CXCR4/SDF-1 axis is involved in lymph node metastasis of gastric carcinoma

AIM:To investigate the role of CXC chemokine receptor-4 (CXCR4) and stromal cell-derived factor-1 (SDF-1) in lymph node metastasis of gastric carcinoma.METHODS:In 40 cases of gastric cancer,expression of CXCR4 mRNA in cancer and normal mucous membrane and SDF-1 mRNA in lymph nodes around the stomach was detected using quantitative polymerase chain reaction (PCR) (TaqMan) and immunohistochemistric assay.SGC-7901 and MGC80-3 cancer cells were used to investigate the effect of SDF-1 on cell proliferation and migration.RESULTS:Quantitative reverse transcription PCR and immunohistochemistry revealed that the expression level of CXCR4 in gastric cancer was significantly higher than that in normal mucous membrane (1.6244 ± 1.3801 vs 1.0715 ± 0.5243,P < 0.05).The expression level of CXCR4 mRNA in gastric cancer with lymph node metastasis was also significantly higher than that without lymph node metastasis (0.823 ± 0.551 vs 0.392 ± 0.338,P < 0.05).CXCR4 expression was significantly related to poorly differentiated,high tumor stage and lymph node metastasis.Significant differences in the expression level of SDF-1 mRNA were found between lymph nodes in metastatic gastric cancer and normal nodes (0.5432 ± 0.4907 vs 0.2640 ± 0.2601,P < 0.05).The positive expression of SDF-1 mRNA in lymph nodes of metastatic gastric cancer was consistent with the positive expression of CXCR4 mRNA in gastric cancer (r=0.776,P < 0.01).Additionally,human gastric cancer cell lines expressed CXCR4 and showed vigorous proliferation and migratory responses to SDF-1.AMD3100 (a specific CXCR4 antagonist) was also found to effectively reduce the migration of gastric cancer cells.CONCLUSION:The CXCR4/SDF-1 axis is involved in the lymph node metastasis of gastric cancer.CXCR4 is considered as a potential therapeutic target in the treatment of gastric cancer.

Preliminary study on proteomics of gastric carcinoma and its clinical significance

AIM： To explore the preliminary identification of serum protein pattern models that may be novel potential biomarkers in the detection of gastric cancer. METHODS： A total of 130 serum samples, including 70 from patients with gastric cancer and 60 from healthy adults, were detected by surface-enhanced laser desorption and ionization time-of-flight mass spectrometry （SELDI-TOF-MS）. The data of spectra were analyzed by Biomarker Patterns Software （BPS）. Thirty serum samples of gastric cancer patients and 30 serum samples of healthy adults were grouped into the training group to build models, and the other 70 samples were used to test and evaluate the models. The samples of the test group were judged only with their peaks＇ height and were separated into cancer group or healthy control group by BPS automatically and the judgments were checked with the histopathologic diagnosis of the samples. RESULTS： Sixteen mass peaks were found to be potential biomarkers with a significant level of P〈0.01. Among them, nine mass peaks showed increased expression in patients with gastric cancer. Analyzed by BPS, two peaks were chosen to build the model for gastric cancer detection. The sensitivity, specificity, and accuracy of the model were 90%, 36/40, 86.7%, 26/30, and 88.6%, 62/70, respectively, which were greatly higher than those of clinically used serum biomarkers CEA （carcinoembryonic antigen）, CAlg-g and CA72-4. Stage Ⅰ/Ⅱ gastric cancer samples of the test group were all judged correctly.CONCLUSION： The novel biomarkers in serum and the established model could be potentially used in the detection of gastric cancer. However, large-scale studies should be carried on to further explore the clinical impact on the model.

Clinical study of enhanced recovery after surgery in laparoscopic appendectomy for acute appendici

BACKGROUND Enhanced recovery after surgery(ERAS)protocol is a comprehensive manage-ment modality that promotes patient recovery,especially in the patients undergo-ing digestive tumor surgeries.However,it is less commonly used in the appen-dectomy.AIM To study the application value of ERAS in laparoscopic surgery for acute appen-dicitis.METHODS A total of 120 patients who underwent laparoscopic appendectomy due to acute appendicitis were divided into experimental group and control group by random number table method,including 63 patients in the experimental group and 57 patients in the control group.Patients in the experimental group were managed with the ERAS protocol,and those in the control group were received the tra-ditional treatment.The exhaust time,the hospitalization duration,the hospita-lization expense and the pain score between the two groups were compared.RESULTS There was no significant difference in age,gender,body mass index and Sunshine Appendicitis Grading System score between the experimental group and the con-trol group(P>0.05).Compared to the control group,the patients in the expe-rimental group had earlier exhaust time,shorter hospitalization time,less hospi-talization cost and lower degree of pain sensation.The differences were statis-tically significant(P<0.01).CONCLUSION ERAS could significantly accelerate the recovery of patients who underwent la-paroscopic appendectomy for acute appendicitis,shorten the hospitalization time and reduce hospitalization costs.It is a safe and effective approach.

Successful diagnosis and treatment of jejunal diverticular haemorrhage by full-thickness enterotomy: A case report

BACKGROUND Jejunal diverticula are the rarest of all small bowel diverticula and usually have no classic clinical symptoms.Jejunal diverticular haemorrhage(JDH)is a rare complication and can be difficult to identify and manage,hence it always resulting in a diagnostic delay and unsatisfactory clinical outcomes.Although with the advances in endoscopic technology,no consensus have been reached on the diagnosis and management of JDH,the conventional surgical intervention still remains the mainstream for the management of JDH.We report an unique case of a 63-year-old male who presented with massive haemorrhage from jejunal diverticula,which was successfully managed by initial resuscitation and definitive surgery.CASE SUMMARY A 63-year-old male was admitted as an emergency with 6 h history of haematemesis and melena.The haematemesis appeared to be bright red,with volume exceeding 100 mL.The amount of melena was estimated to be 200 mL.Initially,the patient received fluid resuscitation and three unit blood transfusion.Then,in order to localize the bleeding sites,colonoscopy,upper gastrointestinal endoscopy,and mesenteric angiography were utilized but failed to identify the source of haemorrhage.Informed consent form was obtained for further treatment,and he was treated with an exploratory laparotomy and the bleeding site was successfully located during the procedure.He was diagnosed with JDH.The postoperative period was uneventful,and he was discharged on day 18 after surgery.No rebleeding occurred at the 1-year follow-up.CONCLUSION In patients with gastrointestinal bleeding,if various techniques fail to identify the cause of haemorrhage in small bowel and haemodynamic instability is sustained with continuous resuscitation,we recommend surgical intervention should be the ultimate treatment of choice.

Xanthogranulomatous Cholecystitis and Misdiagnosis Analysis

INTRODUCTION Gastric sub-epithelial masses （SEMs） are relatively common findings when receiving gastric endoscopy. It is a mass, bulge, or impression visible. Computed tomography （CT） and magnetic resonance imaging can assist in making a diagnosis,