结直肠癌术后早期炎性肠梗阻的诊断和治疗

术后早期炎性肠梗阻(EPISBO)是胃肠道手术后常见的并发症,结直肠癌术后EPISBO的发病率为4%~15%。EPISBO发病机制复杂,纤溶系统平衡破坏、神经反射、炎症反应及药物的相互作用可能是其主要机制。EPISBO的治疗应尽可能采用保守治疗,术前完善肠道准备,术中减少肠道损伤及肠内容物外溢,减少腹腔污染的机会,术中适当应用防粘连剂,术后抑制炎症反应可预防EPISBO。

奥曲肽治疗术后早期炎症性肠梗阻临床疗效和安全性的Meta分析

目的评价奥曲肽治疗术后早期炎症性肠梗阻的临床疗效和安全性。方法在CNKI、VIP、PubMed、CBM、Web of Science数据库系统检索奥曲肽治疗术后早期炎症性肠梗阻的临床随机对照试验(随机对照试验),依据Cochrane国际协作网评价员工作手册规程,对纳入Meta分析的文献进行质量评价和偏倚分析,运用RevMan 5.2对数据进行统计学分析。结果13项随机对照试验,916例患者纳入研究,Meta分析结果显示奥曲肽治疗术后早期炎症性肠梗阻在胃肠减压引流量[WMD=-403.30(95%CI:-532.99,-273.62)]、肛门恢复排气时间[SMD=-1.33(95%CI:-1.75,-0.91)]、住院时间[WMD=-4.19(95%CI:-5.79,-2.59)]有潜在的临床疗效,同时无严重的药物不良反应(P=0.050)。结论奥曲肽在治疗术后早期炎症性肠梗阻方面有一定的优势,改变奥曲肽给药方式可能减少药物不良反应。

ANGPTL2 expression in gastric cancer tissues and cells and its biological behavior

AIM To explore expression of angiopoietin-like protein 2(ANGpT L2) and its effect on biological behavior such as proliferation and invasiveness in gastric cancer. METHODS Western blotting was used to detect expression of ANGp TL2 in 60 human normal gastric tissues, 60 human gastric cancer tissues and gastric cell lines including GES-1, N87, SGC7901, BGC823 and pA MC82. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT) and Transwell assay were used to detect the proliferation and invasive ability of gastric cancer cells. RESULTS Compared to normal tissues, ANGp TL2 protein levels were significantly upregulated in gastric tissues, and this level was closely correlated with gastric tumor grade, clinical stage and lymph node metastasis. Compared to GES-1 cells, ANGpT L2 mR NA and protein levels were significantly increased in gastric cancer cells including N87, SGC7901, BGC823 and p AMC82. The expression of ANGpT L2 in highly malignant gastric cancer cell lines BGC823 and pA MC82 was significantly higher than in low malignancy gastric cancer cell lines N87 and SGC7901. MTT and Transwell experiments indicated that the proliferation rate and invasive ability of stable overexpressed gastric cancer cells was faster than in cells transfected with Lv-NC and blank controlcells, and the invasive ability of stable overexpressed gastric cancer cells was higher than that of cells transfected with Lv-NC and blank control cells.CONCLUSION ANGp TL2 contributed to proliferation and invasion of gastric cancer cells. In clinical treatment, ANGpT L2 may become a new target for treatment of gastric cancer.

Endoscopic biliary drainage for biliary obstruction

OBJECTIVE: To improve the successful rate of endoscopic biliary drainage. METHODS: Three hundred and fifty-two patients with biliary obstruction were given biliary drainage via duodenoscope from January 1998 to December 2002. 258 patients received endoscopic naso-biliary drainage (ENBD), 51 endoscopic retrograde biliary drainage (ERBD), and 43 endoscopic metal biliary endoprothesis (EMBE). RESULTS: Of the 352 patients with biliary obstruction, 337 succeeded in drainage by endoscopy and 15 failed. Ten ENBD failed patients were handled successfully by readjustment of the site of the naso-biliary tube. In 3 ERBD failed patients, 2 were given plastic stents with appropriate length and got a fluent drainage. Percutaneous transhepatic biliary drainage (PTBD) was performed in one patient after failure of endoscopic management. In 2 patients with failed EMBE, one stent could not exceed the site of tumor stricture and one was obstructed by tumor implantation only one month after EMBE. Placement of another metallic stent and a plastic stent through the previous prothesis for each patient ensured a successful drainage. CONCLUSIONS: The effect of endoscopic biliary drainage for biliary obstruction is definite. Drainage failure can be avoided or remedied as early as possible by taking some active measures.

Micro RNA-21 promotes phosphatase gene and protein kinase B/phosphatidylinositol 3-kinase expression in colorectal cancer

AIM: To explore the regulatory mechanism of the target gene of micro RNA-21(mi R-21), phosphatase gene(p TEN), and its downstream proteins, protein kinase B(AKT) and phosphatidylinositol 3-kinase(p I3K), in colorectal cancer(CRC) cells. METHODS: Quantitative real-time p CR(q RT-p CR) and Western blot were used to detect the expression levels of mi R-21 and p TEN in HCT116, HT29, Colo32 and SW480 CRC cell lines. Also, the expression levels of p TEN m RNA and its downstream proteins AKT and p I3 K in HCT116 cells after downregulating mi R-21 were investigated. RESULTS: Comparing the mi R-21 expression in CRC cells, the expression levels of mi R-21 were highest in HCT116 cells, and the expression levels of mi R-21 were lowest in SW480 cells. In comparing mi R-21 and p TEN expression in CRC cells, we found that the protein expression levels of mi R-21 and p TEN were inversely correlated(p < 0.05); when mi R-21 expression was reduced, m RNA expression levels of p TEN did not significantly change(p > 0.05), but the expression levels of its protein significantly increased(p < 0.05). In comparing the levels of p TEN protein and downstream AKT and p I3 K in HCT116 cells after downregulation of mi R-21 expression, the levels of AKT and p I3 K protein expression significantly decreased(p < 0.05). CONCLUSION: p TEN is one of the direct target genesof mi R-21. Thus, phosphatase gene and its downstream AKT and p I3 K expression levels can be regulated by regulating the expression levels of mi R-21, which in turn regulates the development of CRC.

Endoscopic sphincterotomy or papillary balloon dilatation for choledocholithiasis

Objective: To assess the safety and effect of endoscopicsphincterotomy (EST) and endoscopic papillary bal-loon dilatation (EPBD) for choledocholithiasis.Methods: 328 patients with choledocholithiasis weresubjected to EST or EPBD; they included 174 patientswith single stone, 112 patients with two stones and 42patients with three stones (one patient with 20 stones).Patients with stones less than 10 mm in diameter un-derwent EPBD and those with stones larger than 11mm in diameter underwent EST.Results: EST and EPBD succeeded in 323 patients(98.5%), and failed in 5. Stones in 98 patients wereexcluded spontaneously after endoscopic therapy. 207patients were subjected to basket or balloon stone ex-traction. Stones in 14 patients were discharged bybasket lithotripsy. Four patients were given wavelithotripsy. Stones in 22 of the 323 patients were ex-tracted thoroughly after 2-3 times attempts. Totalcomplications were noted in 2.5% of the patients.Hemorrhage from the gastrointestinal tract was seenin one patient, cholangitis in 4 patients, and pancre-atitis in 3 patients. In 92 patients receiving digestivetract barium X-ray examination, 86 developed nobarium reflux to the baliary tract, 2 pneumobilia, 4barium reflux to the biliary tract.Conclusion: EST and EPBD are relatively safe and effec-tive in treatment of choledocholithiasis, and have fewcomplications.