OBJECTIVE:To investigate the hemostatic effect and safety of hemocoagulase in radical gastrectomy.METHODS:60 cases with gastric cancer were divided on average into 2 groups.Therapy group received hemocoagulase 2 KU during and after operation,and control group received dicynone 0.5 g and aminomethylbenzoic acid 0.2 g during and after operation.Intraoperative blood loss and amount of blood drainage at 6 h and 24 h after operation were observed.The value of D-dimer was monitored after operation.RESULTS:Intraoperative blood loss and amount of blood drainage at 6 h and 24 h after operation in therapy group were less than in control group (P

Liver metastasis is the leading cause of death from colorectal cancer (CRC).Multidisciplinary team model has become standard strategy for the diagnosis and treatment of colorectal liver metastases (CRLM),making individualized treatment through precise staging and molecular typing.Preoperative hepatic and regional arterial infusion chemotherapy and portal vein chemotherapy during surgery can reduce the incidence of liver metastases for stage Ⅲ CRC.Surgical resection of CRLM has been accepted by all scholars,and can be performed by minimally invasive surgery.The criteria for hepatic resection of CRLM have been extended including complete tumor resection,negative resection margin and adequate remnant liver volume.Simultaneous resections of primary tumor and liver metastases are safe and feasible.However,neoadjuvant chemotherapy is still controversial.For unresectable liver metastases,conversion therapy should be implemented to make the liver metastases become resectable.For unconvertible and unresectable CRLM,aggressive and comprehensive treatment is required to control the disease progression.

Liver metastasis is the main fact or affecting prognosis.The treatment includes surgery,chemotherapy,gene therapy and local therapy(radiofrequecy,late,PEI and cryotherapy),of which surgery is only curative method.Mortality of surgery is 1%-2%,5-year survival is 35%-38%,but only 10%-25% of liver metastasis of colorectal cancer can receive surgery,so other methods of therapy are considered.We will summarize the mulfi-modal therapy of liver metastasis of colorectal cancer.

Objective To evaluate the relationship between the expression of MMP-2,MMP-9 and invasion of gallbladder carcinoma.Method Seventeen specimens of gallbladder carcinoma,9 cases of gallbladder adenoma and 9 cases of chronic cholecystis were assessed by using immunohistochemical method(S-P method).Results There were no significant difference in MMP-2 and MMP-9 expressions between gallbladder carcinoma and adenoma,but they were significantly higher than that of chronic cholecystis.The expressions of MMP-2 and MMP-9 had no correlation with the histological differentiation or Nevin staging.Conclusion MMP-2 and MMP-9 may play an important role in tumor invasion and metastasis in gallbladder carcinoma.

Objective To observe the feasibility of laryngeal mask ventilation general anesthesia com- bined epidural block in laparoseopie eholecystectomy. Methods One hundred and forty eases of selective laparoscopie eholecystectomy were performed to T8～T9 gap catheterization, with 1.5 percent lidoeaine epi- dural block, block levels in the following T4. After conventional anesthesia into 4# or 5# LMA, balloon gas was injected in 20 mL～30 mL, manual ventilation, respiratory resistance and the situation thorax ups and downs were observed. Results The patients epidural catheterization smoothly, in the anesthesia plane fol- lowing T4, insert the LMA blood pressure, heart rate without significant change. Pneumoperitoneum after the rebound in blood pressure[(20.6 5.0) mm Hg], heart rate did not change significantly, and then airway pressure increased[(5.7 1.6)cm H2O] , surgery performed smoothly, and quickly regained consciousness after the surgery, when all patients admitted gallbladder, they have resumed breathing independently. Con- dusion Laryngeal Mask Airway general anesthesia combined epidural block cause mechanical damage vocal cords and airway, make the stress response light and the sense of rapid recovery, which is a safe and feasible method of anesthesia.

Objective To evaluate a chemically-modified chitosan anti-adhesion film in the prevention of intestinal adhesion after abdominal surgery.Method In this study 240 patients at the Department of Surgery, Fudan University Zhongshan Hospital undergoing abdominal surgery from Jan 2006 to Dec 2006 were randomly divided into two groups.In the research group, chemically-modified chitosan antiadhesion film was put both at the area of operation and under the incision before closing the abdomen.The recovery procedures were recorded including the recovery of gut movement, the degree and the lasting time of abdominal pain, complication after surgery, the abdominal pain and ileus within 1 year.Result Postoperative incision pain was less significant in research group.The gut function recovered quicker and dietary began earlier.The ratio of early ileus after the surgery decreased significantly.The abdominal adhesion symptom in 1 year after surgery ameliorated significantly.There was no significant difference in other postoperative complications in the two groups.Conclusion The use of chemicallymodified chitosan anti-adhesion film helps to prevent the intestinal adhesion after the abdominal surgery.

ERAS combines modern anesthesia, pain control, and nutritional support technologies, and contains a series of evidence-based perioperative optimization measures, including preoperative preparation, intraoperative anesthesia and postoperative care, to reduce surgical stress and enhance recovery. Several clinical studies and meta-analysis have demonstrated that ERAS can accelerate postoperative rehabilitation in colorectal patients. In addition, minimally invasive colorectal surgery has the advantages of less trauma, less bleeding, and faster postoperative recovery, compared with open surgery. It has become the standard operation for colon resection. Recently 3D laparoscopic and robotic colorectal surgery, which overcomes limitations of conventional laparoscopic surgery, is increasingly used. Therefore, whether ERAS combined with minimally invasive colorectal surgery causes a cumulative advantage receives much concern. A number of studies and meta-analysis have demonstrated that ERAS combined with laparoscopic colorectal cancer surgery can shorten the length of hospital stay and reduce the incidence of complications, as the best perioperative plan for elective colorectal surgery.
Colorectal Neoplasms ; surgery ; Digestive System Surgical Procedures ; Humans ; Laparoscopy ; Length of Stay ; Minimally Invasive Surgical Procedures ; Postoperative Care ; Postoperative Period ; Robotic Surgical Procedures

Objective:To investigate the risk factors for lymph node metastasis in T1 colorectal cancer and application value of its nomogram prediction model.Methods:The retrospective case-control study was conducted. The clinicopathological data of 914 patients with T1 colorectal cancer who underwent radical resection in the Zhongshan Hospital of Fudan University from June 2008 to December 2019 were collected. There were 528 males and 386 females, aged from 25 to 87 years, with a median age of 63 years. Observation indicators: (1) clinicopathological data of patients with T1 colorectal cancer; (2) follow-up; (3) analysis of influencing factors for lymph node metastasis; (4) development and internal validation of a nomogram predition model. Patients were regularlly followed up once three months within postoperative 2 years and once six months thereafter to detect tumor recurrence and survival. The endpoint of follow-up was at postoperative 5 years. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. The Kaplan-Meier method was used to calculate survival rates and draw survival curves. The Log-rank test was used for survival analysis. Univariate and multivariate analyses were performed using the Logistic regression analysis. Based on results of multivariate analysis, a Logistic regressional nomogram for prediction of lymph node metastasis probability was constructed using R language software. The calibration curve was used to evaluate the consistency between probability predicted by the nomogram model and actual observation probability, which was reprensented by a consistency index. The Bootstrap method was used for evaluation of the model performance to receive the calibration curve. The Hosmer-Lemeshow test was used to calculate the goodness of fit in model. Results:(1) Clinicopathological data of patients with T1 colorectal cancer: 687 of 914 patients underwent direct surgery and 227 underwent remedial operation after endoscopic resection. All the 914 patients were confirmed as pT1NxM0 colorectal cancer by pathological examination. The tumor diameter was (2.3±1.2)cm. The pathological catogaries of 914 patients included 865 cases of adenocarcinoma and 49 cases of mucinous adenocarcinoma. The tumor differentiation degree of 914 patients included 727 cases of high or middle differentiation and 187 cases of low differentiation or undifferentiation. Of the 914 patients, 633 cases had submucosal infiltration depth ≥1 000 μm and 281 cases had submucosal infiltration depth <1 000 μm. There were 110 cases with nerve vessel invasion and 804 without nerve vessel invasion. The number of intraoperative lymph node dissection was 13 (range, 1-48). There were 804 cases in stage N0 of N staging, 98 cases in stage N1 and 12 cases in stage N2. There was no perioperative death. (2) Follow-up: 886 of 914 patients were followed up for 25 months (range, 1-129 months). During the follow-up, 24 patients had tumor recurrence or metastasis. The 5-year cumulative tumor recurrence rate of 914 patients was 4.8% and the median recurrence time was 17.0 months. Liver was the main site of tumor recurrence, accounting for 58.3%(14/24). The 5-year recurrence-free survival rate of 914 patients was 95.2%. The 5-year recurrence-free survival rate was 96.3% of 804 patients without lymph node metastasis, versus 86.6% of 110 patients with lymph node metastasis, showing a significant difference between the two groups ( χ2=6.83, P<0.05). (3) Analysis of influencing factors for lymph node metastasis: results of univariate analysis showed that preoperative carcinoembryonic antigen (CEA), preoperative CA19-9, tumor differentiation degree, submucosal infiltration depth, nerve vessel invasion were related factors for lymph node metastasis in T1 colorectal cancer ( odds ratio=2.56, 3.25, 2.21, 2.68, 3.39, 95% confidence interval as 1.41-4.67, 1.22-8.66, 1.43-3.41, 1.56-4.88, 2.10-5.48, P<0.05). Results of multivariate analysis showed that preoperative CEA ≥5 μg/L, preoperative CA19-9 ≥37 U/mL, poor differentiation or undifferentiation, submucosal infiltration depth ≥1 000 μm and nerve vessel invasion were independent risk factors for lymph node metastasis in T1 colorectal cancer ( odds ratio=2.23, 3.47, 2.01, 2.31, 2.91, 95% confidence interval as 1.02-4.15, 1.08-10.87, 1.03-3.27, 1.40-4.47, 1.64-5.13, P<0.05). (4) Development and internal validation of a nomogram predition model: based on results of multivariate Logistic analysis, a nomogram prediction model for lymph node metastasis in T1 colorectal cancer was developed. The nomogram score was 59 for preoperative CEA >5 μg/L, 100 for preoperative CA19-9 ≥37 U/mL, 48 for poor differentiation or undifferentiation, 67 for submucosal infiltration depth ≥1 000 μm and 92 for nerve vessel invasion, respectively. The total of different scores for different clinicopathological factors corresponded to the probability of lymph node metastasis. The receiver operating characteristic curve was drawed to evaluate the predictive performance of nomogram for lymph node metastasis in T1 colorectal cancer, with the area under curve of 0.70(95% confidence interval as 0.64-0.75, P<0.05). The Bootstrap internal validation of predictive performance in the nomogram predition model showed a consistency index of 0.70 (95% confidence interval as 0.65-0.75). The calibration chart showed a good consistency between the probability predicted by the nomogram model and actual probability of lymph node metastasis. The Hosmer-Lemeshow test showed a good fitting effect in model ( χ2=1.61, P>0.05). Conclusions:Preoperative CEA ≥5 μg/L, preoperative CA19-9 ≥37 U/mL, poor differentiation or undifferentiation, submucosal infiltration depth ≥ 1 000 μm and nerve vessel invasion are independent risk factors for lymph node metastasis in T1 colorectal cancer. The constructed nomogram model can help predict the probability of lymph node metastasis in T1 colorectal cancer.

Proteins in the human body are usually made of 20 natural amino acids.Through different amino acid combinations and isomerization, proteins of diverse functions are built.An emerging genetic code expansion technology can introduce unnatural amino acids into specific sites of target protein, endowing the protein with new biological characteristics including covalently binding with proximal proteins, carrying fluorescence, and mimicking specific protein post-translational modifications.In this paper, based on the structure and function of unnatural amino acids, the applications of different types of unnatural amino acids in regulating protein''s stability, studying protein''s conformation, expression level, and localization, and uncovering heretofore unknown protein-protein interactions were reviewed.Besides, genetic code expansion of unnatural amino acids is anticipated to find broad utilities in biomedicine by bringing new ideas and methods to the design and optimization of biologics.

To study the effects of rCBF and brain function in the patients with cerebral infarction byearly rehabilitation training. 89 cases were randomized into rehabilitation and control groups and were ex-amined rCBF by 133Xe inhalation method and BEAM. Total effect rate was 93.9%in rehabilitationgroup,to the control 77.5%(X2=3. 95,P<0.05). The rCBF rised up in two groups,but it was higher inthe foriner,to the contro1,t=4. 99,P<0. 01. BEAM improve rate was 95.9%,to the control,77.5%(X2=5. 30,P<0. 05). So we confirmed that early rehabilitation training may promote rCBF and improve brainfunction of patients with cerebral infarction.