Objective To explore regularity of lymph node metastasis and analyze its relation between lymph node metastasis and histological features and its immunohistochemical markers of gastric cancer, and to provide evidence for selection of reasonable operation. Method The clinical data of 160 patients with gastric cancer who underwent D2, D3 or D3+ from August 2013 to May 2016 in the Second Hospital of Lanzhou University were retrospectively studied, and the relation between the lymph node metastasis and the pathological features and the immunohistochemical markers in the different location of gastric cancer was analyzed. Results ① The rate of lymph node metastasis in the early gastric cancer was significantly lower than that in the advanced gastric cancer (P<0.05), which in the T4 stage was significantly higher than that in the T1–T3 stages (P<0.05), in the poorly differentiated gastric cancer was significantly higher than that in the well differentiated gastric cancer (P<0.05), or in the Borrmann type Ⅲ+Ⅳ (infiltrative type) was significantly higher than that in the Borrmann type Ⅰ+Ⅱ (topical type,P<0.05), but which wasn’t associated with the gender, tumor location, or tumor diameter (P>0.05). ② The lymph node metastasis occurred mainly in the first and the second stations for the well differentiated gastric cardia cancer, which not only occurred in the first and the second stations, but also occurred in the No.13 lymph node for the poorly differentiated gastric cardia cancer; which occurred mainly in the first and the second stations and occasionally occurred in the No.12 lymph node for the well differentiated gastric body cancer, which not only occurred in the first and the second stations, but also occurred in the No.12, No.13 and No.14 lymph nodes for the poorly differentiated gastric body cancer; which occurred in the No.11, No.12 and No.13 lymph nodes for the part of well differentiated gastric antrum cancer, which even occurred in the No.15 and No.16 lymph nodes for the part of poorly differentiated gastric antrum cancer. ③ The expression positive rates of the TopoⅡα, Villin, Ki-67, CK-8, and CK-18 proteins in the poorly differentiated gastric cancer were significantly higher than those in the well differentiated gastric cancer (P<0.05), which of the P-gp, GST-π, and c-erbB-2 proteins in the poorly differentiated gastric cancer were significantly lower than those in the well differentiated gastric cancer (P<0.05). The expression positive rates of the TopoⅡα, P-gp, Villin, Ki-67, CK-8, and CK-18 proteins in the gastric cancer with lymph node metastasis were significantly higher than those in the gastric cancer without lymph node metastasis (P<0.05), whereas there were no relation between the expression positive rates of the GST-π and c-erbB-2 proteins and the lymph node metastasis of gastric cancer (P>0.05). ④ The different location of gastric cancer wasn’t associated with the gender, gross type, clinical stage, T stage, degree of differentiation, Borrmann type, or tumor diameter. Conclusions In advanced gastric cancer, depth of tumor invasion reached T4, poor degree of differentiation, and Borrmann infiltration type of gastric cancer, lymph node metastasis rates are higher. For gastric cardia cancer patients with well differentiation, standard D2 should be performed, D2+No.13 should be performed for poor differentiation. For gastric body cancer patients with well differentiation, D2+No.12 should be performed, D3 should be performed for poor differentiation. For gastric antrum cancer patients with differentiation degree or not, D3 should be performed, selective dissection of No.15 or No.16 lymph node should be performed for poor differentiation. Combined detection of TopoⅡα, Villin, Ki-67, CK-8, CK-18, P-gp, GST-π, and c-erbB-2 immunohistochemical markers might be helpful to improve accuracy of lymph node metastasis and evaluate degree of malignancy and prognosis of patients with gastric cancer.
Objective To analyze and summarize the research progression of phenotypic markers of hepatic sinusoidal endothelial cell （HSEC） and its role in the development and progression of the liver diseases. Methods Databases such as PubMed， Wanfang， CNKI， etc were retrieved for the latest articles on research advance in HSEC using “hepatic sinus endothelial cell”， “liver regeneration”， and “liver disease” as key words. All of the publications about studies on relation between HSEC and liver disease were reviewed and summarized. Results HSEC with specific cytoarchitectures and phenotypic markers was initially received “the message of damage” in the process of liver regeneration， hepatic immunological tolerance， hepatic fibrosis， and liver damage. Additionally， HSEC as the first barrier not only enabled liver to be protected but also was regarded as the first alternation of liver damage. Therefore， HSEC played a great important role in the process of the onset and progression of the liver disease. Conclusions The function of HSEC is complex. How do play a role and its the mechanism is unclarified， it is needed to be further studied.
Objective To investigate the protective effect of melatonin on rat liver injury induced by bile duct ligation. Methods Sixty-four rats were randomly divided into four groups：control group （CN group， n=16）， shamoperation group （SO group， n=16）， bile duct ligation group （BDL group， n=16）， and bile duct ligation with melatonin injection （BDL＋MT group， n=16）. The model of obstructive jaundice was done by ligation of the common bile duct. Melatonin was injected daily （0.5 mg/kg） via peritoneal cavity from 1 d before the operation to 7 d following oper-ation. On day 4 and 8 after the ligation， the plasma levels of total bilirubin （TBIL）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， gamma glutamyl transferase （GGT）， and alkaline phosphatase （AKP） were measured by routine methods. Malonaldehyde （MDA）， superoxide dismutase （SOD）， glutathione （GSH）， catalase （CAT）， and glutathione peroxidase （GSH-Px） in the liver tissue were determined by spectrophtometry， too. Hepatocytes apoptosis was analyzed by terminal deoxynucleotidyl transferase-mediated deoxynuridine triphosphate nick-end labeling （TUNEL） assay. Results Compared with the CN group and SO group， the levels of TBIL， ALT， AST， GGT， and AKP in the plasma， the content of MDA in the liver tissue， and the apoptosis index （AI） in the hepatocyte markedly increased （P＜0.05， P＜0.01）， the content of GSH and the activities of SOD， CAT， and GSH-Px in the liver tissue markedly decreased（P＜0.01） in the BDL group. Compared with the BDL group， the levels of TBIL， ALT， AST， GGT， and AKP in the plasma， the content of MDA in the liver tissue， and the AI in the hepatocyte markedly decreased （P＜0.01）， the content of GSH and the activities of SOD， CAT， and GSH-Px in the liver tissue markedly increased （P＜0.01） in the BDL＋MT group. In the BDL group， the level of MDA in the liver tissue and the levels of TBIL， ALT， AST， GGT， and AKP were positively correlated （P＜0.01）， the content of GSH and the activities of SOD， CAT， and GSH-Px in the liver tissue and TBIL， ALT， AST， GGT， and AKP were negatively correlated （P＜0.01）. The level of MDA in the liver tissue and AI in the hepatocyte was positively correlated （P＜0.01）. The content of GSH and the activities of SOD， CAT， and GSH-Px in the liver tissue and AI were negatively correlated （P＜0.01）. Conclusions The participation of free radical of oxygen in the pathogenesis and severity of cholestasis produced by the acute obstruction of the extra-hepatic biliary duct is likely. The result of the present study indicates that melatonin exerts a protective effect on cholestatic liver injury in rats with BDL. The mechanism of melatonin’s protection on hepatocyte may be through its antioxidant action and by inhibiting hepatocyte apoptosis.
Objective To investigate for a reasonable reconstruction method in patients undergoing total gastrectomy. Methods Data of 63 cases receiving total gastrectomy from January 2000 to October 2005 in Ganzhou District Hospital of Zhangye City were analyzed retrospectively, and the patients were divided into double pouch jejunum interposition （DPJI） group (n=30) and Roux-en-Y ρ pouch （RYρ） group (n=33) according to the operation methods, then operation time， morbidity of complications, amount and frequency of meat and drink, complications of digestive tract, amount of total protein and albumin were compared between two groups. Results There were no significant differences in operation time，morbidity of complications, the amount or frequency of meat and drink between two groups (Pgt;0.05); but the incidence of digestive tract complications of DPJI group was lower than that of RYρ group （P＜0.05). GradeⅠ/Ⅱof Vervaeck index and the amount of total protein and albumin in DPJI group were statistical significantly higher than those of RYρ group （P＜0.05）. Conclusion Functional DPJI is a reasonable digestive tract reconstruction method.
ObjectiveTo summarize the progress of surgical treatment of colorectal cancer in recent years from the anatomical features of the mesorectum, aiming to provide a new basis for surgical treatment of colorectal cancer. MethodThe relevant literatures about total mesorectal excision and complete mesocolic excision in colorectal cancer surgery in recent years were reviewed. ResultsTotal mesorectal excision and complete mesocolic excision significantly reduced the local recurrence rate of patients with colorectal cancer, improved the tumor-free survival rate and overall survival rate, and significantly improved the prognosis of patients, which may benefited from the surgeon’s detailed anatomy of mesenteric plane. In addition, based on current evidence, total mesorectal excision for colorectal cancer was safe and had fewer postoperative complications, which helped to promote the standardization of surgical treatment of colorectal cancer. ConclusionsTotal mesorectal excision and complete mesocolic excision can significantly improve histopathological prognosis compared with conventional surgery, but the advantages of long-term oncological prognosis need further study. In recent years, the combination of new techniques such as laparoscopy, robotic surgery and natural lumens, and mesenteric resection has provided new directions and new ways for surgical treatment of colorectal cancer.
【Abstract】Objective To investigate the role of interleukin-10（IL-10） and interleukin-18 （IL-18） in the pathogenesis of acute lung injury in experimental severe acute pancreatitis.Methods Forty-eight SD rats were divided into control group and SAP group by the random data table. The model of experimental severe acute pancreatitis was established by injection of 3.5% sodium taurocholate into the bili-pancreatic duct. Lung wet weight index, ascities and level of serum amylase, IL-10 and IL-18 were quantitatively measured in different time. Intrapulmonary expressions of IL-10 mRNA and IL-18 mRNA were detected by semiquantitative RTPCR. The histopathology of pancreas and lung were observed under the light microscope.Results Lung wet weight index, ascities, level of serum amylase, IL-10 and IL-18, intrapulmonary expressions of IL-10 mRNA and IL-18 mRNA were significantly increased in SAP group (P＜0.01). The level of serum IL-18 and intrapulmonary expression of IL-18mRNA are positively correlated with lung wet weight index （r=0.68,P＜0.01; r=0.72,P＜0.01） and lung injury score （r=0.74,P＜0.01; r=0.79,P＜0.01) respectively, whereas the level of serum IL-10 and intrapulmonary expression of IL-10 mRNA are negatively correlated with lung wet weight index（r=-0.62,P＜0.01; r=-0.69,P＜0.01） and lung injury score（r=-0.66,P＜0.01; r=-0.60,P＜0.01）. Conclusion IL-18 may play a key role in the pathogenesis of acute lung injury in experimental severe acute pancreatitis, and IL-10 exerts the protection role in this process.
ObjectiveTo investigate the regulation mechanism of neutrophils extracellular traps (NETs) on inflammatory diseases and to provide guidance for the treatment of related inflammatory diseases.MethodThe literatures about the relationship between NETs and inflammatory diseases were reviewed.ResultsNETs played an important role in sepsis, anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis, acute pancreatitis, inflammatory bowel disease, and other inflammatory diseases, which were related to the development or activity of the diseases. By regulating the formation of NETs pathway, reducing the production of NETs, we could ultimately reduce the inflammation of the disease.ConclusionNETs is involved in the course of sepsis, ANCA-associated vasculitis, acute pancreatitis, inflammatory bowel disease, and other inflammatory diseases, but further investigation and clinical inflammatory verification are needed.
Objective To investigate the effects of N-acetylcysteine （NAC） on the intestinal barrier in rats with severe acute pancreatitis （SAP） and its possible mechanism. Methods Eighty Wistar rats were randomly （random number method） divided into normal control group （CON group， n=8）， sham operation group （SO group， n=24）， SAP group （n=24）， and NAC group （n=24）， then the rats of latter 3 groups were sub-divided into 6， 12， and 24 hours group， each time point group enrolled 8 rats， respectively. Rats of CON group didn’t receive any treatment. SAP rat models were established by injecting 5.0% sodium taurocholate into the biliary-pancreatic duct for SAP group and NAC group， while rats of SO group were injected normal saline instead of sodium taurocholate. The rats of NAC group were given an intraperitoneal injection of NAC at 1 hour before operation， and the rats of SO group and SAP group were given an intraperitoneal injection of normal saline instead at the same time. Rats of CON group were sacrificed to get ileum （about 5cm） and blood from right ventricular （5mL） for further test， and rats of the other 3 groups were sacrificed at 6， 12， and 24hours after operation. Then the levels of amylase （AMY）， C-reactive protein （CRP）， endotoxin， D-lactic acid， and diamine oxidase （DAO） in plasma， the levels of superoxide dismutase （T-SOD）， myeloperoxidase （MPO）， and malondialdehyde （MDA） in ileum tissues were tested. Apoptosis of mucosal cells in ileum tissues was determined by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling （TUNEL）. Pathological changes in ileum tissues were observed and scored. Expression levels of bax and bcl-2mRNA in ileum tissues were determined by real-timefluorescence quantitative PCR （real-time PCR）， and related proteins were tested by Western blot method， respectively. Results Compared with SAP group at the same time point， the levels of CRP in NAC group were lower at all the 3 time points （P＜0.05） and AMY were lower at 12 and 24 hours （P＜0.05）， levels of DAO， endotoxin， and D-lactic acid were lower at 12 and 24 hours （P＜0.05）， but level of DAO was higher than SAP group at 6 hours （P＜0.05）. Compared with SAP group at the same time point， the levels of MPO and MDA in ileum tissues were lower in NAC group at all the 3 time points （P＜0.05）， but levels of T-SOD increased significantly at 12 and 24 hours （P＜0.05）. Compared with SAP group at the same time point， the apoptosis indexes were lower in NAC group at all the 3 time points （P＜0.01）， and pathologic scores of ileum tissues were lower at 12 and 24 hours （P＜0.05）. The pathological changes under a light microscope were observed better in NAC group than that of SAP group at each time point. Moreover， compared with SAP group at the same time point， the expression levels of bax mRNA and protein were lower in NAC group at all the 3 time points （P＜0.05）， while higher in bcl-2 mRNA and protein （P＜0.05）. Conclusions NAC can protect the function of small intestinal barrier， and can alleviate SAP-induced injury of the intestinal mucosa. In addition to antioxidant effects， the underlying mechanisms also may include the anti-apoptotic effects.