Short-term efficacy of laparoscopy-assisted vs open radical gastrectomy in gastric cancer

AIM:To investigate the short-term benefits of laparoscopic radical gastrectomy(LARG)and open radical gastrectomy(ORG)in patients with gastric cancer.METHODS:A total of 400 patients with gastric cancer aged≤65 years who were treated at General Hospital of Lanzhou Military Region were enrolled.Among these,200 patients underwent LARG between October2008 and August 2012(LARG group);and 200 patients underwent ORG between March 2000 and September2008(ORG group).The short-term therapeutic benefits between the two groups were analyzed.RESULTS:The LARG procedure offered significantly better benefits to the patients compared to the ORG procedure,including less intraoperative blood loss(103.1±19.5 mL vs 163.0±32.9 mL,P【0.0001),shorter postoperative hospital stay(6.8±1.2 d vs 9.5±1.6 d,P【0.0001),less frequent occurrence of postoperative complications(6.5%vs 13.5%,P=0.02),shorter time to mobilization(1.0±0.3 vs 3.3±0.4 d,P【0.0001),shorter time to bowel opening(3.3±0.7 d vs 4.5±0.7 d,P【0.0001),and shorter time to normal diet(3.0±0.4 vs d 3.8±0.5 d,P【0.0001).However,LARG required a longer time to complete than the ORG procedure(192.3±20.9 min vs 180.0±26.9 min,P【0.0001).CONCLUSION:Compared to ORG,LARG is safer,more effective,and less invasive for treating gastric cancer,with better short-term efficacy.

Adenosine triphosphate promotes locomotor recovery after spinal cord injury by activating mammalian target of rapamycin pathway in rats

The mammalian target of rapamycin （mTOR） pathway plays an important role in neuronal growth, proliferation and differentiation. To better understand the role of mTOR pathway involved in the induction of spinal cord injury, rat models of spinal cord injury were established by modified Allen＇s stall method and interfered for 7 days by intraperitoneal administration of mTOR activator adenosine triphosphate and mTOR kinase inhibitor rapamycin. At 1-4 weeks after spinal cord injury induction, the Basso, Beattie and Bresnahan locomotor rating scale was used to evaluate rat locomotor function, and immunohistochemical staining and western blot analysis were used to detect the expression of nestin （neural stem cell marker）, neuronal nuclei （neuronal marker）, neuron specific enolase, neurofilament protein 200 （axonal marker）, glial fibrillary acidic protein （astrocyte marker）, Akt, mTOR and signal transduction and activator of transcription 3 （STAT3）. Results showed that adenosine triphosphate-mediated Akt/mTOR/STAT3 pathway increased endogenous neural stem cells, induced neurogenesis and axonal growth, inhibited excessive astrogliosis and improved the locomotor function of rats with spinal cord injury.

Radiofrequency ablation for hepatic hemangiomas: A consensus from a Chinese panel of experts

Recent studies have shown that radiofrequency(RF) ablation therapy is a safe, feasible, and effective procedure for hepatic hemangiomas, even huge hepatic hemangiomas. RF ablation has the following advantages in the treatment of hepatic hemangiomas: minimal invasiveness, definite efficacy, high safety, fast recovery, relatively simple operation, and wide applicability. It is necessary to formulate a widely accepted consensus among the experts in China who have extensive expertise and experience in the treatment of hepatic hemangiomas using RF ablation, which is important to standardize the application of RF ablation for the management of hepatic hemangiomas, regarding the selection of patients with suitable indications to receive RF ablation treatment, the technical details of the techniques, therapeutic effect evaluations, management of complications, etc. A final consensus by a Chinese panel of experts who have the expertise of using RF ablation to treat hepatic hemangiomas was reached by means of literature review, comprehensive discussion, and draft approval.

Pancreas-sparing duodenectomy with regional lymph node dissection for early-stage ampullary carcinoma: A case control study using propensity scoring methods

AIM:To investigate the outcomes of pancreas-sparing duodenectomy(PSD)with regional lymph node dissection vs pancreaticoduodenectomy(PD).METHODS:Between August 2001 and June 2014,228 patients with early-stage ampullary carcinoma(Amp Ca)underwent surgical treatment(PD,n=159;PSD with regional lymph node dissection,n=69).The patients were divided into two groups:the PD group and the PSD group.Propensity scoring methods were used to select patients with similar disease statuses.A total of 138 matched cases,with 69 patients in each group,were included in the final analysis.RESULTS:The median operative time was shorter among the patients in the PSD group(435 min)compared with those in the PD group(481 min,P=0.048).The median blood loss in the PSD group was significantly less than that in the PD group.The median length of hospital stay was shorter for patients in the PSD group vs the PD group.The incidence of pancreatic fistula was higher among patients in the PD group vs the PSD group.The 1-,3-,and 5-year overall survival and disease-free survival rates for patients in the PSD group were 83%,70%,44%and 73%,61%,39%,respectively,and these values were not different than compared with those in the PD group(P=0.625).CONCLUSION:PSD with regional lymph node dissection presents an acceptable morbidity in addition to its advantages over PD.PSD may be a safe and feasible alternative to PD in the treatment of earlystage Amp Ca.

Detection of telomerase activity in biopsy samples for predicting prognosis in cirrhotic patients with hepatocellular carcinoma after laparoscopic radiofrequency ablation therapy

Objective: To explore the role of telomerase activity detected in biopsy samples for evaluating the efficacy of lapa- roscopic radiofrequency ablation (RFA) therapy in patients with hepatocellular carcinoma (HCC) and liver cirrhosis. Methods: From August 2001 to October 2004, 34 cirrhotic patients with HCC were treated by laparoscopic RFA under general anesthe- sia. A total of 34 tumors, with a mean maximum tumor diameter of 4.0 ± 1.0 cm, were all located on the liver surface or adja- cent to the gallbladder. Laparoscopic ultrasound-guided core biopsy for liver lesions was performed before and immediately after RFA therapy. In these biopsy samples, telomerase activity was detected by the ELISA-based telomeric repeat amplifica- tion protocol (ELISA-TRAP) assay, and pathological examination was routinely performed. Results: Laparoscopic RFA was successfully performed in all the 34 patients. A complete tumor necrosis was achieved in all patients on the contrast-enhanced helical CT scanning one month after laparoscopic RFA. The positive rates of telomerase activity and histopathologic diagnosis in biopsy samples were 91.2% (31/34) and 100% (34/34) respectively before RFA, and 26.5% (9/34) and 0% respectively after RFA. During a median follow-up period of 35 months (range, 18–51 months), the rates of local tumor recurrence at the ablation sites in post-RFA telomerase-positive and negative patients were 88.9% (8/9) and 4% (1/25) respectively (P < 0.01), and the rates of distant recurrence within the livers were 0% (0/9) and 12% (3/25) respectively (P > 0.05). Conclusion: For cirrhotic patients with HCC treated by laparoscopic RFA, detection of telomerase activity in biopsy samples may be useful for evaluating the therapeutic efficacy of RFA and predicting postoperative local tumor recurrence.

Biological effect of NK4 gene mediated by attenuated Salmonella typhimurium on hepatocellular carcinoma cell HepG2

Objective： The aim of the study was to construct a stable strain of recombined attenuated Salmonella typhimurium expressing NK4 gene, and observe the effect of the strain on the metastatic potentiality of HepG2 cells. Methods： The NK4 cDNA was isolated from PCAGGS/hNK4 plasmid by PCR, and subcloned into eukaryotic expression vector pcDNA4. The recombinant plasmid was electro-transferred into attenuated Salmonella typhimurium Ty21a to obtain the recombinant strain encoding NK4 gene （TPN）. Simultaneously, the recombinant attenuated Salmonella typhimurium carrying GFP gene （TPG） was also constructed. After the TPG and TPN were transferred into HepG2 cells, the transfection rate and the expression level of NK4 protein were detected by flow cytometry and ELISA, and the effects of expression product on the proliferation and migration of HepG2 and angiogenesis were observed. Results： The TPN and TPG were successfully constructed. Fortyeight hours after transfection with TPG, the infection rate was 82.58% ± 1.74%, and the expression level of NK4 protein in supernatant was （181.5 ± 11.7） ng/6 × 10^5 cells. The supematant had obviously depressant effect on the proliferative activity of HepG2 cells （P 〈 0.05）, and could obviously restrain the hepatocyte growth factor-mediated migration of tumor cells （P 〈 0.01）. The inhibitory effect of the expression product on the tumor angiopoiesis was obviously observed （P 〈 0.05）, without a dosage-effect relation. Conclusion： The TPN could effectively transfer tumor cells in vitro and express interest NK4 protein. The expression product could effectively inhibit the proliferation and migration of hepatocellular carcinoma cells and the tumor angiopoiesis.

Early rehabilitation care of the cranio-cerebral injury patients in the recovery stage

BACKGROUND: The chief target of rehabilitation care intervention to the craniocerebral trauma patients is to regain the function to the most limits, decrease the sequela and improve the living quality and to turn back and rejoin the society.OBJECTIVE: To obsenre the effect of early rehabilitation care to the craniocerebral injury patients.

自体骨移植在腰椎后路椎间融合中的临床疗效分析

目的探讨腰椎后路手术中应用自体椎板、棘突骨颗粒为植骨材料行椎间融合治疗特殊的腰椎间盘突出症、腰椎管狭窄症及腰椎滑脱症等腰椎退变性疾病的临床效果。方法特殊腰椎间盘突出症、腰椎管狭窄症及腰椎滑脱症并行后路腰椎融合术（PLIF和TLIF）患者184例，按椎间融合材料分为3组，A组61例，单纯自体骨组；B组64例，PEEK椎间融合器组；C组59例，异体骨垫组。平均随访18个月（12～60个月）。统计3组患者术前一般资料、手术时间、术中出血量、术后下床时间、住院天数、术后融合率以及术后椎间高度及融合节段角度的变化情况，按JOA评分标准评价功能恢复情况。结果3组患者术前一般资料、术中出血量、手术时间、术后下床时间、住院时间、JOA评分、术后1年椎间隙高度及融合节段角度比较，差异均无统计学意义（P〉0．05）；3组患者术后3个月JOA评分较术前均显著提高（P〈0．05）。A组术后1年的融合效果高于C组（P〈0．05）；B组术后融合器移位的并发症发生率较高。结论在后路椎间融合中纯自体棘突、椎板骨移植能起到和PEEK融合器和异体骨融合器一样的维持椎间隙高度的作用，不延长术后卧床时间，且具有经济效益。

Acute liver failure in Chinese children:a multicenter investigation

BACKGROUND: Currently, no documentation is available regarding Chinese children with acute liver failure(ALF). This study was undertaken to investigate etiologies and outcomes of Chinese children with ALF.METHODS: We retrospectively enrolled 32 pediatric patients with ALF admitted in five hospitals in different areas of China from January 2007 to December 2012. The coagulation indices, serum creatinine, serum lactate dehydrogenase,blood ammonia and prothrombin activity were analyzed; the relationship between these indices and mortality was evaluated by multivariate analysis.RESULTS: The most common causes of Chinese children with ALF were indeterminate etiology(15/32), drug toxicity(8/32),and acute cytomegalovirus hepatitis(6/32). Only 1 patient(3.13%)received liver transplantation and the spontaneous mortality of Chinese children with ALF was 58.06%(18/31). Patients who eventually died had higher baseline levels of international normalized ratio(P=0.01), serum creatinine(P=0.04), serum lactate dehydrogenase(P=0.01), blood ammonia(P<0.01) and lower prothrombin activity(P=0.01) than those who survived.Multivariate analysis showed that the entry blood ammonia was the only independent factor significantly associated with mortality(odds ratio=1.069, 95% confidence interval 1.023-1.117,P<0.01) and it had a sensitivity of 94.74%, a specificity of 84.62%and an accuracy of 90.63% for predicting the death. Based on the established model, with an increase of blood ammonia level,the risk of mortality would increase by 6.9%.CONCLUSIONS: The indeterminate causes predominated in the etiologies of ALF in Chinese children. The spontaneous mortality of pediatric patients with ALF was high, whereas the proportion of patients undergoing liver transplantation was significantly low. Entry blood ammonia was a reliable predictor for the death of pediatric patients with ALF.

Clinical epidemiological survey of gallbladder carcinoma in northwestern China, 2009-2013: 2379 cases in 17 centers

Objective: To analyze the clinical epidemiological characteristics of patients with gallbladder carcinoma recruited from 17 hospitals in five northwestern provinces of China (Shaanxi Province, Gansu Province, Qinghai Province, Ningxia Hui Autonomous Region, and Xinjiang Uygur Autonomous Region) from 2009 to 2013, and to summarize the clinical diagnosis and treatment data of gallbladder carcinoma. Methods: Clinical information of 2379 patients with gallbladder carcinoma from 17 hospitals in five northwestern provinces of China was retrospectively collected and analyzed using the 'Questionnaire for Gallbladder Carcinoma Patients in Northwestern Area of China.' All information was verified with EpiData software and analyzed with SPSS 13.0 software. Results: (1) Gallbladder carcinoma accounted for 2.7% (2379/86,609) of all biliary tract diseases during the study period, which was significantly higher than that from 1986 to 1998 (P < 0.001). (2) Gallbladder carcinoma was more prone to occur in elderly women. The male:female incidence ratio was 1.0:2.1, the average age of onset of disease was 63.7 ± 11.3 years, and the incidence was higher in farmers than in other occupational groups. (3) A total of 57.2% (1360/2379) of patients with gallbladder carcinoma also had gallstones. (4) Abdominal pain (1796/2379, 75.5%) and jaundice (727/2379, 30.6%) were the most common clinical manifestations, 81.2% (1527/1881) were positive in those receiving B ultrasound examinations and 90.7% (1567/1727) were positive in those undergoing computed tomography, and 64.5% (1124/1742) of patients with gallbladder carcinoma were positive for carbohydrate antigen (CA) 19-9. (5) The pathological type of gallbladder carcinoma was mainly moderately and poorly differentiated adenocarcinoma with a high degree of malignancy. At admission, 55.1% (1091/1981) of patients had stage Ⅳ cancer among patients with TNM staging information; 55.9% (1331/2379) had lymphatic metastasis, 29.7% (706/2379) had bile duct metastasis, and 53.1% (1263/2379) had liver metastasis. (6) A total of 283 patients (283/2379, 11.9%) had incidentally detected gallbladder carcinoma. (7) The rate of radical surgical resection was 30.4% (723/2379). Conclusion: The proportion of gallbladder carcinoma in biliary tract diseases in the northwestern area of China was significantly higher from 2009 to 2013 than from 1986 to 1998. Gallbladder carcinoma was common in older women and mainly diagnosed at an advanced stage. Compared with other surveys in different regions, the rate of metastasis in this survey was high, leading to a low resection rate. Populations at high risk should undergo B-ultrasound examinations at regular follow-up intervals to increase the rate of early diagnosis of gallbladder carcinoma.

Long-term follow-up of haploidentical transplantation in relapsed/refractory severe aplastic anemia:a multicenter prospective study

In recent decades,haploidentical stem cell transplantation(haplo-SCT)to treat severe aplastic anemia(SAA)has achieved remarkable progress.However,long-term results are still lacking.We conducted a multicenter prospective study involving SAA patients who underwent haplo-SCT as salvage therapy.Long-term outcomes were assessed,mainly focusing on survival and quality of life(QoL).Longitudinal QoL was prospectively evaluated during pretransplantation and at 3 and 5 years posttransplantation using the SF-36 scale in adults and the PedsQL 4.0 scale in children.A total of 287 SAA patients were enrolled,and the median follow-up was 4.56 years(range,3.01–9.05 years)among surviving patients.During the long-term follow-up,268 of 275 evaluable patients(97.5%)obtained sustained full donor chimerism,and 93.4%had complete hematopoietic recovery.The estimated overall survival and failure-free survival for the whole cohort at 9 years were 85.4%±2.1%and 84.0%±2.2%,respectively.Age(≥18 years)and a poorer performance status(ECOG>1)were identified as risk factors for survival outcomes.For Qo L recovery after haplo-SCT,we found that QoL progressively improved from pretransplantation to the 3-year and 5-year time points with statistical significance.The occurrence of chronic graft versus host disease was a risk factor predicting poorer QoL scores in both the child and adult cohorts.At the last followup,74.0%of children and 72.9%of adults returned to normal school or work.These inspiring long-term outcomes suggest that salvage transplantation with haploidentical donors can be routine practice for SAA patients without human leukocyte antigen(HLA)-matched donors.

Treatment of 57 Headache Cases by Needling Point Xingjian (LR 2) Through Taichong(LR 3)

Needling point Xingjian (LR 2) through Taichong (LR 3) was used as main therapy to treat 57 headache cases by syndromic differentiation, which was compared with the treatment of another 60 cases with conventional points. The curative rate was 100% and 91.7% separately in one of the two groups. There was a significant difference in curative effect (P<0.01). The effect of the point-through-point method was superior to that of the conventional point method. Key Words Acupuncture Therapy - Point-through-point Method - Headache Author: LIU Jin (1968-), female, attending physicianTranslator: WANG Si-youAn erratum to this article is available at http://dx.doi.org/10.1007/BF02850966.

Very late recovery of a chronic complete atrioventricular block？

To the editor：Acute complete atrioventricular （AV） block might have a good chance to recover,and late recovery of surgicallyinduced AV block has been reported.1-3 Here we report a chronic complete AV block without prior surgery resolved 18 years later.A female patient was first diagnosed as complete AV block for syncope with documented ECG in April 1994,when she was 13 years old.The patient underwent an electrophysiologic study in June and the block below His bundle was confirmed.In September,a VVI pacemaker （65 ppm） was implanted.The follow-up was irregular,and a 3-day Holter in March 1997 showed no intrinsic conducted QRS complex.In January 2006,the pulse generator was replaced with a DDD pacemaker （AV delay 170 ms） because of battery depletion,and a 24-hour Holter in February demonstrated no intrinsic conducted QRS complex.

15-deoxy-△12,14-prostaglandin J2 ameliorates endotoxin-induced acute lung injury in rats

Background A proinflammatory milieu emerging in the lung due to neutrophil accumulation and activation is a key in the pathogenesis of acute lung injury （ALI）.15-deoxy-△12,14-prostaglandin J2 （15d-PGJ2）,one of the terminal products of the cyclooxygenase-2 pathway,is known to be the endogenous ligand of peroxisome proliferator-activated receptor y （PPAR-y） with multiple physiological properties.Growing evidence indicates that 15d-PGJ2 has anti-inflammatory,antiproliferative,cytoprotective and pro-resolving effects.We investigated whether 15d-PGJ2 has a protective effect against endotoxin-induced acute lung injury in rats.Methods Twenty-four male Wistar rats were randomly assigned into four groups （n=6 per group）：sham＋vehicle group,sham＋15d-PGJ2 group,LPS＋vehicle group,and LPS＋15d-PGJ2 group.The rats were given either lipopolysaccharide （LPS,6 mg/kg intravenously） or saline,and pretreated with 15d-PGJ2 （0.3 mg/kg intravenously） or its vehicle （dimethyl sulphoxide） 30 minutes before LPS.Histological alterations,wet/dry weight （W/D） ratio and myeloperoxidase （MPO） activity as well as tumor necrosis factor （TNF）-α and cytokine-induced neutrophil chemoattractant-1 （CINC-1） levels were determined in lung tissues four hours after LPS injection.Immunohistochemical analysis for intercellular adhesion molecule-1 （ICAM-1） expression and Western blotting analysis for nuclear factor （NF）-κB p65 translocation and IκBα protein levels were also studied.Results 15d-PGJ2 pretreatment significantly attenuated LPS-induced lung injury,and reduced the increased W/D ratio,MPO activity,TNF-α,CINC-1 levels,and ICAM-1 expression in the lung.15d-PGJ2 also suppressed the nuclear NF-ΚB p65 translocation and increased cytosolic IKBα levels.Conclusions 15d-PGJ2 protects against endotoxin-induced acute lung injury,most likely through the reduction of proinflammatory protein levels during endotoxemia subsequent to the inhibition of NF-ΚB activation.