Gut dysfunction is defined as the impairment of intestinal parenchyma and(or) intestinal function leading to dyspepsia, malabsorption, and(or) intestinal barrier dysfunction. In the stress state, gastrointestinal tract contributes to the physiopathological change, which is considered as the "central organ after stress". Because of ischemia, anoxia and metabolic disturbance, critical illness is frequently complicated with intestinal dysfunction, which is one of the difficulties to treat critically ill patients. Undoubtedly, nutritional support is one of the indispensable therapies of intestinal dysfunction, which is also difficult to manage. This report was aimed to elaborate the definition, causes of intestinal dysfunction, assessment of nutritional status, and design of nutritional support in these patients.
Critical Illness ; Gastrointestinal Diseases ; etiology ; therapy ; Humans ; Multiple Organ Failure ; complications ; Nutritional Support

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the surgical treatment of choice for patients with medically refractory ulcerative colitis (UC) or UC with dysplasia and for the majority of patients with familial adenomatous polyposis. However, UC patients with IPAA are susceptible to a number of inflammatory and non-inflammatory sequelae, such as pouchitis, Crohn disease(CD) of the pouch, cuffitis, and irritable pouch syndrome, in addition to common surgery-associated complications, which adversely affect the surgical outcome and compromise patient's health-related quality of life. Pouchitis is the most frequent long-term complication of IPAA in patients with UC, with a cumulative prevalence of up to 50%. Pouchitis may be classified based on the etiopathogenesis into "idiopathic" and "secondary" types and the management is often different. Pouchoscopy is the most important tool for the diagnosis and differential diagnosis in patients with pouch dysfunction. Antibiotic therapy is the main stay of treatment for active pouchitis. Some patients may develop dependency on antibiotics, requiring long-term maintenance therapy. While management of antibiotic-dependent or antibiotic-refractory pouchitis has been challenging, secondary etiology for pouchitis should be evaluated and modified, if possible.
Humans ; Pouchitis ; diagnosis ; etiology ; therapy

OBJECTIVETo investigate single nucleotide polymorphisms(SNPs) and haplotypes of interleukin-18(IL-18) gene associated with the susceptibility to colorectal cancer(CRC).

METHODSTwo SNPs of IL-18 gene promoter -137G/C and -607C/A in 170 patients with CRC and 160 healthy controls matched by age and sex in a Chinese population were analyzed using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) strategy. Frequency of haplotypes and linkage disequilibrium of IL-18 gene in different groups were analyzed by SHEsis programs.

RESULTSThe distributions of IL-18 gene -607C/A polymorphism did not differ between CRC patients and healthy controls, but IL-18 gene -137G/C polymorphism was significantly different(P<0.05). The relative risk of C allele for CRC was 1.814 times of the G allele (OR=1.814,95% CI:1.246-2.642). Consistent with the results of the genotyping analyses, IL-18 -137G/C and -607C/A polymorphisms showed strong linkage disequilibrium(|D'|=0.945), frequency of the -137C/-607A haplotype in patients with CRC was significantly higher than that in healthy controls(P<0.05). The -137C/-607A haplotype was associated with a significantly increased risk of CRC(OR=1.637, 95% CI:1.100-2.437).

CONCLUSIONSIL-18 gene -137G/C polymorphism and -137C/-607A haplotype are associated with CRC. -137C allele may be an important genetic susceptibility gene for CRC.

Adult ; Case-Control Studies ; Colorectal Neoplasms ; genetics ; Female ; Genetic Predisposition to Disease ; Haplotypes ; Humans ; Interleukin-18 ; genetics ; Male ; Middle Aged ; Polymorphism, Restriction Fragment Length ; Polymorphism, Single Nucleotide

OBJECTIVETo study the expression of JAG1 and DLL1 in colorectal cancer and its clinical significance.

METHODSPatients with colorectal cancer were treated in the Center of Colorectal Surgery of the Third Affiliated Hospital of Nanjing University of TCM were collected prospectively and followed up. A tissue microarray was made and expressions of JAG1 and DLL1 were detected by immunohistochemical staining.

RESULTSA total of 146 cases with colorectal cancer were included. The differences in JAG1 expression were significant among different tumor differentiation types and the differences in DLL1 expression were significant among different tumor locations(all P<0.05). There were no significant differences in the expression of the two genes and microsatellite instability(MSI)(P>0.05). One hundred and thirty-four (91.8%) cases were followed up and the mean follow-up time was (42.3±13.3) months. Tumor-free survival was noticed in 86 patients. The overall survival was 93% at 1 year, 74% in 3 years, and 67% in 5 years. Multivariate analysis showed that long-term survival rate was related to TMN stage, pathology types, MSI status and expression of JAG1. The prognosis of patients with high expression of JAG1 was better than those with low and negative expression(P<0.05).

CONCLUSIONSThe expressions of JAG1 and DLL1 are related to tumor differentiation and tumor location. The expression of JAG1 gene is associated with long-term survival.

Adult ; Aged ; Aged, 80 and over ; Calcium-Binding Proteins ; genetics ; metabolism ; Colorectal Neoplasms ; genetics ; metabolism ; pathology ; Female ; Follow-Up Studies ; Humans ; Intercellular Signaling Peptides and Proteins ; genetics ; metabolism ; Jagged-1 Protein ; Male ; Membrane Proteins ; genetics ; metabolism ; Microsatellite Instability ; Middle Aged ; Prognosis ; Retrospective Studies ; Serrate-Jagged Proteins ; Survival Analysis ; Young Adult

OBJECTIVETo detect the expression of fibroblast activation protein(FAP) in colorectal cancer tissue, and to investigate the association between expression of FAP with pathological parameters.

METHODSFifty-five cancer tissues and 50 normal colorectal samples were examined using immunohistochemistry with anti-FAP polyclonal antibody. The distribution of positive cells in different tissues, and associations of positive cell number with tumor staging, lymph node metastasis and tumor invasion were investigated to evaluate the effects of FAP on pathological progress in colorectal cancer.

RESULTSNo FAP expression was observed in 50 normal colorectal tissue samples. FAP positive cells were seen in carcinoma associated fibroblasts(CAFs), and in few colorectal cancer cells. The numbers of FAP positive cells in tissue samples of TNM III(-IIII((40.1±15.9) was significantly greater than that of TNMI(-II( (18.3±7.7)(P<0.01). Furthermore, the number of FAP positive cells in tissue samples with lymph node metastasis (44.4±13.3) was also significantly higher than those without lymph node metastasis (18.5±8.1)(P<0.01). Significant positive correlations were found between the number of FAP-positive cells with the tumor TNM staging and lymph node metastasis(r=0.544 and r=0.793, respectively)(P<0.01). The number of FAP-positive cells was 25.2±8.9 in T2, 32.41±19.30 in T3, and 29.2±16.5 in T4. The association between number of positive cells and depth of invasion was not statistically significant(P>0.05).

CONCLUSIONSThe FAP mainly expresses in CAFs locating in colorectal cancer tissues. The number of FAP positive cells is positively correlated with TNM staging of colorectal cancer and lymph node metastasis.

Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Colorectal Neoplasms ; metabolism ; pathology ; Female ; Gelatinases ; metabolism ; Humans ; Lymphatic Metastasis ; Male ; Membrane Proteins ; metabolism ; Middle Aged ; Serine Endopeptidases ; metabolism

OBJECTIVETo identify novel multi-drug resistance-related genes, and to explore the mechanisms of multi-drug resistance.

METHODSMulti-drug resistant cell line Lovo/5-FU was established by incubation with increasing dose of 5-FU. The sensitivity to 5-FU and cis-diaminodichloroplatinum (CDDP) was measured by MTT assay. Two dimensional electrophoresis plus mass spectrum(2-DE/MS) was used to identify the differentially expressed protein between Lovo and Lovo/5-FU. The identified protein was then verified by Western blot analysis.

RESULTSThe IC50 concentrations of Lovo/5-FU to 5-FU and CDDP were increased by 31 and 3 times, compared with Lovo (both P<0.01). 2DE-MS showed that CAP-G and RhoGDI2 were up-regulated, whereas 6-PGL, DCI, Prdx-6 and Maspin were down-regulated in Lovo/5-FU. Western blot analysis confirmed that the expression levels of RhoGDI2 and CAP-G in Lovo/5-FU were increased by 6.14 and 2.98 fold respectively (both P<0.01), whereas Maspin was decreased to 5.2% of Lovo(P<0.01).

CONCLUSIONSMulti-gene and multi-pathway are involved in the development of multi-drug resistance of colorectal cancer cells. CAP-G, RhoGDI2 and Maspin are potential multi-drug resistant genes.

Cell Line, Tumor ; Colonic Neoplasms ; genetics ; Drug Resistance, Multiple ; genetics ; Drug Resistance, Neoplasm ; genetics ; Humans ; Microfilament Proteins ; genetics ; Nuclear Proteins ; genetics ; Serpins ; genetics ; rho Guanine Nucleotide Dissociation Inhibitor beta ; genetics

OBJECTIVETo analyze the clinicopathological features and prognosis of colorectal cancer patients with preoperative cancer-related anemia.

METHODSClinical data of 354 patients with colorectal cancer in the Second Affiliated Hospital of Guangzhou Medical College from January 2003 to July 2009 were analyzed retrospectively. Those with hemoglobin(Hb)<120 g/L before surgery were defined as cancer-related anemia.

RESULTSOf the 354 colorectal cancer cases, 195 were males and 159 were females. The median age was 65(range 22-92) years. Preoperative cancer-related anemia tended to be occurred in female(P<0.01) and those with preoperative albumin ≤35 g/L (P<0.01), right colon cancer(P<0.01) and full-thickness invasion(P<0.05). Cox regression analysis showed preoperative cancer-related anemia was an independent unfavorable factor for overall survival (HR=1.60, 95% CI:1.05-2.44; P<0.05), but not for disease-free survival (HR=1.43, 95% CI:0.97-2.12; P>0.05) in colorectal cancer.

CONCLUSIONSPreoperative cancer-related anemia plays an important role in the development and prognosis of colorectal cancer and great attention should be paid to clinical practice.

Adult ; Aged ; Aged, 80 and over ; Anemia ; etiology ; Colorectal Neoplasms ; complications ; surgery ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Young Adult

OBJECTIVETo study the risk factors associated with lymphatic metastasis of T2 rectal carcinoma.

METHODSA consecutive series of 122 patients with T2 rectal cancer who underwent radical surgery in the First Affiliated Hospital of Fujian Medical University from 2006 to 2011 were included for retrospective analysis. Risk factors associated with lymphatic metastasis were investigated.

RESULTSThe rate of lymph node metastasis was 21.3% (26/122). Distance to anal verge(P<0.05), morphological type(P<0.05), histological type(P<0.05), tumor differentiation(P<0.05), and depth of invasion(P<0.05) were risk factors for lymph node metastasis in T2 rectal cancer by univariate analysis. The depth of invasion remained statistically significant by multivariate analysis. The rate of lymph node metastasis was 13%(7/54) in patients with shallow muscularis propria involvement, and 28%(19/68) in those with deep muscularis involvement.

CONCLUSIONFor T2 rectal cancer with shallow muscularis involvement, the risk of lymph node metastasis is low and transanal excision should be considered.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Rectal Neoplasms ; pathology ; surgery ; Retrospective Studies ; Risk Factors

OBJECTIVETo evaluate the benefit and safety of fluorouracil implants on colorectal cancer.

METHODSBased on the methods of Cochrane systematic reviews, databases including CBM(1982 to March 2011), CNKI(1911 to March 2011), EMBASE(1966 to March 2011), and Medline(1950 to March 2011) were searched to identify randomized controlled trials assessing the benefit of fluorouracil implants on colorectal cancer. The quality of the included studies was assessed using the Cochrane's tool for assessing bias. RevMan5.0 was used for meta-analysis.

RESULTSSixteen studies were included(n=1223). The quality of included studies was moderate. Fluorouracil implants could reduce the 2-year mortality(RR=0.33. 95% CI:0.18-0.59), 2-year metastasis rate(RR=0.35, 95% CI: 0.19-0.66), and 2-year recurrence rate(RR=0.48, 95% CI:0.36-0.65). There were no significant differences in complications and adverse effects between fluorouracil implants and the control group.

CONCLUSIONSCurrent evidence demonstrates that fluorouracil implants may modestly improve the outcome of colorectal cancer patients without increasing its adverse events. However, the results should be interpreted with caution due to the risk of bias of included studies.

Antineoplastic Agents ; therapeutic use ; Colorectal Neoplasms ; drug therapy ; Fluorouracil ; therapeutic use ; Humans ; Randomized Controlled Trials as Topic ; Treatment Outcome

OBJECTIVETo compare outcomes of left and right thoracic incision for middle and lower thoracic esophageal squamous cancer, and to determine reasonable surgical approach for thoracic esophageal squamous carcinoma.

METHODSOne hundred and twenty patients with middle or lower thoracic esophageal squamous cancer who received esophagectomy plus lymphadenectomy between January 2004 and December 2007 were divided into two groups including left(n=60) and right thoracic(n=60) approach. Clinical data were analyzed including the results of surgical resection, lymphadenectomy, postoperative complication, recurrence, and survival.

RESULTSThe rate of surgical resection was 91.7%(55/60) in the left approach group and 95%(57/60) in the right approach group. There was no significant difference(P>0.05). But the average number of lymph nodes resected (4.60 vs. 8.32) and metastatic lymph nodes(0.57 vs. 1.33) were both significantly higher in the right approach group(P<0.01). There was no statistical difference in postoperative complications[26.7%(16/60) vs. 31.7%(19/60), P>0.05] between the two groups. However, the incidence of local recurrence was lower[43.3%(26/60) vs. 23.3%(14/60), P<0.05] in the right approach group than that in left-approach group. There was no significant difference in distant metastasis(P>0.05).

CONCLUSIONSThe resection rate is comparable between left and right approach for thoracic esophageal cancer. However, it is easier to perform systemic lymphadenectomy via right thoracic approach and therefore the local recurrence is reduced and long-term survival improved.

Adult ; Aged ; Carcinoma, Squamous Cell ; surgery ; Esophageal Neoplasms ; surgery ; Esophagectomy ; Female ; Humans ; Lymph Node Excision ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome