Radical gastrectomy with hepatoarterial catheter implantation for late-stage gastric cancer

AIM:To determine the optimal type of surgery for latestage gastric cancer with hepatic metastases.METHODS:We retrospectively analyzed 49 gastrectomies for late-stage gastric cancer conducted in the FirstHospital Affiliated to Henan University of Science and Technology between September 2003 and September 2010.All gastrectomy operations were divided into two groups:radical resection(gastrectomy and simultaneous resection of hepatic metastases,n =31),and palliative resection(gastrectomy without hepatic resection,n =18).All 49 patients had chemotherapy catheter implantation in the hepatic artery via the gastroduodenal artery.Postoperative complications and cumulative survival rates of the two groups were compared and analyzed.RESULTS:There was no significant difference in the number of perioperative complications between the radical and palliative resection groups(6 and 3 cases,respectively,P > 0.05).The incidence of long-term complications including ileus(3 in the radical resection and 2 in the palliative resection groups) and anastomosis(2 cases in each group) was not significantly different(P > 0.05).The cumulative survival rate was significantly lower in the palliative resection group(P < 0.05).CONCLUSION:Radical gastrectomy with resection of hepatic metastases and hepatoarterial catheter implantation is the recommended surgery for late-stage gastric cancer patients with hepatic metastases.

Obturator nerve impingement caused by an osteophyte in the sacroiliac joint:A case report

BACKGROUND Cases of obturator nerve impingement(ONI)caused by osteophytes resulting from bone hyperplasia on the sacroiliac articular surface have never been reported.This paper presents such a case in a patient in whom severe lower limb pain was caused by osteophyte compression of the sacroiliac joint on the obturator nerve.CASE SUMMARY A 65-year-old Asian man presented with severe pain and numbness in his left lower limb,which became aggravated during walking and showed intermittent claudication.The physical examination revealed that the muscle strength of the left lower limb had decreased and that the passive knee flexion test result was positive.Computed tomography(CT)and 3D reconstruction showed a large osteophyte located in the anterior lower part of the left sacroiliac joint.The results of electrophysiological examination showed peripheral neuropathy.A CT-guided obturator nerve block significantly reduced the severity of pain in this patient.According to the above findings,ONI caused by the osteophyte in the sacroiliac joint was diagnosed.This patient underwent an operation to remove the bone spur and symptomatic treatment.After therapy,the patient's pain and numbness were significantly relieved.The last follow-up was performed 6 mo after the operation,and the patient recovered well without other complications,returned to work,and resumed his normal lifestyle.CONCLUSION Osteophytes of the sacroiliac joint can cause ONI,which leads to symptoms including severe radiative pain in the lower limb in patients.The diagnosis and differentiation of this disease should attract the attention of clinicians.Surgical excision of osteophytes should be considered when conservative treatment is not effective.

Down-regulation of protein kinase C alpha/ezrin signals in light-induced phagocytic crisis of retinal pigment epithelium cells

AIM： To investigate the roles of PKC-α/ezrin signals in phagocytosis crisis of retinal pigment epithelium（RPE） cells in light damage model. METHODS： Light induced mice RPE injury model was established by continuously irradiating cool white light at different exposure time（0, 4, 8h light intensity： 4.18×10^-6 J/cm^2）. In vitro, human ARPE-19 cells treated with the doses and intensity（1.57×10^-6 J/cm^2） of laser irradiation. Histology analysis was evaluated by hematoxylin and eosin（HE） staining. In vivo RPE phagocytosis was quantified by measuring the accumulation of photoreceptor outer segments in the sub-retinal space. In vitro RPE phagocytosis was assessed by calculating the relative fluorescence intensity of FITC-labeled microspheres in ARPE-19 cells. To further investigate the molecular mechanism, the activation of PKC-α/ezrin signal was evaluated by Western blot in vivo and in vitro.RESULTS： HE staining revealed that the thickness of outer nuclear layer decreased significantly after 4 and 8h light exposure. By immunostaining with rhodopsin, a significant greater accumulation of photoreceptor outer segment was noticed after light injury. In vitro, light injuredRPE cells had less phagocytic activity in a dose dependent manner than that of the normal control（P〈0.01）. Western blot suggested the activation of PKC-α/ezrin signaling was down-regulated in a dose-dependent manner after light exposure. CONCLUSION： Our data suggest that light induced phagocytic crisis of RPE cells may result from the downregulation of PKC-α/ezrin signaling.