in the direction as its axis. The occipitocervical plate was slightly bent to fit the occipital contour and fixed onto the occiput. Hyperflexion alignment of the occipitoatlantoaxial complex was corrected by application of extensional force created by tightening of the nut on the pedicle screws. The autogenous cancellous bones were grafted between the occiput and the axis.In this series, neither vertebral artery nor spinal cord was injured. 36 of 38 cases were followed up for an average of 18 months, all cases achieved solid bony fusion. No implant failure was found.Occipitocervical reconstruction by the combination of C(2) pedicle screws and occipitocervical plate systems can provide sufficient correction of malalignment in the occipitoatlantoaxial region and achieve high fusion rate.

Introduction Preoperative chemoradiotherapy (CRT), followed by total mesorectal excision, has become the standard of care for patients with clinical stages II and III rectal cancer. Patients with pathologic complete response (pCR) to preoperative CRT have been reported to have better outcomes than those without pCR. However, the factors that predict the response to neoadjuvant CRT have not been well defined. In this study, we aimed to investigate the impact of clinical parameters on the development of pCR after neoadjuvant chemoradiation for rectal cancer. Methods A total of 323 consecutive patients from a single institution who had clinical stage II or III rectal cancer and underwent a long-course neoadjuvant CRT, followed by curative surgery, between 2005 and 2013 were included. Patients were divided into two groups according to their responses to neoadjuvant therapy: the pCR and non-pCR groups. The clinical parameters were analyzed by univariate and multivariate analyses, with pCR as the dependent variable. Results Of the 323 patients, 75 (23.2%) achieved pCR. The two groups were comparable in terms of age, sex, body mass index, tumor stage, tumor location, tumor differentiation, radiation dose, and chemotherapy regimen. On multivariate analysis, a pretreatment carcinoembryonic antigen (CEA) level of ≤5 ng/mL [odds ratio (OR) = 2.170, 95% confidence interval (CI) = 1.195–3.939, P = 0.011] and an interval of >7 weeks between the completion of chemoradiation and surgical resection (OR = 2.588, 95% CI = 1.484–4.512, P = 0.001) were significantly associated with an increased rate of pCR. Conclusions The pretreatment CEA level and neoadjuvant chemoradiotherapy-surgery interval were independent clinical predictors for achieving pCR. These results may help clinicians predict the prognosis of patients and develop adaptive treatment strategies.