Fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for colorectal malignancy: A meta-analysis

AIM:To evaluate the fast-track rehabilitation protocol and laparoscopic surgery(LFT)vs conventional care strategies and laparoscopic surgery(LCC).METHODS:Studies and relevant literature comparing the effects of LFT and LCC for colorectal malignancy were identified in MEDLINE,the Cochrane Central Register of Controlled Trials and EMBASE.The complications and re-admission after approximately 1 mo were assessed.RESULTS:Six recent randomized controlled trials(RCTs)were included in this meta-analysis,which related to 655 enrolled patients.These studies demonstrated that compared with LCC,LFT has fewer complications and a similar incidence of re-admission after approximately 1 mo.LFT had a pooled RR of 0.60(95%CI:0.46-0.79,P<0.001)compared with a pooled RR of 0.69(95%CI:0.34-1.40,P>0.5)for LCC.CONCLUSION:LFT for colorectal malignancy is safe and efficacious.Larger prospective RCTs should be conducted to further compare the efficacy and safety of this approach.

Full robot-assisted gastrectomy with intracorporeal robot-sewn anastomosis produces satisfying outcomes

AIM:To evaluate the feasibility and safety of full robotassisted gastrectomy with intracorporeal robot handsewn anastomosis in the treatment of gastric cancer.METHODS:From September 2011 to March 2013,110consecutive patients with gastric cancer at the authors’institution were enrolled for robotic gastrectomies.According to tumor location,total gastrectomy,distal or proximal subtotal gastrectomy with D2 lymphadenectomy was fully performed by the da Vinci Robotic Surgical System.All construction,including Roux-en-Y jejunal limb,esophagojejunal,gastroduodenal and gastrojejunal anastomoses were fully carried out by the intracorporeal robot-sewn method.At the end of surgery,the specimen was removed through a 3-4 cm incision at the umbilicus trocar point.The details of the surgical technique are well illustrated.The benefits in terms of surgical and oncologic outcomes are well documented,as well as the failure rate and postoperative complications.RESULTS:From a total of 110 enrolled patients,radical gastrectomy could not be performed in 2 patients due to late stage disease;1 patient was converted to laparotomy because of uncontrollable hemorrhage,and1 obese patient was converted due to difficult exposure;2 patients underwent extra-corporeal anastomosis by minilaparotomy to ensure adequate tumor margin.Robot-sewn anastomoses were successfully performed for 12 proximal,38 distal and 54 total gastrectomies.The average surgical time was 272.52±53.91 min and the average amount of bleeding was 80.78±32.37 mL.The average number of harvested lymph nodes was 23.1±5.3.All specimens showed adequate surgical margin.With regard to tumor staging,26,32 and 46 patients were staged asⅠ,ⅡandⅢ,respectively.The average hospitalization time after surgery was 6.2 d.One patient experienced a duodenal stump anastomotic leak,which was mild and treated conservatively.One patient was readmitted for intra-abdominal infection and was treated conservatively.Jejunal afferent loop obstruction occurred in 1 patient,who underwent re-operation and recovered quickly.CONCLUSION:This technique is feasible and can produce satisfying postoperative outcomes.It is also convenience and reliable for anastomoses in gastrectomy.Full robotic hand-sewn anastomosis may be a minimally invasive technique for gastrectomy surgery.

Safety of fast-track rehabilitation after gastrointestinal surgery:Systematic review and meta-analysis

AIM:To compare the safety of fast-track rehabilitation protocols(FT) and conventional care strategies(CC),or FT and laparoscopic surgery(LFT) and FT and open surgery(OFT) after gastrointestinal surgery.METHODS:We searched MEDLINE,WHO International Trial Register,Embase and The Cochrane Central Register of Controlled Trials up to 2014 for randomized controlled trials(RCTs) comparing FT and CC or comparing LFT and OFT,with 10 or more randomized participants and about 30 d follow-up.Two reviewers independently extracted data on complications,anastomotic leak,obstruction,wound infection,re-admission between FT and CC or LFT and OFT after gastrointestinal surgery.RESULTS:Twenty-four RCTs of FT vs CC or LFT vs OFT were included.Compared with CC,FT reduced overall complications and wound infection.However,anastomotic leak,obstruction and re-admission were not significantly reduced.The pooled risk ratio(RR) of 0.69(95%CI:0.60-0.78; P < 0.001),pooled RR of 0.71(95%CI:0.57-0.88; P < 0.001),pooled RR of 0.93(95%CI:0.68-1.25; P > 0.05),a pooled RR of 0.87(95%CI:0.67-1.15; P > 0.05) and pooled RR of 0.94(95%CI:0.73-1.22; P > 0.05) respectively.Compared with OFT,LFT reduced complications,with a pooled RR of 0.66(95%CI:0.54-0.81; P < 0.001).CONCLUSION:FTs are safe after gastrointestinal surgery.Additional large,prospective RCTs should be conducted to establish further the safety of this approach.

Efficacy evaluation of imatinib treatment in patients with gastrointestinal stromal tumors:A meta-analysis

AIM:To perform a meta-analysis to derive a more precise estimation of imatinib treatment for different genotypes of gastrointestinal stromal tumors(GIST).METHODS:Studies were identified by searching PubMed and Embase.Inclusive criteria were patients with exon 9-mutant,exon 11-mutant or wide type(WT) GIST,receiving chemotherapy of imatinib for clinical trial,and efficacy evaluation was cumulative response (CR)including complete response and partial response.The odds ratios(OR)for CR in stem cell factor receptor (KIT)mutation patients vs WT genotype patients,KIT exon 11-mutant genotype patients vs KIT exon 9-mutant genotype patients and KIT exon 9-mutant genotype patients vs WT genotype patients were calculated with 95%confidence interval(CI)for each study as an estimation of the efficacy of imatinib.RESULTS:Five studies including 927 patients were involved in this meta-analysis.The overall OR(KIT group vs WT group)was 3.34(95%CI:2.30-4.86,P <0.00001,P heterogeneity=0.04).The overall OR in KIT exon 11 group vs KIT exon 9 group was 3.29(95%CI: 2.17-5.00,P<0.00001,P heterogeneity=0.33).The overall OR in KIT exon 9 group vs WT group was 1.23(95% CI:0.73-2.10,P=0.44,P heterogeneity=0.42).CONCLUSION:Most patients with different genotypes of GIST and KIT exon 11-mutant will benefit from the individualized treatment of imatinib.

S-1-based combination therapy vs S-1 monotherapy in advanced gastric cancer:A meta-analysis

AIM:To assess the efficacy and safety of combination therapy based on S-1,a novel oral fluoropyrimidine,vs S-1 monotherapy in advanced gastric cancer(AGC).METHODS:We searched PubMed,EMBASE and the Cochrane Library for eligible studies published before March 2013.Our analysis identified four randomized controlled trials involving 790 participants with AGC.The outcome measures were overall survival(OS),progression-free survival(PFS),overall response rate(ORR)and grade 3-4 adverse events.RESULTS:Meta-analysis showed that S-1-based combination therapy significantly improved OS(HR=0.77,95%CI:0.66-0.91,P=0.002),PFS(HR=0.58,95%CI:0.46-0.72,P=0.000)and ORR(OR=2.23,95%CI:1.54-3.21,P=0.000).Sensitivity analysis further confirmed this association.Lower incidence of grade 3-4 leucopenia(OR=4.06,95%CI:2.11-7.81),neutropenia(OR=3.94,95%CI:2.1-7.81)and diarrhea(OR=2.41,95%CI:1.31-4.44)was observed in patients with S-1 monotherapy.CONCLUSION:S-1-based combination therapy is superior to S-1 monotherapy in terms of OS,PFS and ORR.S-1 monotherapy is associated with less toxicity.

Role of MRI in Differentiation between Postoperative Tumoral Recurrence and Radiation-Induced Brain Necrosis in Patients of Glioblastoma Multiform

The distinction of radiation-induced brain necrosis (RBN) and recurrent glioblastoma multiform (rGBM) remains a diagnostic challenge due to their similarly on routine follow-up imaging studies and also their clinical manifestations. Our purpose of this review article is to evaluate the role of advanced MR imaging techniques such as Perfusion-weighted imaging (PWI), Diffusion-weighted imaging (DWI) and Magnetic resonance spectroscopy (MRS) in the differentiation of RBN and rGBM and their complications together with our experience and knowledge gained during our neuroimaging practice.

Tumor cells undergoing direct lineage conversion to neurons: unnatural but useful?

Dear Editor, In 2011, Son et al. （2011） reported that the forced expression of selected transcription factors is sufficient to convert mouse and human fibroblasts into induced motor neurons （iMNs）. The authors used three factors （Ascll, Brn2, and Mytll） to convert fibroblasts into neuronal-like ceils. After confirming that the cells had neuronal morphology, but with absence of motor neuron markers, eight candidate transcription factors were added, which participate in various stages of motor neuron specification. As expected, a significant number of motor cells emerged with known characteristics of cultured embryonic motor neurons.

Serotonin Influences the Endogenous Opiate Peptides in the Rat Spinal Cord to Participates in Pain Modulation

Spinal cord is a necessary pathway that transfers the body nociceptive inputs to the brain. Endogenous opiate peptides have been proven to participate in the nociceptive process at spinal level. It has reported that serotonin (5-HT, 5-hydroxytryptamine) in spinal cord plays a role in pan modulation, which can be blocked by opiate receptor antagonists. The present study was designed to investigate the interaction between 5-HT and endogenous opiate peptides at rat spinal level effecting on pain modulation. The results showed that 1) pain stimulation increased not only leucine-enkephalin (L-Ek), β-endorphin (β-Ep) and dynorphin A1-13 (DynA1-13) concentrations but also 5-HT and 5-hydorxyindoleace acid (5-HIAA, the 5-HT main metabolic product) concentrations in spinal cord significantly;2) 5-HT could increase L-Ek, β-Ep and DynA1-13 concentrations in spinal cord in a dose-dependent manner, whereas cypotolamine (a 5-HT receptor antagonist) decreased L-Ek, β-Ep and DynA1-13 concentrations in spinal cord. The data suggested that 5-HT antinociceptive role might be involved in the endogenous opiate peptide system through 5-HT receptors at spinal level.

Matrix from urine stem cells boosts tissue-specific stem cell mediated functional cartilage reconstruction

Articular cartilage has a limited capacity to self-heal once damaged.Tissue-specific stem cells are a solution for cartilage regeneration;however,ex vivo expansion resulting in cell senescence remains a challenge as a large quantity of high-quality tissue-specific stem cells are needed for cartilage regeneration.Our previous report demonstrated that decellularized extracellular matrix(dECM)deposited by human synovium-derived stem cells(SDSCs),adipose-derived stem cells(ADSCs),urine-derived stem cells(UDSCs),or dermal fibroblasts(DFs)provided an ex vivo solution to rejuvenate human SDSCs in proliferation and chondrogenic potential,particularly for dECM deposited by UDSCs.To make the cell-derived dECM(C-dECM)approach applicable clinically,in this study,we evaluated ex vivo rejuvenation of rabbit infrapatellar fat pad-derived stem cells(IPFSCs),an easily accessible alternative for SDSCs,by the abovementioned C-dECMs,in vivo application for functional cartilage repair in a rabbit osteochondral defect model,and potential cellular and molecular mechanisms underlying this rejuvenation.We found that C-dECM rejuvenation promoted rabbit IPFSCs’cartilage engineering and functional regeneration in both ex vivo and in vivo models,particularly for the dECM deposited by UDSCs,which was further confirmed by proteomics data.RNA-Seq analysis indicated that both mesenchymal-epithelial transition(MET)and inflammation-mediated macrophage activation and polarization are potentially involved in the C-dECM-mediated promotion of IPFSCs’chondrogenic capacity,which needs further investigation.

Serum microRNA expression profiling revealing potential diagnostic biomarkers for lung adenocarcinoma

Background:Recent studies have demonstrated that microRNAs(miRNAs)in the blood circulation can serve as promising diagnostic markers for cancers.This four-stage study aimed at finding serum miRNAs as potential biomarkers for lung adenocarcinoma(LA)diagnosis.Methods:The study was carried out between 2016 and 2017.The Exiqon miRNA qPCR panel(3 LA vs.1 normal control[NC]pooled serum samples)was used for initial screening to acquire miRNA profiles.Thirty-five dysregulated miRNAs were further evaluated in the training(24 LA vs.24 NCs)and testing stages(110 LA vs.110 NCs)using quantitative real-time polymerase chain reaction assays.Results:Four serum miRNAs(miR-133a-3p,miR-584-5p,miR-10b-5p,and miR-221-3p)were significantly overexpressed in LA patients compared with NCs.The diagnostic value of the four-miRNA panel was validated by an external cohort(36 LA vs.36 NCs).The areas under the receiver operating characteristic curve of the four-miRNA panel in the training,testing,and external validation stages were 0.734,0.803,and 0.894 respectively.Meanwhile,the expression level of miR-221-3p was much higher in LA tumor samples than that in the adjacent normal tissues(19 LA vs.19 NCs).The expression level of miR-10b-5p was also elevated in the serum-derived exosomes samples(18 LA vs.18 NCs).The expression of miR-133a-3p,miR-584-5p,and miR-10b-5p was significantly elevated in LA patients with epidermal growth factor receptor mutation compared with NCs.Conclusion:The study established a four-miRNA signature in serum that could improve the diagnostic capability of LA.