Aim To investige the protective effect of FMCL on the apoptosis of PC12 cells induced by H_2O_2 and its mechanisms.Methods Apoptosis of PC12 cells induced by H_2O_2 at the concentration of 0.5 mmol?L~(-1).The cell activity was determined by MTT.The morpholog changes were observed by invert microscope.DNA ladder was observed through agarose gel electrophoresis.The subdiploid peaks showing cell apoptosis rate and △?m were detected by flow cytometry.Results Compared with those of the Model group the cell activity of FMCL 100、30 mg?L~(-1) group reinforced,the injury of the cell relieved.The apoptosis rate of those two groups decreased,but the△?m and the cell activity increased in a dose-dependent manner.Conclusion FMCL can inhibit the apoptosis of PC12 induced by H_2O_2 which might be correlated with the increasion of △?m.

Aim To investigate the protective effect of gross saponin tribulus terrestris(GSTT) on the apoptosis of PC12 cells was induced by H2O2 and its mechanism.Methods Apoptosis of PC12 cells was induced by H2O2 at the concentration of 300 ?mol?L-1.The cell activity was determined by MTT.Cells were observed by inverted phase contrast microscope.Hochest33258 staining was detected by fluorescence microscope.The subdiploid peaks showing cell apoptosis rate was detected by flow cytometry.Protein of Bcl-2 and Bax was detected by Western blot.Results Compared with model group,the survival rate of PC12 cells increased (P

Objective To investigate the protective effect of gross saponin tribulus terrestris(GSTT) on the apoptosis of pheochromocytoma cells(PC12 cells)induced by H2O2 and its mechanisms.Methods PC12 cells were divided into control,model,high dose GSTT(GSTT1) and low dose GSTT(GSTT2) groups.Apoptosis of PC12 cells was induced by H2O2 at the concentration of 300? mmol?L-1.The cell activity was determined by MTT.The subdiploid peaks showing cell apoptosis rate and ?m were detected by flow cytometry.Proteins of Bcl-2 and Bax were detected by immunohistochemistry.Results Compared with model group,the survival rate of PC12 increased(P

Objective To explore the computed tomography (CT) features of gastric cancer invasion to the pancreas and significance in the assessment of resectability of primary lesions.Methods The retrospective cohort study was conducted.The clinical data of 31 gastric cancer patients who were admitted to the Peking University Cancer Hospital between February 2011 and August 2016 were collected.Of 31 patients receiving CT examinations,11 who were diagnosed with suspected pancreas invasion by preoperative CT examinations but operation confirmed no invasion were allocated into the pancreas negative (PN) group,11 who were confirmed as pancreas invasion and under vent radical gastrectomy of gastric cancer combined with pancreas resection were allocated into the pancreas invasion (PI) group,and 9 who were confirmed as pancreas invasion and had unresectable primary lesions were allocated into the pancreas invasion non-resected (PI-NR) group.Observation indicators:(1) morphologic type of contact surface between gastric cancer and pancreas;(2) comparison of CT findings among the 3 groups:primary lesion location,tunor thickness,Borrmann type,serosa pattern of gastric cancer,judging obvious region invaded by gastric cancer,contact or invasion site with pancreas,contact length between gastric cancer and pancreas,pattern,clarity and CT values of contact surface or peripancreas invaded and normal peripancreas;(3) treatment or follow-up situations.All the patients underwent radical resection and palliative resection for gastric cancer or non-operation according to results of exploration.Telephone interview was performed to detect the survival of patients up to February 2017.Measurement data with skewed distribution were described as M (Qn),and comparisons among groups were done by the Kruskal-Wallis test.Comparison of count data were done by the Fisher exact probability.Results (1) Morphologic type of contact surface between gastric cancer and pancreas:there were 4 types according to results of CT examination.Type Ⅰ.pancreas contacted with gastric cancer and there was no change in the morphology and radian of contact surface.Type Ⅱ:pancreas contacted with gastric cancer and radian of contact surface became flattened or shallow depression.Type Ⅲ:contact surface showed a inserted sign or obvious depression.Type Ⅳ:pancreas didn't contact with gastric cancer and there was increased density in fat space between pancreas and gastric cancer,with a smudge sign or strip-and sheet-like opacity.Of 31 patients,type Ⅰ,Ⅱ,Ⅲ and Ⅳ were detected in 5,10,4 and 12 patients,respectively.(2) Comparison of CT findings among the 3 groups:nodular protrusion,spiculation and strip shape,clounding patch opacity of serosa panern of gastric cancer were detected in 1,6,4 patients in the PN group and 5,4,2 patients in the PⅠ group and 0,2,7 patients in the PI-NR group,respectively,with a statistically significant difference (X2=10.054,P＜0.05).Two,8 and 8 patients in the PN,PI and PI-NR groups had obvious tumor invasion located at a adjacent region between stomach and pancreas,with a statistically significant difference (X2 =11.259,P＜0.05).Contact or invasion site with pancreas located at head,body and tail of pancreas was detected in 6,5,0 patients in the PN group and 1,7,3 patients in the PI group and 5,4,0 patients in the PI-NR group,respectively,with a statistically significant difference (X2=8.390,P＜0.05).Type Ⅰ,Ⅱ,Ⅲ and Ⅳ of contact surface between gastric cancer and pancreas were detected in 5,6,0,0 patients in the PN group and 0,4,4,3 patients in the PI group and 0,0,0,9 patients in the PI-NR group,respectively,with a statistically significant difference (X2=29.291,P＜0.05).Number of patients with clear and ambiguous contact surface was 10,1 patients in the PN group and 0,11 patients in the PI group and 0,9 patients in the PI-NR group,respectively,with a statistically significant difference (X2 =26.227,P＜ 0.05).CT values of contact surface or peripancreas invaded were-46 HU (-57 HU,-20 HU) in the PN group and-34 HU (-41 HU,-25 HU) in the PI group and-10 HU (-15 HU,-10 HU) in the PI-NR group,respectively,with a statistically significant difference (Z=15.306,P＜0.05).CT values of normal peripancreas were-87 HU (-96 HU,-76 HU) in the PN group and-88HU (-70 HU,-1 HU) in the PI group and-83 HU (-98 HU,-74 HU) in the PI-NR group,respectively,with statistically significant differences in CT values between contact surface or peripancreas invaded and normal peripancreas among the 3 groups (Z=12.581,13.780,7.793,P＜0.05).(3) Treatment or followup situations:of 31 patients,22 underwent radical gastrectomy and 9 underwent simplex exploration or short surgery.All the 31 patients were followed up for 6.0-71.0 months,with a median time of 13.5 months.Postoperative 1-and 2-year survival rates were 82.6％ and 77.1％.Conclusions There are significant differences in pancreatic invasion and resectability between CT features of contact surface of gastric cancer and pancreas and tumor classification.CT features include that pancreas contacts with gastric cancer in the PN group,radian of contact surface becomes flattened and with a inserted sign in the PI group,and there are increased density in fat space between pancreas and gastric cancer and a smudge sign or strip-and sheet-like opacity in the PI-NR group.

Objective To investigate the multi-detector computed tomography (MDCT) evaluating the clinical staging of adenocarcinoma of the esophagogastric junction (AEG) after neoadjuvant chemotherapy.Methods The retrospective cross-sectional study conducted.The clinicopathological data of 46 AEG patients who were admitted to the Peking University Cancer Hospital between January 2016 and April 2018 were collected.All patients underwent MDCT before and after neoadjuvant chemotherapy and at preoperative 2 weeks,the distance between tumor center and boundary of esophagogastric junction (EGJ) was judged through coronal measured values and axial formula method.Patients underwent radical resection of gastric cancer + D2 lymph node dissection after neoadjuvant chemotherapy,pathologists reviewed the distance between center of AEG and boundary of EGJ,T staging (ycT) and N staging (ycN) of clinical staging,T staging (ypT) and N staging (ypN) of pathological staging after neoadjuvant chemotherapy were determined according to TNM staging of American Joint Committee on Cancer (AJCC) (8th edition),and tumor regression grading (TRG) was determined according to the criterion established by National Comprehensive Cancer Network.Observation indicators:(1) CT examination after neoadjuvant chemotherapy;(2) clinical staging after neoadjuvant chemotherapy;(3) postoperative pathological examination;(4) postoperative pathological staging;(5) accuracy of clinical staging after neoadjuvant chemotherapy;(6)relationship between imaging changes of CT examination and pathological reactions.Count data were described as absolute number or percentage,and comparisons among groups were analyzed by the chi-square test.Comparisons of ordinal data were analyzed by the non-parametric test.Results (1) CT examination after neoadjuvant chemotherapy:5 of 46 AEG patients,coronal images of CT showed whole tumor and boundary of EGJ,axial images of CT showed EGJ wall thickening,heterogeneous enhancement in all layers of lesions,and unsmooth serosal surface;the distance between tumor center and boundary of EGJ is less than 2 cm by direct measurement,5 patients were confirmed as esophageal cancer staging.For 41 patients,the same coronal image of CT cannot showed whole tumor and boundary of EGJ,axial images of CT showed EGJ wall thickening,heterogeneous enhancement in all layers of lesions,and irregular-shaped serosal surface;27 patients whose calculated values were negative based on formula method used esophageal cancer staging,and 14 patients whose calculated values were positive used gastric staging.(2) Clinical staging after neoadjuvant chemotherapy:among 46 AEG patients,ycT staging:staging ycT1,ycT2,ycT3,ycT4a and ycT4b were respectively detected in 1,6,31,6 and 2 patients;ycN staging:staging ycN0,ycN1,ycN2 and ycN3a were respectively detected in 5,14,23 and 4 patients.(3) Postoperative pathological examination:of 46 patients,38,3,3 and 2 were respectively confirmed as adenocarcinoma,adenocarcinoma with signet-ring cell carcinoma,adenocarcinoma with neuroendocrine carcinoma and adenocarcinoma with squamous carcinoma.Of 46 patients,the distance between tumor center and boundary of EGJ can be observed in 14 patients by gastric cancer staging and 32 patients by esophageal cancer staging.(4) Postoperative pathological staging:ypT staging:1,3,5,29,7 and 1 patients were respectively detected in staging ypT0,ypT1,ypT2,ypT3,ypT4a and ypT4b;ypN staging:17,4,15,9 and 1 patients were respectively detected in staging ypN0,ypN1,ypN2,ypN3a and ypN3b.One,3,16 and 26 patients were confirmed as staging TRG 0,TRG 1,TRG 2 and TRG 3,including 20 patients tumor regression and 26 patients without tumor regression.(5) Accuracy of clinical staging after neoadjuvant chemotherapy:the accuracies of ycT staging and ycN staging were 78.3％ (36/46) and 54.3％ (25/46).(6) Relationship between imaging changes of CT examination and pathological reactions:of 46 patients,33 and 13 had respectively reduced and stable gastric wall thickness of primary lesion.Among 20 patients with tumor regression,17 and 3 had respectively reduced and stable gastric wall thickness of primary lesion;of 26 patients without tumor regression,reduced and stable gastric wall thickness of primary lesion were respectively in 16 and 10 patients,with no statistically significant difference (x2 =3.069,P＞0.05).Of 46 patients,31,14 and 1 had respectively reduced,stable and increased sum of minor diameters of suspicious celiac lymph nodes.The reduced,stable and increased sum of minor diameters of suspicious celiac lymph nodes were detected in 16,4,0 of 20 patients with tumor regression and 15,10,1 of 26 patients without tumor regression,respectively,with no statistically significant difference (Z =-1.629,P＞ 0.05).The changes of gastric wall thickness of primary lesion and sum of minor diameters of celiac lymph nodes before operation were not consistent to that after operation in 3 patients.CT examination showed gastric wall thickness of primary lesion reduced after chemotherapy,and sum of minor diameters of celiac lymph nodes didn't change;pathological staging and clinical staging were respectively in staging ypN0 and ycN1.Conclusion According to the TNM staging of AJCC (Sth edition),the distance between tumor center and boundary of EGJ is judged through coronal measured values and axial formula method and therefore determining to select staging system of esophageal cancer or gastric cancer,meanwhile,rectifying over T3 staging of Siewert Ⅱ gastric cancer and increasing overall accuracy of clinical staging.

OBJECTIVETo investigate the correlation of the apparent diffusion coefficient (ADC) on diffusion-weighted MRI (DWI) with the prognosis of locally advanced gastric carcinoma after neoadjuvant chemotherapy (NACT).

METHODSPatients with locally advanced gastric carcinoma undergoing NACT in our hospital from November 2010 to September 2011 were enrolled in this prospective study. MRI examinations were performed before and after NACT. ADCs of the whole lesion (ADCentire) and high signal area on DWI (ADCmin) were calculated, and the cancer thickness on T2-weighted images was measured. All the patients were divided into long-term survival group and poor prognosis group, according to the 3-year survival status. The pre-therapy baseline values and early percentage changes (%delta) of the above parameters were compared between the two groups. Receiver operating characteristics (ROC) curves were employed to compare the performance of the above parameters in the discrimination of different prognosis groups.

RESULTSA total of 24 patients were enrolled in the study. There were 14 patients of long-term survival group and 10 patients of poor prognosis group. No statistical difference in baseline ADCmin and ADCentire was shown between long-term survival group and poor prognosis group [ADCmin: (1.17 ± 0.23)×10⁻³ mm²/s vs. (1.23 ± 0.27) × 10⁻³ mm²/s, P>0.05; ADCentire: (1.43 ± 0.20) × 10⁻³ mm²/s vs. (1.50 ± 0.24) × 10⁻³ mm²/s, P>0.05]. The % ΔADCmin and % ΔADCentire were both higher in long-term survival group than those in poor prognosis group (% ΔADCmin: 21% vs. 5%, P=0.06; % ΔADCentire: 23% vs. 1%, P=0.02). Through ROC curves, the AUCs for pre-therapy cancer thickness, ADCmin and ADCentire were 0.693, 0.543 and 0.600 respectively, and AUCs for % deltathickness, % ΔADCmin and % ΔADCentire were 0.532, 0.729 and 0.779 respectively, in the differentiation of prognosis. Using % ΔADC≥15% to predict long-term survival, the positive predictive value (PPV) for % ΔADCmin was 81.8% and % ΔADCentire was 83.3%. Using % ΔADC ≤ 10% to predict poor prognosis, the PPV for % ΔADCmin was 63.6% and % ΔADCentire was 70.0%.

CONCLUSIONSThe change of ADC after NACT of gastric carcinoma is correlated with long-term prognosis. The significantly increased ADC is prone to signify long-term survival. ADCentire is better than ADCmin in the prognosis prediction.

Antineoplastic Agents ; Diffusion Magnetic Resonance Imaging ; Humans ; Neoadjuvant Therapy ; Prognosis ; Prospective Studies ; ROC Curve ; Stomach Neoplasms

OBJECTIVETo investigate the accuracy of CT in preoperative discrimination of cT3 from cT4 in patients with Siewert II esophagogastric junction (EGJ) adenocarcinoma according to UICC/AJCC 8th edition and IGCA 4th edition.

METHODSCT imaging data of 43 consecutive patients with Siewert II EGJ adenocarcinoma who underwent preoperative CT and were diagnosed as pT3 or pT4 by postoperative pathology were retrospectively analyzed. Inclusion criteria were as follows:(1)no previous history of gastric operation, radiochemotherapy, targeted treatment; no contraindications of CT enhanced scanning; (2) good filling of gastric cavity by CT, clear image without artifacts, all axial-coronal-sagittal 3-plane reconstruction images obtained by abdominal stage 3 enhanced scan; (3) operation within 1 week after CT examination; (4) Siewert II EGJ adenocarcinoma confirmed by operation, pT3 and pT4 by postoperative pathology. Transverse and multiplanar reconstruction images were reviewed by two radiologists in double-blind method. Distance between cancer epicenter and esophagogastric junction line, and the contour of the serosa were retrospectively measured on CT scans. The cT staging judgment was performed according to the UICC/AJCC 8th edition (Siewert II EGJ adenocarcinoma should be staged as esophageal cancer) and IGCA 4th edition (Siewert II EGJ adenocarcinoma should be staged as gastric cancer) respectively. Consistency of cT staging and pathological pT staging was compared between UICC/AJCC and IGCA.

RESULTSPreoperative CT revealed that the mean length between tumor epicenter and esophagogastric junction line was(1.5±0.4) cm (0.7-2.5 cm), and such length was ≤2 cm in 41 cases, whose concordance with surgical judgment was 95.3%(41/43). IGCA staging: 18 cases were preoperatively assessed as cT3 and 25 cases as cT4a. UICC/AJCC staging: 41 cases with cancer epicenter locating within 2 cm below esophagogastric junction line were staged as cT3 according to esophageal cancer staging; 2 cases with cancer epicenter locating > 2 cm below esophagogastric junction line were staged according to gastric cancer staging, of whom one was staged as cT3 due to regular serosa and the other was staged as cT4a due to irregular serosa. Postoperative pathology: 33 cases were pT3 and 10 cases were pT4a. The accuracy of preoperative CT in discrimination of T3 from T4a was 74.4%(32/43) with UICC/AJCC criteria and 65.1%(28/43) with IGCA criteria, whose difference was significant(P<0.01).

CONCLUSIONSPreoperative CT can accurately localize the 2 cm threshold line of Siewert II esophagogastric junction adenocarcinoma, which is beneficial to the discrimination of cT3 from cT4a EGJ adenocarcinoma. Application of the UICC/AJCC 8th edition criteria to above discrimination has higher accuracy as compared to IGCA 4th edition in cT-staging by CT.

Adenocarcinoma ; Double-Blind Method ; Esophageal Neoplasms ; diagnostic imaging ; Esophagogastric Junction ; Humans ; Neoplasm Staging ; Retrospective Studies ; Stomach Neoplasms ; diagnostic imaging ; Tomography, X-Ray Computed

OBJECTIVETo investigate the safety and efficacy of organ preservation surgery or "watch and wait" strategy for rectal cancer patients who are evaluated as clinical complete response(cCR) or near-cCR following neoadjuvant chemoradiotherapy (nCRT).

METHODFrom March 2011 to June 2016, 35 patients with mid-low rectal cancers who were diagnosed as cCR or near-cCR following nCRT underwent organ preservation surgery with local excision or surveillance following "watch and wait" strategy in the Peking University Cancer Hospital. All the patients received re-evaluation and re-staging 6-12 weeks after the completion of nCRT, according to Habr-Gama and MSKCC criteria for the diagnosis of cCR or near-cCR. The near-cCR patients who received local excision and were pathologically diagnosed as T0Nx were also regarded as cCR. The end-points of this study included organ-preservation rate (OPR), sphincter-preservation rate (SPR), non-re-growth disease-free survival (NR-DFS), stoma-free survival, cancer-specific survival (CSS) and overall survival(OS). Kaplan-Meier curve was used to estimate the survival data at 3 years.

RESULTSA total of 35 cases were analyzed including 24 males (68.6%) and 11 females (31.4%). The median age was 60 (range 37-79) years and the median distance from tumor to anal edge was 4(2-8) cm. Thirty-three patients received 50.6 Gy/22f IMRT with capecitabine and two patients received 50 Gy/25f RT with capecitabine. The cCR and near-cCR rates were 74.3%(26/35) and 25.7%(9/35) respectively. Excision biopsy was performed in 4 near-cCR cases to confirm the diagnosis of cCR. The non-re-growth DFS rate was 14.3%(5/35) and the median time of tumor re-growth was 6.7 (4.7-37.4) months. In five patients with tumor re-growth, four were salvaged by radical rectal resections and one received local excision. The distant metastasis rate was 5.7%(2/35), one patient presented resectable liver metastasis and received radical resection, another patient presented multiple bone metastases and was still alive. The median follow-up time was 43.7(6.1-71.4) months. At three years, the organ-preservation rate was 88.6%(31/35), the sphincter-preservation rate was 97.1% (34/35). No local recurrence was observed in five patients who received salvage surgery. The non-re-growth DFS was 94.0%. Three patients died of non-rectal cancer related events. The cancer-specific survival was 100%, the overall survival was 92.7% and the stoma-free survival rate was 90.0%.

CONCLUSIONSOrgan preservation surgery or "watch and wait" strategy for cCR or near-cCR patients is feasible and achieves good outcomes. This strategy can be an alternative to standard care, improve patient's quality of life and facilitate tailored treatment for mid-low rectal cancer following nCRT, however, it should be cautiously applied in near-cCR patients before local excision biopsy.

Adult ; Aged ; Anal Canal ; surgery ; Biopsy ; Chemoradiotherapy ; Digestive System Surgical Procedures ; Disease-Free Survival ; Female ; Humans ; Liver Neoplasms ; secondary ; surgery ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local ; prevention & control ; Organ Preservation ; Quality of Life ; Rectal Neoplasms ; mortality ; surgery ; therapy ; Reoperation ; Salvage Therapy ; Survival Rate ; Treatment Outcome ; Watchful Waiting ; methods

OBJECTIVE: To investigate the long-term outcome of organ preservation with local excision or "watch and wait" strategy for mid-low rectal cancer patients evaluated as clinical complete remission (cCR) or near-cCR following neoadjuvant chemoradiotherapy (NCRT). METHODS: Clinical data of 62 mid-low rectal cancer patients evaluated as cCR/near-cCR after NCRT undergoing organ preservation surgery with local excision or receiving "watch and wait" strategy at Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute from March 2011 to August 2017 were retrospectively analyzed. According to the approximate 1:2 pairing, 123 patients who underwent radical resection with complete pathological remission(ypCR) after neoadjuvant chemotherapy during the same period were selected for prognosis comparison. The primary endpoint of the study was 3-year non-regrowth disease-free survival (NR-DFS) and tumor specific survival (CSS). Survival analysis was performed using the Kaplan-Meier curve (Log-rank method). The secondary endpoint of the study was 3-year organ preservation and sphincter preservation. RESULTS: The retrospective study included 38 male and 24 female patients. The median age was 60 (31-79) years and the median distance from tumor to anal verge was 4(1-8) cm. The ratio of cCR and near-cCR was 79.0%(49/62) and 21.0%(13/62) respectively. Local regrowth rate was 24.2%(15/62). Of 15 with tumor regrowth, 9 patients received salvage radical rectal resection and no local recurrence was found during follow-up; 4 patients received salvage local excision among whom one patient had a local recurrence occurred patient; 2 patients refused further surgery. The overall metastasis rate was 8.1%(5/62), including resectable metastasis(4.8%,3/62) and unresectable metastasis (3.2%,2/62). The valid 3-year organ preservation rate and sphincter preservation rate were 85.5%(53/62) and 95.2%(59/62) respectively. The median follow-up was 36.2(8.6-89.0) months. The 3-year NR-DFS of patients with cCR and near-cCR was 88.6% and 83.1% respectively, which was not significantly different to that of patients with ypCR (94.7%, P=0.217). The 3-year CSS of patients with cCR and near-cCR was both 100%, which was not significantly different to that of patients with ypCR(93.4%, P=0.186). CONCLUSIONS Mid-low rectal cancer patients with cCR or near-cCR after NCRT undergoing organ preservation with local excision or receiving "watch and wait" strategy have good long-term prognosis with low rates of local tumor regrowth and distant metastasis, which is similar to those with ypCR after radical surgery. This treatment mode may be used as an option for organ preservation in mid-low rectal cancer patients with good tumor remission after NCRT.
Adult ; Aged ; Chemoradiotherapy ; Female ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Rectal Neoplasms ; diagnosis ; therapy ; Retrospective Studies ; Treatment Outcome ; Watchful Waiting