Objective To investigate the clinicopathological features of multiple primary colorectal carcinoma. Methods The clinical data of 30 patients with multiple primary colorectal carcinoma and 580 patients with single colorectal carcinoma who were admitted to the Peking University People's Hospital from January 2001 to March 2008 were retrospectively analyzed. There were 16 patients with multiple synchronous carcinoma and 14with multiple metachronous carcinoma. The survival of the patients was analyzed using Kaplan-Meier method and the survival rates were compared using Log-rank test. All data were analyzed using the chi-square test. Results The onset age of multiple metachronous primary carcinoma was younger than that of multiple synchronous carcinoma and single colorectal carcinoma, while the onset age of multiple metachronous secondary carcinoma was close to that of multiple synchronous carcinoma and single colorectal carcinoma. Most of the synchronous carcinoma located at the left colon; while most of the metachronous primary carcinoma located at the rectum and sigmoid colon, and most of the metachronous secondary carcinoma located at the ascending colon. Patients with multiple synchronous carcinoma or multiple metachronous primary carcinoma received radical resection. Of the 14 patients with multiple metachronous carcinoma, 9 received radical resection for secondary focus. Except for three patients with multiple synchronous carcinoma and two patients with multiple metachronous carcinoma, all patients received postoperative chemotherapy with FCF, FOLFOX or XELOX regimen. Of the 580 patients with single colorectal carcinoma, 512 received radical resection, 68 received palliative operation, and 519 received postoperative chemotherapy. The cumulative survival rate of patients with multiple metachronous primary carcinoma was significantly higher than that of single colorectal carcinoma (x2 = 17. 289, P ＜ 0. 05). There was no significant difference in the cumulative survival rate between patients with single colorectal carcinoma and those with multiple metachronous secondary carcinoma or multiple synchronous carcinoma (x2 = 1.731, 0. 800, P ＞ 0. 05). Conclusion The prognosis of patients with colorectal multiple metachronous carcinoma is better than those with single colorectal carcinoma, and the prognosis of colorectal synchronous carcinoma is similar to those with single colorectal carcinoma.

Objective To summarize the clinical experience of laparoscopic radical resection of colorectal carcinoma.Methods Clinical data of 13 cases of colorectal carcinoma treated by laparoscopic radical resection from November 2002 to April 2006 in this department were retrospectively analyzed.There were 10 cases of colon cancer(Duke's A,4 cases;Duke's B,6 cases) and 3 cases of rectal cancer(all Duke's A).Results According to the size of the tumor,the 13 patients were treated with either laparoscopic-assisted operation(10 cases) or hand-assisted laparoscopic surgery(3 cases).All the operations were performed successfully.No conversions to open surgery were needed and no mortality occurred.Follow-up checkups for 1~36 months(mean,17 months) showed no recurrence.Conclusions In patients with colorectal carcinoma,the selection of laparoscopic-assisted procedure or hand-assisted laparoscopic surgery can not only provide the operative safety and effectiveness,but also enable the operation minimally invasive.

Metastatic cancer is often occurred in advanced digestive system tumors and the most involved organ is liver.Multiple therapeutic managements and strategies such as surgery,systemic chemotherapy,radiofrequency ablation,portal vein embolization and transarterial chemoembolization are used in the treatment of liver metastasis.However,the treatment of advanced digestive system tumors liver metastasis is still challenging,different therapeutic methods show different results for different tumors,comprehensive treatment should be used based on features of patients and muliidisciplinary cooperation.With the accumulation of clinical experiences,the emergence of novel chemotherapeutics,wider indications of surgical resection in treating liver metastases and accumulated evidence from randomized controlled trials,the therapeutic management of metastatic hepatic cancer should be standardized and more effective in the future.

Objective To explore the expression of ininor histocompatibility antigen 13 (HM1 3) in gastric carcinoma and the relationship with clinicopathological parameters and prognosis.Methods The expression of HM 13 was detected by immunohistochemistry in a total of 90 pairs of paraffin-embedded gastric cancer tissue specimens and corresponding paraneoplastic tissues.The correlation between clinicopathological parameters and the expression of HM13 in gastric carcinoma were also analyzed.Downstream gene heme oxygenase-1 (HO-1) expression was detected by qRT-PCR after HM13 gene was interfered.Results High expression of HM13 protein was observed in 47％ gastric carcinoma compared with that in 61％ corresponding paraneoplastic tissues (x2 =3.78,P =0.052).HM13 expression has positive correlation with pathological TNM stage (x2 =5.022,P =0.025) and distant metastasis (P =0.033),but not with age (x2 =0.832,P =0.362),gender (x2 =0.779,P =0.378),tumor size (x2 =0.804,P =0.370),tumor differentiation (x2 =0.430,P =0.512),gross types (x2 =2.069,P =0.150),tumor stromal invasion (x2 =0.167,P =0.683) and lymph node status (x2 =0.396,P =0.529).The patients with low HM13 expression had worse overall survival [(OS):(30 ± 5) months vs.(47 ± 5) months,x2 =6.456,P =0.011] and progress free survival [(PFS):(29 ± 5) months vs.(46 ± 5) months,x2 =6.742,P =0.009].Expression of HO-1 was up-regulated after HM13 gene was interfered (0.532±0.013 vs.0.395±0.011,t=13.93,P＜0.05).Conclusion The low expression of HM13 is associated closely with advanced stage and distant metastases of gastric carcinoma.

Objective To detect the expressions of enhancer of zeste homology 2 (EZH2) and signal transducer and activator of transcription 3 (STAT3) in gastric cancer tissues,and analyze the relationship between their expressions and clinicopathological factors and prognosis of patients.Methods The clinical data of 67 patients with gastric cancer who were admitted to the People's Hospital of Peking University from May 1999 to April 2000 were retrospectively analyzed.Gastric cancer tissues and adjacent normal tissues were harvested and fixed in 4％ formaldehyde,and then to make the tissue chips.The protein expressions of EZH2 and STAT3 were detected by immunohistochemical staining,and the relationship between the expressions of EZH2 and STAT3 and the prognosis of patients was analyzed.The correlation between the protein expressions of EZH2 and STAT3 in the gastric and colorectal tissues and the clinicopathological parameters was analyzed using the paired chi-square test.The survival curve was drawn by Kaplan-Meier method,and the survival rate was analyzed by using the Logrank test.The relationship between the clinicopathological factors and the prognosis of patients was analyzed using the COX proportional hazard model.Results The positive protein expression rates of EZH2 and STAT3 in the gastric cancer tissues were 73.1％ (49/67) and 67.2％ (45/67),which were significantly higher than 32.8％ (22/67) and 37.3％ (25/67) in the adjacent normal tissues (x2=21.839,11.964,P ＜0.05).The protein expression of STAT3 was correlated with the age,TNM staging,lymph node metastatic status (x2=5.475,9.998,5.475,P ＜ 0.05).The protein expression of EZH2 was correlated with TNM staging and lymph node metastatic status (x2=11.573,5.902,P ＜ 0.05).The co-expression rate of EZH2 and STAT3 proteins was 73.1％ (49/67),EZH2 and STAT3 had the common expression trend (r =0.397,P ＜ 0.05).The co-expression rate of EZH2 and STAT3 was increased as the increase of TNM stages,and the co-expression of EZH2 and STAT3 in the gastric cancer tissue was correlated with the TNM stages (x2 =6.997,P ＜ 0.05).The 5-year survival rate of patients with low protein expression of EZH2 was significantly higher than those with high protein expression of EZH2 (x2=7.386,P ＜ 0.05).The 5-year survival rate of patients with low proteins expression of STAT3 was significantly higher than those with high proteins expression of STAT3 (x2=12.253,P ＜ 0.05).The 5-year survival rate of patients with low co-expression of EZH2 and STAT3 protein was significantly higher than those with high co-expression of EZH2 and STAT3 proteins (x2 =8.765,P ＜ 0.05).The results of univariate analysis showed that age,TNM staging,EZH2 and STAT3 expression,lymph node metastasis and distal metastasis were the factors influencing the survival of patients with gastric cancer (RR =2.136,3.452,3.179,8.341,11.773,6.873,P ＜0.05).The results of multivariate analysis showed that TNM staging and STAT3 expression were independent factors influencing the prognosis of patients with gastric cancer (RR =2.453,7.535,P ＜ 0.05).Conclusions There is significant correlation between EZH2 and STAT3 protein expressions in gastric cancer tissues,and co-expression of EZH2 and STAT3 is associated with the TNM staging and the prognosis of the patients with gastric cancer.

Objective To explore the clinical outcomes of laparoscopic appendectomy in acute and chronic appendicitis,and sum up the surgical experiences of lapaproscopic appendectomy.Method In this study 129 cases of appendicitis at the Department of Gastroentrological Surgery,Peking University People's Hosptial were collected retrospectively from June 2008 to December 2009.The clinical results of laparoscopic and open procedures for acute appendicitis and the outcomes of laparoscopic operation for acute and chronic appendicitis were compared.Results For acute appendicitis,the length of hospitalization [(4.8 ± 2.6) d vs.(7.0 ± 1.3) d,t =0.679,P =0.006] was significantly shorter in laparoscopic group than that in open surgery group.In addition,the mean length of operation time [(77 ± 33) min vs.(55 ± 23) min,t =3.431,P ＜0.01] were longer,postoperative first passing flatus [(2.3 ± 1.2) d vs.(1.4 ±0.9) d,t =4.665,P ＜0.01] and oral intake [(2.3 ± 1.4) d vs.(1.2 ±0.6) d,t =4.517,P＜0.01] were later for acute appendicitis patients than for chronic appendicitis in laparoscopic group.Conclusions Laparoscopic appendectomy for acute appendicitis is a safe and effective procedure,though it might cause more postoperative complications such as intra-abdominal abscess and small intestinal obstruction in patients with acute appendicitis.

Objective To investigate microRNA-217 expression and its significance in colorectal cancer.Methods MiR-217 expression was detected in 30 cases of colorectal cancer tissues and corresponding adjacent normal colorectal tissues by qRT-PCR.The clinicopathologic correlations of miR-217 expression were performed using Fisher's exact test.Kaplan-Meier method was used to evaluate the overall survival of patients.Results MiR-217 was significantly lower in colorectal cancer tissues than in normal colorectal tissues (P ＜ 0.01).Moreover,the decreased miR-217 level was significantly associated with tumor size and TNM stage,as well as lymph node and distant metastasis.Meanwhile,patients of colorectal cancer with low levels of miR-217 expression had a significantly shorter median survival (x2 =4.584,P ＜ 0.05) than those with high levels of miR-217 expression.Conclusions Downregulated miR-217 in colorectal cancer tissues correlates to poor prognosis in postoperative colorectal cancer patients.

Objective To compare the effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) for the treatment of type 2 diabetes mellitus (T2DM) patients in various obesity degree.Methods A total of 36 T2DM patients undergoing LRYGB were enrolled in this study in our hospital from June 2012 to June 2014.The patients were divided into BMI ≥ 32.5 kg/m2 group (n =13) and 27.5 kg/m2 ≤ BMI ＜ 32.5 kg/m2 group (n =23) based on BMI.Results In group 1,following the degression of BMI from (37.7±3.6) kg/m2 to (29.1 ±3.5) kg/m2 at 12 months after surgery,fasting blood glucose of group 1 decreased from (7.8 ± 1.6)mmol/L to (5.2 ±1.0)mmol/L (t =5.796,P =0.000),and HbA1c decreased from 7.3％ ±0.7％ to 6.1％ ± 1.0％ (t =5.589,P =0.000);and following the degression of BMI from(30.0 ± 1.6) kg/m2 to (25.8 ± 3.2) kg/m2,fasting blood glucose of group 2 decreased from (8.9 ± 1.7) mmol/L to (6.1 ± 1.5) mmol/L (t =6.577,P =0.000),and HbA 1 c decreased from 7.8 ％ ± 1.8％ to 6.4％ ± 1.0％ (t =4.257,P =0.000).Though Homa-IR of two groups was significantly improved after surgery (t =6.415,4.135;P =0.000,0.000),there was no difference to Homa-β (t =1.007,-0.155;P =0.334,0.878).Complete remission ratio of BMI ≥ 32.5 kg/m2 group was not significantly different with 27.5 kg/m2 ≤ BMI ＜ 32.5 kg/m2 group.Conclusion LRYGB is effective for the treatment of type 2 diabetes patients despite preoperative various obesity degree.

Objective To investigate the key steps of hepatic artery reconstruction and the factors influencing the outcome of hepatic artery reconstruction in orthotopic liver transplantation. Methods The clinical data of 107 consecutive orthotopic liver transplantation patients was retrospectively reviewed to assess the key steps in hepatic artery reconstruction. The risk factors and the diagnosis and treatment of vascular complications were also discussed. Results The incidence of hepatic artery related complications in orthotopic liver transplantation was associated with the quality of the donor hepatic artery,the method used for anastomosis and the use of microsurgical technique. The main hepatic artery related complications were hepatic artery thrombosis and stenosis. The incidence of the vascular complications was 6.54%,and the mortality rate was 85.7%. Conclusion The major influence factors of vascular complications were the quality of the donor artery,the reconstruction way of donor-recipient artery and the use of microsurgical technique .

Objective To investigate the association between extramural vascular invasion (EMVI) detected by multi-detectors computed tomography (MDCT) with contrast enhanced (ceMDCT) and clinicopathologic characteristics in patients with colon cancer.Methods Between February 2009 and December 2013,patients with histologically proven primary colon cancer and undergoing curative resection were included in this retrospective study.According to American Joint Committee on Cancer TNM staging system,patients of stage Ⅱ and Ⅲ were included in this study.EMVI status detected by MDCT (ctEMVI) was defined according to the EMVI scores.Chi-square test was used to analyze the association between clinicopathologic characteristics and ctEMVI.Results 165 stage Ⅱ and stage Ⅲ patients were included in this study as confirmed by pathology based on AJCC.Positive ctEMVI was demonstrated in 51 patients (34.5％,51/165).There were significant association between positive ctEMVI and age ＜ 65 years (x2 =4.810,P =0.031),ceMDCT defined tumor stage (x2 =17.911,P =0.000),ceMDCT defined metastatic lymph node (x2 =5.436,P =0.022),tumor size≥5 cm (x2 =3.799,P =0.036) and pathological T stage (x2 =13.346,P =0.001).Conclusions EMVI,detected by ceMDCT,is significantly associated with age,tumor size and T staging in colon cancer.