Multidisplinary treatment is the mordent means of local-regional gastric cancer therapy, and individualized treatment decisions are dependent on the patient's characteristics. Stage II patients previously treated with standard D2 resection should receive oral administration of S-1 or combination chemotherapy of XELOX. However, patients at stage IIIb or at a more advanced stage should receive combination treatment as priority. Concurrent radiochemotherapy was recommended to treat patients that had been operated by D0 or D1 resection. Perioperative chemotherapy is more reasonable than pure neoadjuvant chemotherapy. No evidence has verified that perioperative or neoadjuvant chemotherapy leads to better survival compared with postoperative adjuvant chemotherapy. The value of chemotherapy before operation is rest with the effect of downstaging and conversion of the unresectable tumor to a resectable one. Con-current radiochemotherapy prior to an operation needs further investigation to affirm its high efficacy of downstaging and conversion.

Exosomes are cell-derived vesicles that contain protein and RNA from the same source and function. The vesicle has a diam-eter between 30 and 100 nm. Exosomes are the natural carriers and have been recently used as drug delivery system for cancer treat-ment. MicroRNAs (miRNAs) function in RNA silencing and regulation of gene expression. They can exist as intracellular and extracellu-lar miRNAs. Extracellular miRNAs can function as secreted signaling molecules that affect receptor cell phenotype. They can also re-flect molecular changes in donor cells. Therefore, extracellular miRNAs can be potentially used for diagnosis and therapeutics. Studies show that the volume of exosomes in cancer patients' blood is higher than that in normal controls. The ability to package cancer-relat-ed miRNAs is a biological function of exosomes. In conclusion, specific miRNAs transferred by exosomes may play an important role in the pathogenesis of tumor or cancer. This paper presents a summary of research on exosomes as the carrier of miRNAs in the develop-ment and treatment of cancer.

Objective:To analyze the clinico-pathological features of intestinal neuroendocrine tumors (NET), as well as the treat-ment protocols and survival of intestinal NET patients. Methods:Clinico-pathological features of 82 intestinal NET patients were retro-spectively reviewed. Results:The male to female ratio was 1.41:1 in the group of patients, and the mean age was 48.72 ± 13.26. Up to 72 cases were NET, 7 were neuroendocrine cancer, and 3 were mixed adeno-neuroendocrine carcinoma. The most commonly observed organ exhibiting primary lesion of the tumors was the rectum. The overall five-year survival rates were 78%and 80%among all the pa-tients and among the NET patients, respectively. Tumors of different histological types demonstrated statistically significant differences in terms of primary site, pT stage, and metastasis (P<0.05). The pT stage, histological classification, age, and primary site of the tumors were associated with the metastasis of the intestinal NETs (P<0.05). Age was the main risk factor of metastasis in the tumors. Conclu-sions:Intestinal neuroendocrine neoplasms usually occur in males, and the most commonly involved organ is the rectum. Age is an im-portant factor of neuroendocrine tumor metastasis.

The efficacy of conventional chemotherapy for gastric cancer is extremely limited because of its relatively low chemo-sensitivity and obvious heterogeneity. Molecular phenotype-directed target therapy is important for the improvement of the effi-cacy of conventional chemotherapy in treating advanced gastric cancer. Trastuzumab has been confirmed to have a survival benefit when added to chemotherapy for HER-2 positive gastric cancer. Ramucirumab can increase the survival of gastric cancer patients as second line treatment compared with a placebo. The anti-c-MET monoclonal antibody Rilotumumab indicates promising results in phaseⅡtrial. However, most of the targeting drugs in gastric cancer clinical trials have failed. Therefore, further efforts are required to explore critical targeted genes and effective agents.

In recent years, the incidence and mortality of colorectal cancer have gradually increased in China. This review sum-marized the differences in pathogenic factors, clinical manifestations, pathological features, gene expression, therapeutic modalities, and other aspects between left-and right-sided colon cancers. Results showed that the onset of both left-and right-sided colon cancers is associated with gender and age. Significant differences existed among the clinical manifestations and pathological features. Differenc-es in gene expression, allelic deletion, and DNA mismatch repair affected the occurrence, metastasis, and prognosis of left-and right-sided colon cancers. Moreover, the location of primary tumor is a potential predictor of targeted drug efficacy. Differences in survival rates are possibly related to TNM stage. Hence, new ideas for individualized treatment should be provided by analyzing the differences between left-and right-sided colon cancers.

Gastric cancer is a malignant cancer with high morbidity and mortality in China. The main aim for advanced gastric cancer is improvement of life quality and overall survival. Chemotherapy is the backbone for advanced gastric cancer's treatment. There are some new evidences in the recent years. We review the chemotherapy options for advanced gastric cancer.

Adult ; Elbow Joint ; physiopathology ; Female ; Fracture Fixation ; methods ; Fracture Healing ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Ulna Fractures ; physiopathology ; surgery

Objective:To investigate the differentially expressed miRNAs in serum collected post operation and compared these miR-NAs with those collected pre-surgery among patients suffering from glioblastoma multiform (GBM) and undergoing regular clinical fol-low-up. These miRNAs may be potential biomarkers for the post-operative evaluation of patients with GBM. Methods:Forty-eight pa-tients with GBM and clinical pathological diagnosis were enrolled in this study. In the initial biomarker screening stage, total RNAs were extracted and subjected to Solexa sequencing to select miRNAs with significantly altered expression pre-and post-operation. Some of these differentially expressed miRNAs were chosen and verified through TaqMan probe-based qRT-PCR assay. A t-test was performed to determine the miRNAs that satisfied the two criteria, namely, fold change>2 and P<0.05. All of the patients were fol-lowed-up, and survival data were collected. The patients were then classified into two groups, namely, long-and short-survival groups, on the basis of the median of the miR-30e expression levels in the sera collected post-operation. Kaplan-Meier method and Log-rank test (SPSS version 19.0, IBM) were employed to determine the possible relationships between miR-30e expression levels in the sera collected post-operation and patients' overall survival. Results: Solexa revealed 63 differentially expressed miRNAs. Four miRNAs, namely, miR-26b, miR-30e, miR-129-3p, and miR-206, were selected on the basis of previous and present findings. These miRNAs were then verified in the RT-qPCR phase. Among these miRNAs, only miR-30e was significantly upregulated post-operation. The serum miR-30e expression level post-operation was not significantly associated with the overall survival of the patients. A low miR-30e expression level corresponded to prolonged survival. Conclusion:miR-30e was upregulated in the sera collected post-operation from patients with GBM. This miRNA may be negatively related to the tumor load of these patients. The miR-30e expression level in the serum col-lected post-surgery serum was not significantly associated with overall survival. Therefore, miR-30e may serve as a novel potential non-invasive biomarker for the post-operative evaluation of patients with GBM.

Objective: To analyze the association of thrombocytosis with the prognosis of patients with gastric cancer.Methods: The clinical materials of 782 patients with gastric cancer who underwent initial surgery in our hospital between January 1995 and December 1999 were retrospectively analyzed.Kaplan- Meier and Log-Rank test were used to analyze the data.Prognostic factors were analyzed by multivariate Cox proportional hazards model.Results: Thrombocytosis oc-curred in 11.4% (87/782) patients.The platelet level was not significantly different among patients of different gender, tumor stage, and histological differentiation (P>0.05).However, a significant difference was observed in the platelet level among patients with different age and surgical approach (P<0.05).The 1-, 3-, and 5-year survival rates were 75.0%, 40.1% and 28.9% in patients without thrombocytosis and 52.8%, 16.9%, and 13.5% in patients with thrombocytosis (P=0.002).Univari-ate analysis showed that histological differentiation, pathological stage, surgical approach and thrombocytosis significantly affected the survival of patients.While age and gender had no significant impact on patient survival.Multivariate analysis showed that pathological stage, surgical approach, and thrombocytosis were independent prognostic factors for gastric can-cer.The relative risk of death of patients with thrombocytosis was elevated by 1.454 times (RR=1.454, 95% CI: 1.135～1.861, P=0.005).Conclusion: Thrombocytosis is an independent prognostic indicator for the survival of initially treated pa-tients with gastric cancer.

Objective:To investigate the influence of chemotherapy on the phenotype of secreted protein, acidic and rich in cysteine (SPARC) in gastric cancer (GC). Methods:Immunohistochemistry was used to analyze SPARC expression in 132 GC patients. Among these patients, 54 with preoperative chemotherapy and 78 without preoperative chemotherapy were selected to analyze the effect of chemotherapy on SPARC phenotype by comparing the postoperative specimens of the two cohorts. Results:SPARC expression was higher in GC lesions than in the desmoplastic stroma surrounding the tumor cells and noncancerous tissues. High SPARC expression was related to invasion depth, lymph node metastasis, and TNM staging. SPARC expression was lower in patients with preoperative chemotherapy than in controls ( P<0.05). Gross type, histology, depth of invasion, lymph node metastasis, TNM staging, and SPARC phenotype correlated with the overall survival of the patients with preoperative chemotherapy. Further multivariate analysis suggested that lymph node metastasis, histology, and SPARC phenotype after chemotherapy were independent prognostic indicators of GC. Conclusion:SPARC expression was associated with invasion depth, lymph node metastasis, TNM staging and GC prognosis. Preoperative chemotherapy may change the phenotype of SPARC in GC patients.