AIM:To investigate the effects of carbon dioxide (CO2) and helium insufflation administered at different pressures on the growth and apoptosis of cultured human gastric cancer cells. METHODS:The gastric cancer cells M...AIM:To investigate the effects of carbon dioxide (CO2) and helium insufflation administered at different pressures on the growth and apoptosis of cultured human gastric cancer cells. METHODS:The gastric cancer cells MKN-45 were exposed to a CO2 and helium environment maintained at different pressures (0, 5, 10 and 15 mmHg). The cells were exposed to simulated pneumoperitoneum environment for 4 h, and pH of the culture media was measured after it was moved to normal conditions for 0, 2, 4, 6 and 8 h. Proliferation viability of MKN-45 was examined by 3-4,5Dimethylthiazol-2-yl,5-diphenyltetrazolium bromide or triazolyl blue (MTT) assay after it was moved to normal conditions. Apoptotic ratio was measured by Annexin V-FITC/PI double labelled staining. RESULTS:The pH of media was acid and recovered to normal after 4 h in the CO2 group while it was basic in the helium group. There was no difference between CO2 groups (under 10 mmHg ) and control group (P > 0.05) in the proliferative viability of the cells. The cultured cells exposed to 15 mmHg CO2 environment grew more slowly than control group from 4 to 7 d (P < 0.01 ) while there was no difference from 1 to 3 d (P > 0.05). The proliferative viability in helium group was not obviously different from the control group (P > 0.05). The apoptotic ratio of the cultured cells was markedly higher than that of the control group (P < 0.01) at 10 and 15 mmHg CO2 insufflation pressure. In helium group, the apoptotic ratio was not obviously different from the control group (P > 0.05). CONCLUSION:There is no obvious effect in the proliferation and apoptosis of MKN-45 cells under 10 mmHg CO2 insufflation pressure and helium in any pressure. Fifteen mmHg CO2 insufflation pressure can inhibit the proliferation of the cells and improve apoptosis.展开更多
BACKGROUND Malignant splenic tumors are rare but fatal,presenting a challenge in diagnosis and management involving hematology,oncology,and general surgery.By contrast,diagnosing and treating other common malignant tu...BACKGROUND Malignant splenic tumors are rare but fatal,presenting a challenge in diagnosis and management involving hematology,oncology,and general surgery.By contrast,diagnosing and treating other common malignant tumors(such as lung and gastrointestinal cancer)offers multiple strategies for chemotherapy,radiotherapy,targeted therapy,and immunotherapy with the prospect of a cure.With various specialists involved in clinical multiple disciplinary team(MDT)discussion,personal bias can be minimized.It can also ignite important discussion which can benefit not only one patient but many patients.CASE SUMMARY Here,we report on the MDT diagnosis and management of the malignant splenic tumors littoral cell angiosarcoma and histiocytic sarcoma.Although only two cases of rare primary splenic malignancy are presented,MDT is a novel means of rare disease treatment.CONCLUSION To benefit patients,imaging analysis,safe operation,precise pathology examination,and individualized therapeutic treatment strategies are required.The involvement of various specialists in a clinical MDT discussion minimizes personal bias and can create important ideas to benefit all patients.展开更多
The safety and feasibility of pregnancy following liver transplantation(LT) have been accredited in a series of LT center.The first case in China's Mainland is reported.The follow-up data of a 22-year-old pregnant...The safety and feasibility of pregnancy following liver transplantation(LT) have been accredited in a series of LT center.The first case in China's Mainland is reported.The follow-up data of a 22-year-old pregnant patient with end-stage liver disease undergone orthotopic liver transplantation were analyzed retrospectively.After surgery,the patient was uneventfully recovered and became pregnant 33 mo after LT.The patient was closely monitored and treated with a standard and individualized triple-drug immunosuppressive therapy throughout her pregnancy.Caesarean section was performed in March 18,2004,and a health live-born infant was delivered.After the delivery,a 4-year follow-up period indicated that the patient was satisfactory with her condition and her baby was healthy.Our case shows that a successful pregnancy following LT is possible and safe in women with end-stage liver diseases under close monitoring.Three factors including mother,baby,and transplanted liver function must be considered for the safety of high-risk pregnancies.展开更多
This study aimed to investigate the expression ofβ-catenin in hepatocellular carcinoma(HCC)tissues and its relationship withα-fetoprotein(AFP)in HCC.Immunohistochemistry was used to determine the expression ofβ-cat...This study aimed to investigate the expression ofβ-catenin in hepatocellular carcinoma(HCC)tissues and its relationship withα-fetoprotein(AFP)in HCC.Immunohistochemistry was used to determine the expression ofβ-catenin in normal liver tissues(n=10),liver cirrhosis tissues(n=20),and primary HCC tissues(n=60).The relationship betweenβ-catenin expression and clinical parameters of HCC was investigated.Real-time PCR and Western blotting were used to detect the m RNA and protein expression levels ofβ-catenin in the liver cancer cell line SMMC-7721 transfected with a plasmid encoding AFP,and also the m RNA and protein expression levels ofβ-catenin were measured in the liver cancer cell line Huh7 before and after the transfection with AFP sh RNA plasmids.The results showed thatβ-catenin was only expressed on the cell membrane in normal liver tissues.Its localization to the cytoplasm and nucleus of cells was observed in a small proportion of cirrhotic tissues or adjacent HCC tissues,and such ectopic expression ofβ-catenin was predominant in HCC tissues.The abnormal expression ofβ-catenin was correlated with serum AFP levels,cancer cell differentiation and vascular invasion(P〈0.05).Additionally,the increased expression of AFP resulted in the upregulation ofβ-catenin m RNA and protein levels,while knockdown of AFP with AFP sh RNA led to significantly decreasedβ-catenin m RNA and protein levels(P〈0.05).It was suggested that the abnormal expression ofβ-catenin is implicated in hepatic carcinogenesis and development.AFP can lead to increased expression ofβ-catenin,which may account for the poor prognosis of AFP-associated HCC patients.展开更多
BACKGROUND Laparoscopic radical gastrectomy is widely used,and perioperative complications have become a highly concerned issue.AIM To develop a predictive model for complications in laparoscopic radical gastrectomy f...BACKGROUND Laparoscopic radical gastrectomy is widely used,and perioperative complications have become a highly concerned issue.AIM To develop a predictive model for complications in laparoscopic radical gastrectomy for gastric cancer to better predict the likelihood of complications in gastric cancer patients within 30 days after surgery,guide perioperative treatment strategies for gastric cancer patients,and prevent serious complications.METHODS In total,998 patients who underwent laparoscopic radical gastrectomy for gastric cancer at 16 Chinese medical centers were included in the training group for the complication model,and 398 patients were included in the validation group.The clinicopathological data and 30-d postoperative complications of gastric cancer patients were collected.Three machine learning methods,lasso regression,random forest,and artificial neural networks,were used to construct postoperative complication prediction models for laparoscopic distal gastrectomy and laparoscopic total gastrectomy,and their prediction efficacy and accuracy were evaluated.RESULTS The constructed complication model,particularly the random forest model,could better predict serious complications in gastric cancer patients undergoing laparoscopic radical gastrectomy.It exhibited stable performance in external validation and is worthy of further promotion in more centers.CONCLUSION Using the risk factors identified in multicenter datasets,highly sensitive risk prediction models for complications following laparoscopic radical gastrectomy were established.We hope to facilitate the diagnosis and treatment of preoperative and postoperative decision-making by using these models.展开更多
Objective： To compare laparoscopic gastrectomy and conventional surgery on the dissemination and seeding of tumor cells. Methods：Intraoperative peritoneal lavage cytologic examination was performed in 65 patients wi...Objective： To compare laparoscopic gastrectomy and conventional surgery on the dissemination and seeding of tumor cells. Methods：Intraoperative peritoneal lavage cytologic examination was performed in 65 patients with gastric cancer, during laparoscopic gastrectomy （n = 34） and conventional surgery （n = 31）. Cytology was examined twice, immediately after opening the peritoneal cavity and just before closing the abdomen. Saline was poured into the peritoneal cavity, and 100 ml fluid was retrieved after irrigation. Laparoscopic instruments were lavaged after surgery with 100 ml saline. Carbon dioxide （COz） was derived through the trocar side orifice after pneumoperitoneum during laparoscopic gastrectomy and filtered through 100 ml saline. Cytologic examination of the filtrate was performed after the filtration process. Results： The incidence of positive cytology during laparoscopic surgery was 32.26% in the preoperative lavage and 22.58% in the postoperative lavage. The incidence of positive cytology during conventional surgery was 41.18% before lavage and 26.47% after lavage. Only one positive cytology was detected in the CO2 filtrate gas. The incidence of positive cytology in the lavage of the instruments during laparoscopic surgery was 6.45 %. Conclusion： During gastric laparoscopic surgery, CO2 pneumoperitoneum does not affect tumor cell dissemination and seeding. In this study, laparoscopic techniques used in gastric cancer surgery were not associated with a higher risk for intraperitoneal dissemination of cancer cells than the conventional surgery.展开更多
BACKGROUND A positive resection margin is a major risk factor for local breast cancer recurrence after breast-conserving surgery(BCS).Preoperative imaging examinations are frequently employed to assess the surgical ma...BACKGROUND A positive resection margin is a major risk factor for local breast cancer recurrence after breast-conserving surgery(BCS).Preoperative imaging examinations are frequently employed to assess the surgical margin.AIM To investigate the role and value of preoperative imaging examinations[magnetic resonance imaging(MRI),molybdenum target,and ultrasound]in evaluating margins for BCS.METHODS A retrospective study was conducted on 323 breast cancer patients who met the criteria for BCS and consented to the procedure from January 2014 to July 2021.The study gathered preoperative imaging data(MRI,ultrasound,and molybdenum target examination)and intraoperative and postoperative pathological information.Based on their BCS outcomes,patients were categorized into positive and negative margin groups.Subsequently,the patients were randomly split into a training set(226 patients,approximately 70%)and a validation set(97 patients,approximately 30%).The imaging and pathological information was analyzed and summarized using R software.Non-conditional logistic regression and LASSO regression were conducted in the validation set to identify factors that might influence the failure of BCS.A column chart was generated and applied to the validation set to examine the relationship between pathological margin range and prognosis.This study aims to identify the risk factors associated with failure in BCS.RESULTS The multivariate non-conditional logistic regression analysis demonstrated that various factors raise the risk of positive margins following BCS.These factors comprise non-mass enhancement(NME)on dynamic contrastenhanced MRI,multiple focal vascular signs around the lesion on MRI,tumor size exceeding 2 cm,type III timesignal intensity curve,indistinct margins on molybdenum target examination,unclear margins on ultrasound examination,and estrogen receptor(ER)positivity in immunohistochemistry.LASSO regression was additionally employed in this study to identify four predictive factors for the model:ER,molybdenum target tumor type(MT Xmd Shape),maximum intensity projection imaging feature,and lesion type on MRI.The model constructed with these predictive factors exhibited strong consistency with the real-world scenario in both the training set and validation set.Particularly,the outcomes of the column chart model accurately predicted the likelihood of positive margins in BCS.CONCLUSION The proposed column chart model effectively predicts the success of BCS for breast cancer.The model utilizes preoperative ultrasound,molybdenum target,MRI,and core needle biopsy pathology evaluation results,all of which align with the real-world scenario.Hence,our model can offer dependable guidance for clinical decisionmaking concerning BCS.展开更多
AIM To perform a meta-analysis to investigate the association between cyclooxygenase-2(COX-2)-1195G>A gene polymorphism and gastrointestinal cancers. METHODS Publications related to the COX-2-1195G>A gene polymo...AIM To perform a meta-analysis to investigate the association between cyclooxygenase-2(COX-2)-1195G>A gene polymorphism and gastrointestinal cancers. METHODS Publications related to the COX-2-1195G>A gene polymorphism and gastrointestinal cancers published before July 2016 were retrieved from Pub Med, EMBASE, Web of Science, China Biological Medicine Database, China National Knowledge Infrastructure, and CQVIP Database. Meta-analysis was performed using Stata11.0 software. The strength of the association was evaluated by calculating the combined odds ratios(ORs) and the corresponding 95%CIs. The retrieved publications were excluded or included one by one for sensitivity analysis. In addition, the funnel plot, Begg's rank correlation test, and Egger's linear regression method were applied to analyse whether the included publications had publication bias. RESULTS A total of 24 publications related to the COX-2-1195G>A gene polymorphism were included, including 28 studies involving 11043 cases and 18008 controls. The meta-analysis results showed that the COX-2-1195G>A gene polymorphism significantly correlated with an increased risk of gastrointestinal cancers, particularly gastric cancer(A vs G: OR = 1.35; AA/AG vs GG: OR = 1.54; AA vs GG/AG: OR = 1.43; AA vs GG: OR = 1.80; AG vs GG: OR = 1.35). Compared to the Caucasian population in America and Europe, the COX-2-1195G>A gene polymorphism in the Asian population(A vs G: OR = 1.30; AA/AG vs GG: OR= 1.50; AA vs GG/AG: OR = 1.35; AA vs GG: OR = 1.71; AG vs GG: OR = 1.37) significantly increased gastrointestinal cancer risk. The sensitivity analysis(P < 0.05) and the false positive report probability(P < 0.2) confirmed the reliability of the results. CONCLUSION The results showed that the COX-2-1195G>A gene polymorphism might be a potential risk factor for gastrointestinal cancers. Further validation by a large homogeneous study is warranted.展开更多
The interaction between the gastric epithelium and immune cells plays key roles in H. pylori-associated pathology. Here, we demonstrate a procolonization and proinflammatory role of tubulointerstitial nephritis antige...The interaction between the gastric epithelium and immune cells plays key roles in H. pylori-associated pathology. Here, we demonstrate a procolonization and proinflammatory role of tubulointerstitial nephritis antigen-like 1 (TINAGL1), a newly discovered matricellular protein, in H. pylori infection. Increased TINAGL1 production by gastric epithelial cells (GECs) in the infected gastric mucosa was synergistically induced by H. pylori and IL-1β via the ERK-SP1 pathway in a cagA-dependent manner. Elevated human gastric TINAGL1 correlated with H. pylori colonization and the severity of gastritis, and mouse TINAGL1 derived from non-bone marrow-derived cells promoted bacterial colonization and inflammation. Importantly, H. pylori colonization and inflammation were attenuated in Tinagl1−/− and Tinagl1ΔGEC mice and were increased in mice injected with mouse TINAGL1. Mechanistically, TINAGL1 suppressed CCL21 expression and promoted CCL2 production in GECs by directly binding to integrin α5β1 to inhibit ERK and activate the NF-κB pathway, respectively, which not only led to decreased gastric influx of moDCs via CCL21-CCR7-dependent migration and, as a direct consequence, reduced the bacterial clearance capacity of the H. pylori-specific Th1 response, thereby promoting H. pylori colonization, but also resulted in increased gastric influx of Ly6Chigh monocytes via CCL2-CCR2-dependent migration. In turn, TINAGL1 induced the production of the proinflammatory protein S100A11 by Ly6Chigh monocytes, promoting H. pylori-associated gastritis. In summary, we identified a model in which TINAGL1 collectively ensures H. pylori persistence and promotes gastritis.展开更多
Hepatocellular carcinoma(HCC)remains the most common malignancy to threaten public health globally.With advances in artificial intelligence techniques,radiomics for HCC management provides a novel perspective to solve...Hepatocellular carcinoma(HCC)remains the most common malignancy to threaten public health globally.With advances in artificial intelligence techniques,radiomics for HCC management provides a novel perspective to solve unmet needs in clinical settings,and reveals pixel-level radiological information for medical imaging big data,correlating the radiological phenotype with targeted clinical issues.Conventional radiomics pipelines depend on handcrafted engineering features,and further deep learning-based radiomics pipelines are supplemented with deep features calculated via self-learning strategies.During the past decade,radiomics has been widely applied in accurate diagnoses and pathological or biological behavior evaluation,as well as in prognosis prediction.In this review,we systematically introduce the main pipelines of artificial intelligence-based radiomics and their efficacy in the clinical studies of HCC.展开更多
At present,natural orifice specimen extraction surgery(NOSES)has attracted more and more attention worldwide,because of its great advantages including minimal cutaneous trauma and post-operative pain,fast post-operati...At present,natural orifice specimen extraction surgery(NOSES)has attracted more and more attention worldwide,because of its great advantages including minimal cutaneous trauma and post-operative pain,fast post-operative recovery,short hospital stay,and positive psychological impact.However,NOSES for the treatment of gastric cancer(GC)is still in its infancy,and there is great potential to improve its theoretical system and clinical practice.Especially,several key points including oncological outcomes,bacteriological concerns,indication selection,and standardized surgical procedures are raised with this innovative technique.Therefore,it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES,which is of great significance for healthy and orderly development of NOSES worldwide.展开更多
Background Total gastrectomy for carcinoma in the remnant stomach(CRS)remains a technically demanding procedure.Whether robotic surgery is superior,equal,or inferior to laparoscopic surgery in patients with CRS is unc...Background Total gastrectomy for carcinoma in the remnant stomach(CRS)remains a technically demanding procedure.Whether robotic surgery is superior,equal,or inferior to laparoscopic surgery in patients with CRS is unclear.This study was designed to compare the efficacy and safety of robotic total gastrectomy(RTG)and laparoscopic total gastrectomy(LTG)for the treatment of CRS.Methods In this cohort study,we retrospectively analysed the data from patients who underwent RTG or LTG for CRS at Southwest Hospital(Chongqing,China)between May 2006 and October 2019.The surgical outcomes,post-operative complications,and survival outcomes between the two groups were compared.Results Compared with LTG,RTG was associated with similar effective operation time(272.0 vs 297.9 min,P=0.170),higher total costs(105,967.2 vs 81,629.5 RMB,P<0.001),and less estimated blood loss(229.2 vs 288.8 mL,P=0.031).No significant differences were found between the robotic and laparoscopic groups in terms of conversion rate,time to first flatus,time to first soft diet,post-operative hospital stay,post-operative complications,R0 resection rate,and number of retrieved lymph nodes(all P>0.05).The 3-year disease-free survival and 3-year overall survival rates were comparable between the two groups(65.5%vs 57.5%,P=0.918;69.0%vs 60.0%,P=0.850,respectively).Conclusions RTG is a safe and feasible procedure for the treatment of CRS and could serve as an optimal treatment for CRS.展开更多
基金The "11th Five-Year" Program of People’s Liberation Army of China (PLA), No. 06MB240
文摘AIM:To investigate the effects of carbon dioxide (CO2) and helium insufflation administered at different pressures on the growth and apoptosis of cultured human gastric cancer cells. METHODS:The gastric cancer cells MKN-45 were exposed to a CO2 and helium environment maintained at different pressures (0, 5, 10 and 15 mmHg). The cells were exposed to simulated pneumoperitoneum environment for 4 h, and pH of the culture media was measured after it was moved to normal conditions for 0, 2, 4, 6 and 8 h. Proliferation viability of MKN-45 was examined by 3-4,5Dimethylthiazol-2-yl,5-diphenyltetrazolium bromide or triazolyl blue (MTT) assay after it was moved to normal conditions. Apoptotic ratio was measured by Annexin V-FITC/PI double labelled staining. RESULTS:The pH of media was acid and recovered to normal after 4 h in the CO2 group while it was basic in the helium group. There was no difference between CO2 groups (under 10 mmHg ) and control group (P > 0.05) in the proliferative viability of the cells. The cultured cells exposed to 15 mmHg CO2 environment grew more slowly than control group from 4 to 7 d (P < 0.01 ) while there was no difference from 1 to 3 d (P > 0.05). The proliferative viability in helium group was not obviously different from the control group (P > 0.05). The apoptotic ratio of the cultured cells was markedly higher than that of the control group (P < 0.01) at 10 and 15 mmHg CO2 insufflation pressure. In helium group, the apoptotic ratio was not obviously different from the control group (P > 0.05). CONCLUSION:There is no obvious effect in the proliferation and apoptosis of MKN-45 cells under 10 mmHg CO2 insufflation pressure and helium in any pressure. Fifteen mmHg CO2 insufflation pressure can inhibit the proliferation of the cells and improve apoptosis.
基金Supported by the NSFC,No.81502696Technology Plan Program of Sichuan Province,No.2018JY0185+1 种基金Program of General Hospital of Western Theater,No.2021-XZYG-C3Science&Technology Department of Sichuan Province International Cooperation Program,No.2019YFH0056 and 2020YFSY0022。
文摘BACKGROUND Malignant splenic tumors are rare but fatal,presenting a challenge in diagnosis and management involving hematology,oncology,and general surgery.By contrast,diagnosing and treating other common malignant tumors(such as lung and gastrointestinal cancer)offers multiple strategies for chemotherapy,radiotherapy,targeted therapy,and immunotherapy with the prospect of a cure.With various specialists involved in clinical multiple disciplinary team(MDT)discussion,personal bias can be minimized.It can also ignite important discussion which can benefit not only one patient but many patients.CASE SUMMARY Here,we report on the MDT diagnosis and management of the malignant splenic tumors littoral cell angiosarcoma and histiocytic sarcoma.Although only two cases of rare primary splenic malignancy are presented,MDT is a novel means of rare disease treatment.CONCLUSION To benefit patients,imaging analysis,safe operation,precise pathology examination,and individualized therapeutic treatment strategies are required.The involvement of various specialists in a clinical MDT discussion minimizes personal bias and can create important ideas to benefit all patients.
文摘The safety and feasibility of pregnancy following liver transplantation(LT) have been accredited in a series of LT center.The first case in China's Mainland is reported.The follow-up data of a 22-year-old pregnant patient with end-stage liver disease undergone orthotopic liver transplantation were analyzed retrospectively.After surgery,the patient was uneventfully recovered and became pregnant 33 mo after LT.The patient was closely monitored and treated with a standard and individualized triple-drug immunosuppressive therapy throughout her pregnancy.Caesarean section was performed in March 18,2004,and a health live-born infant was delivered.After the delivery,a 4-year follow-up period indicated that the patient was satisfactory with her condition and her baby was healthy.Our case shows that a successful pregnancy following LT is possible and safe in women with end-stage liver diseases under close monitoring.Three factors including mother,baby,and transplanted liver function must be considered for the safety of high-risk pregnancies.
文摘This study aimed to investigate the expression ofβ-catenin in hepatocellular carcinoma(HCC)tissues and its relationship withα-fetoprotein(AFP)in HCC.Immunohistochemistry was used to determine the expression ofβ-catenin in normal liver tissues(n=10),liver cirrhosis tissues(n=20),and primary HCC tissues(n=60).The relationship betweenβ-catenin expression and clinical parameters of HCC was investigated.Real-time PCR and Western blotting were used to detect the m RNA and protein expression levels ofβ-catenin in the liver cancer cell line SMMC-7721 transfected with a plasmid encoding AFP,and also the m RNA and protein expression levels ofβ-catenin were measured in the liver cancer cell line Huh7 before and after the transfection with AFP sh RNA plasmids.The results showed thatβ-catenin was only expressed on the cell membrane in normal liver tissues.Its localization to the cytoplasm and nucleus of cells was observed in a small proportion of cirrhotic tissues or adjacent HCC tissues,and such ectopic expression ofβ-catenin was predominant in HCC tissues.The abnormal expression ofβ-catenin was correlated with serum AFP levels,cancer cell differentiation and vascular invasion(P〈0.05).Additionally,the increased expression of AFP resulted in the upregulation ofβ-catenin m RNA and protein levels,while knockdown of AFP with AFP sh RNA led to significantly decreasedβ-catenin m RNA and protein levels(P〈0.05).It was suggested that the abnormal expression ofβ-catenin is implicated in hepatic carcinogenesis and development.AFP can lead to increased expression ofβ-catenin,which may account for the poor prognosis of AFP-associated HCC patients.
基金Natural Science Foundation of Fujian Province,No.2021J011360,and No.2020J011230Natural Science Foundation of Xiamen,China,No.3502Z20214ZD1018,and No.3502Z20227096+2 种基金Medical Innovation Project of Fujian Provincial Health Commission,No.2021CXB019Youth Scientific Research Project of Fujian Provincial Health Commission,No.2022QNB013Bethune Charitable Foundation,No.HZB-20190528-10.
文摘BACKGROUND Laparoscopic radical gastrectomy is widely used,and perioperative complications have become a highly concerned issue.AIM To develop a predictive model for complications in laparoscopic radical gastrectomy for gastric cancer to better predict the likelihood of complications in gastric cancer patients within 30 days after surgery,guide perioperative treatment strategies for gastric cancer patients,and prevent serious complications.METHODS In total,998 patients who underwent laparoscopic radical gastrectomy for gastric cancer at 16 Chinese medical centers were included in the training group for the complication model,and 398 patients were included in the validation group.The clinicopathological data and 30-d postoperative complications of gastric cancer patients were collected.Three machine learning methods,lasso regression,random forest,and artificial neural networks,were used to construct postoperative complication prediction models for laparoscopic distal gastrectomy and laparoscopic total gastrectomy,and their prediction efficacy and accuracy were evaluated.RESULTS The constructed complication model,particularly the random forest model,could better predict serious complications in gastric cancer patients undergoing laparoscopic radical gastrectomy.It exhibited stable performance in external validation and is worthy of further promotion in more centers.CONCLUSION Using the risk factors identified in multicenter datasets,highly sensitive risk prediction models for complications following laparoscopic radical gastrectomy were established.We hope to facilitate the diagnosis and treatment of preoperative and postoperative decision-making by using these models.
文摘Objective： To compare laparoscopic gastrectomy and conventional surgery on the dissemination and seeding of tumor cells. Methods：Intraoperative peritoneal lavage cytologic examination was performed in 65 patients with gastric cancer, during laparoscopic gastrectomy （n = 34） and conventional surgery （n = 31）. Cytology was examined twice, immediately after opening the peritoneal cavity and just before closing the abdomen. Saline was poured into the peritoneal cavity, and 100 ml fluid was retrieved after irrigation. Laparoscopic instruments were lavaged after surgery with 100 ml saline. Carbon dioxide （COz） was derived through the trocar side orifice after pneumoperitoneum during laparoscopic gastrectomy and filtered through 100 ml saline. Cytologic examination of the filtrate was performed after the filtration process. Results： The incidence of positive cytology during laparoscopic surgery was 32.26% in the preoperative lavage and 22.58% in the postoperative lavage. The incidence of positive cytology during conventional surgery was 41.18% before lavage and 26.47% after lavage. Only one positive cytology was detected in the CO2 filtrate gas. The incidence of positive cytology in the lavage of the instruments during laparoscopic surgery was 6.45 %. Conclusion： During gastric laparoscopic surgery, CO2 pneumoperitoneum does not affect tumor cell dissemination and seeding. In this study, laparoscopic techniques used in gastric cancer surgery were not associated with a higher risk for intraperitoneal dissemination of cancer cells than the conventional surgery.
文摘BACKGROUND A positive resection margin is a major risk factor for local breast cancer recurrence after breast-conserving surgery(BCS).Preoperative imaging examinations are frequently employed to assess the surgical margin.AIM To investigate the role and value of preoperative imaging examinations[magnetic resonance imaging(MRI),molybdenum target,and ultrasound]in evaluating margins for BCS.METHODS A retrospective study was conducted on 323 breast cancer patients who met the criteria for BCS and consented to the procedure from January 2014 to July 2021.The study gathered preoperative imaging data(MRI,ultrasound,and molybdenum target examination)and intraoperative and postoperative pathological information.Based on their BCS outcomes,patients were categorized into positive and negative margin groups.Subsequently,the patients were randomly split into a training set(226 patients,approximately 70%)and a validation set(97 patients,approximately 30%).The imaging and pathological information was analyzed and summarized using R software.Non-conditional logistic regression and LASSO regression were conducted in the validation set to identify factors that might influence the failure of BCS.A column chart was generated and applied to the validation set to examine the relationship between pathological margin range and prognosis.This study aims to identify the risk factors associated with failure in BCS.RESULTS The multivariate non-conditional logistic regression analysis demonstrated that various factors raise the risk of positive margins following BCS.These factors comprise non-mass enhancement(NME)on dynamic contrastenhanced MRI,multiple focal vascular signs around the lesion on MRI,tumor size exceeding 2 cm,type III timesignal intensity curve,indistinct margins on molybdenum target examination,unclear margins on ultrasound examination,and estrogen receptor(ER)positivity in immunohistochemistry.LASSO regression was additionally employed in this study to identify four predictive factors for the model:ER,molybdenum target tumor type(MT Xmd Shape),maximum intensity projection imaging feature,and lesion type on MRI.The model constructed with these predictive factors exhibited strong consistency with the real-world scenario in both the training set and validation set.Particularly,the outcomes of the column chart model accurately predicted the likelihood of positive margins in BCS.CONCLUSION The proposed column chart model effectively predicts the success of BCS for breast cancer.The model utilizes preoperative ultrasound,molybdenum target,MRI,and core needle biopsy pathology evaluation results,all of which align with the real-world scenario.Hence,our model can offer dependable guidance for clinical decisionmaking concerning BCS.
文摘AIM To perform a meta-analysis to investigate the association between cyclooxygenase-2(COX-2)-1195G>A gene polymorphism and gastrointestinal cancers. METHODS Publications related to the COX-2-1195G>A gene polymorphism and gastrointestinal cancers published before July 2016 were retrieved from Pub Med, EMBASE, Web of Science, China Biological Medicine Database, China National Knowledge Infrastructure, and CQVIP Database. Meta-analysis was performed using Stata11.0 software. The strength of the association was evaluated by calculating the combined odds ratios(ORs) and the corresponding 95%CIs. The retrieved publications were excluded or included one by one for sensitivity analysis. In addition, the funnel plot, Begg's rank correlation test, and Egger's linear regression method were applied to analyse whether the included publications had publication bias. RESULTS A total of 24 publications related to the COX-2-1195G>A gene polymorphism were included, including 28 studies involving 11043 cases and 18008 controls. The meta-analysis results showed that the COX-2-1195G>A gene polymorphism significantly correlated with an increased risk of gastrointestinal cancers, particularly gastric cancer(A vs G: OR = 1.35; AA/AG vs GG: OR = 1.54; AA vs GG/AG: OR = 1.43; AA vs GG: OR = 1.80; AG vs GG: OR = 1.35). Compared to the Caucasian population in America and Europe, the COX-2-1195G>A gene polymorphism in the Asian population(A vs G: OR = 1.30; AA/AG vs GG: OR= 1.50; AA vs GG/AG: OR = 1.35; AA vs GG: OR = 1.71; AG vs GG: OR = 1.37) significantly increased gastrointestinal cancer risk. The sensitivity analysis(P < 0.05) and the false positive report probability(P < 0.2) confirmed the reliability of the results. CONCLUSION The results showed that the COX-2-1195G>A gene polymorphism might be a potential risk factor for gastrointestinal cancers. Further validation by a large homogeneous study is warranted.
基金supported by grants from the National Natural Science Foundation of China(82070578,81870394,82000530 and 81670510)Chongqing Natural Science Fund for Distinguished Young Scholars(cstc2019jcyjjqX0003)+2 种基金Science Innovation Capacity Promotion Project of Army Medical University(2019XQY03)National Key Research and Development Program of China(2016YFC1302200)Collaborative Innovation Center of Chinese Ministry of Education(2020-39).
文摘The interaction between the gastric epithelium and immune cells plays key roles in H. pylori-associated pathology. Here, we demonstrate a procolonization and proinflammatory role of tubulointerstitial nephritis antigen-like 1 (TINAGL1), a newly discovered matricellular protein, in H. pylori infection. Increased TINAGL1 production by gastric epithelial cells (GECs) in the infected gastric mucosa was synergistically induced by H. pylori and IL-1β via the ERK-SP1 pathway in a cagA-dependent manner. Elevated human gastric TINAGL1 correlated with H. pylori colonization and the severity of gastritis, and mouse TINAGL1 derived from non-bone marrow-derived cells promoted bacterial colonization and inflammation. Importantly, H. pylori colonization and inflammation were attenuated in Tinagl1−/− and Tinagl1ΔGEC mice and were increased in mice injected with mouse TINAGL1. Mechanistically, TINAGL1 suppressed CCL21 expression and promoted CCL2 production in GECs by directly binding to integrin α5β1 to inhibit ERK and activate the NF-κB pathway, respectively, which not only led to decreased gastric influx of moDCs via CCL21-CCR7-dependent migration and, as a direct consequence, reduced the bacterial clearance capacity of the H. pylori-specific Th1 response, thereby promoting H. pylori colonization, but also resulted in increased gastric influx of Ly6Chigh monocytes via CCL2-CCR2-dependent migration. In turn, TINAGL1 induced the production of the proinflammatory protein S100A11 by Ly6Chigh monocytes, promoting H. pylori-associated gastritis. In summary, we identified a model in which TINAGL1 collectively ensures H. pylori persistence and promotes gastritis.
基金This study has received funding by the National Key Research and Development Program of China under Grant 2017YFA0700401 and 2021YFC2500402Ministry of Science and Technology of China under Grant No.2017YFA0205200+2 种基金National Natural Science Foundation of China under Grant No.82001917,81930053,82090052,82090051,82093219055,81227901,92159202 and 81527805Beijing Natural Science Foundation under Grant No.L192061the Project of High-Level Talents Team Introduction in Zhuhai City。
文摘Hepatocellular carcinoma(HCC)remains the most common malignancy to threaten public health globally.With advances in artificial intelligence techniques,radiomics for HCC management provides a novel perspective to solve unmet needs in clinical settings,and reveals pixel-level radiological information for medical imaging big data,correlating the radiological phenotype with targeted clinical issues.Conventional radiomics pipelines depend on handcrafted engineering features,and further deep learning-based radiomics pipelines are supplemented with deep features calculated via self-learning strategies.During the past decade,radiomics has been widely applied in accurate diagnoses and pathological or biological behavior evaluation,as well as in prognosis prediction.In this review,we systematically introduce the main pipelines of artificial intelligence-based radiomics and their efficacy in the clinical studies of HCC.
文摘At present,natural orifice specimen extraction surgery(NOSES)has attracted more and more attention worldwide,because of its great advantages including minimal cutaneous trauma and post-operative pain,fast post-operative recovery,short hospital stay,and positive psychological impact.However,NOSES for the treatment of gastric cancer(GC)is still in its infancy,and there is great potential to improve its theoretical system and clinical practice.Especially,several key points including oncological outcomes,bacteriological concerns,indication selection,and standardized surgical procedures are raised with this innovative technique.Therefore,it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES,which is of great significance for healthy and orderly development of NOSES worldwide.
文摘Background Total gastrectomy for carcinoma in the remnant stomach(CRS)remains a technically demanding procedure.Whether robotic surgery is superior,equal,or inferior to laparoscopic surgery in patients with CRS is unclear.This study was designed to compare the efficacy and safety of robotic total gastrectomy(RTG)and laparoscopic total gastrectomy(LTG)for the treatment of CRS.Methods In this cohort study,we retrospectively analysed the data from patients who underwent RTG or LTG for CRS at Southwest Hospital(Chongqing,China)between May 2006 and October 2019.The surgical outcomes,post-operative complications,and survival outcomes between the two groups were compared.Results Compared with LTG,RTG was associated with similar effective operation time(272.0 vs 297.9 min,P=0.170),higher total costs(105,967.2 vs 81,629.5 RMB,P<0.001),and less estimated blood loss(229.2 vs 288.8 mL,P=0.031).No significant differences were found between the robotic and laparoscopic groups in terms of conversion rate,time to first flatus,time to first soft diet,post-operative hospital stay,post-operative complications,R0 resection rate,and number of retrieved lymph nodes(all P>0.05).The 3-year disease-free survival and 3-year overall survival rates were comparable between the two groups(65.5%vs 57.5%,P=0.918;69.0%vs 60.0%,P=0.850,respectively).Conclusions RTG is a safe and feasible procedure for the treatment of CRS and could serve as an optimal treatment for CRS.
