Objective To examine the relationship between inflammatory response induced by cardiopulmonary bypass and postoperative cognitive dysfunction.Methods Twenty-five patients undergoing elective cardiac valve replacement under cardiopulmonary bypass were randomly divided into two groups:ulinastatin group(group U,n=13) and control group(group C,n=12).In group U,ulinastatin 12 000 U/kg Was given intravenously immediately after induction of anesthesia,6 000 U/kg ulinastatin Was added to the priming solution,and 6000 U/kg ulinastatin was given at 5 min before the aortic decamping.In group C,normal saline was given instead of ulinastatin.Venous blood samples were taken after induction of anesthesia,at the end of CPB,and 24 h after operation for determination of plasma IL-6 concentration and neutrophils NF-kB expression.The cognitive function of the patients was evaluated by Mini-Mental State Examination(MMSE) before and 3 d,7 d after operation.Results The concentraion of IL-6 and neutrophils NF-kB expression were lower in group U than in group C(P<0.05 or 0.01).There wag no significant difference in the incidence of postoperative cognitive dysfunction between group C and U.Conclusion Inflammatory response induced by cardiopulmonary bypass is not related to postoperative cognitive dysfunction.

Objective To investigate the impact of enteral nutrition (EN) through jejunal feeding tube on the nutritional status and immunologic function of patients during chemotherapy after total gastrectomy.Methods Totally 86 patients with gastric cancer who had undergone total gastrectomy with radical resection and jejunostomy received adjuvant venous chemotherapy in our department from January 2009 to June 2010.They were divided into EN group ( n =43 ) and control group ( n =43 ) according to the hospitalization number.The EN group maintained the jejunostomy tube until the end of 6 courses of chemotherapy,and was given EN support for 7 days through jejunal tube during each course of chemotherapy; the control group removed the tube before chemotherapy without further dietary restriction or nutrition support.The nutritional and immunologic indicators on the 1 st day before chemotherapy and the 1st day after 6 chemotherapy courses were measured.ResultsThree patients in the EN group withdrew from the study because of catheter blockage or catheter loss and 2 patients in the control group failed to complete the trial because of chemotherapy side effects or economic reasons; 81 patients entered the final analysis.After 6 courses of chemotherapy,both groups experienced body weight loss,but the percentage is significantly lower in EN group than in control group (6.9％ ± 0.95％ vs.11.2％ ± 1.32％,P =0.0000).Compared with the nutritional status before the first chemotherapy,the prognosis nutritional index (PNI) in both groups declined after the 6th chemotherapy.Such decline was not statistically significant in EN group ( P =0.1534) but was significant in control group (P =0.0000).The PNI in EN group after chemotherapy was significantly higher than that in control group (P =0.0040).The levels of IgG,NK,CD4 +,and CD4 +/CD8 + were significantly higher in EN group than in control group ( P =0.0083,0.0143,0.0000,and 0.0000,respectively) after chemotherapy.ConclusionEN during postoperative chemotherapy may improve the nutritional status and immunologic function in gastric cancer patients after total gastrectomy.

Objective To improve the quality of life in gastric cancer patients after total gastrectomy by exogenous trypsin supplement.Method In this study 106 patients were divided into two groups,with 53 patients in each group,oral pancreatic enzyme capsule was given in comparison without in control group.Patients were asked to fill in EORTC QLQ-C30 questionnaire and Korenaga questionnaire at half a year postoperation,stool sample was collected at the same time for fecal fat assay.Results A total of 86 patients completed this test at postoperation half a year.With a comprehensive assessment of quality of life in patients by the scoring system of EORTC QLQ-C30 and Korenaga and the fecal fat contents measurement.Exogenous trypsin plays a positive role in preventing weight loss,improving emotional function,alleviating loss of appetite,insomnia,fatigue,postprandial fullness,nausea,vomiting and diarrhea,and improving intestinal tolerance to fat and the overall health status of patients.Conclusions Total gastrectomy causes exocrine pancreatic dysfunction,exogenous supplement of the enzyme improves postoperative quality of life in these patients.

Objectives To investigate the effect of proliferation and invasiveness by turmeri cvolatile oil on human neuroblastoma cell line SH-SY5Y. Methods Cells were incubated with different concentrations of TVO in vitro. Then cell survival rate was measured by MTT assay. The effect of 160 mg/L TVO on cell migration was assessed by cell scuffing test. Invasive ability of cell was detected by Transwell test. Apoptosis of cells was detected observed by flow cytometry assay. Results Survival rate of SH-SY5Y cells decreased and apoptisis rate was abated with elevated TVO concentration and prolonged cultivation time. Level of cell migration was lower than that in control group after being cultured with 160 mg/L TVO solution for 12 , 24 and 48h. With the in-crease of TVO concentration , the invasion ability of cells gradually decreased , and the invasive force and cis-platin had no obvious difference when the concentration of drug reached 160 mg/L. Conclusion The prolifera-tion of cells can be inhibited by inhibiting the proliferation and invasiveness ability with TVO.

Objective To investigate the effect of Zingiber corallinum oil ( ZCO ) on apoptosis and proliferation of cervical carcinoma cell line HeLa. Methods HeLa cells were treated with different concentrations of ZCO(5-80 mg·L-1)in vitro. Cytotoxicity rate was determined by CCK-8 assay. The morphological changes was observed using inverted microscope after AO/EB staining. Caspase-3 activities were measured with a colorimetric method. Protein level of hsp-70 were detected by Western blotting. Cell cycle and apoptosis were analyzed by flow cytometer ( FCM ) . Results ZCO exhibited effect of proliferation inhibition and apoptosis-inducing on the growth of HeLa cells in a dose-dependent manner. Caspase-3 activities increased in a dose-dependent manner while the expression of hsp-70 decreased. Cell cycle was arrested in G2/M phase. Conclusion ZCO exhibites a marked effect of proliferation inhibition and apoptosis-inducing on HeLa cells. The mechanism of ZCO might be activating the key enzyme in apoptotic pathway, so that the expression of hsp-70 is down-regulated, and cell cycle is arrested in G2/M phase.

Objective To investigate the effects of an ar?turmerone derivative(ATD)on the proliferation and apoptosis of A375 human melanoma cells. Methods Both A375 cells and human skin fibroblasts (HSFs) were cultured with different concentrations(5, 10, 20, 40 and 80μmol/L)of ATD, vincristine and ar?turmerone, separately, for 48 hours in vitro. Subsequently, cell counting kit?8 (CCK?8) was used to evaluate cell proliferation, inverted microscopy to observe cell morphology after acridine orange/ethidium bromide (AO/EB) staining, and a colorimetric method to estimate caspase?3 activity. DNA fragmentation assay and flow cytometry were performed to assess cell apoptosis, and flow cytometry was conducted to analyze cell cycle. Results ATD, vincristine and Ar?turmerone all inhibited the proliferation of A375 cells in a dose?dependent manner(ATD:R2=0.99, F=340.96, P<0.05;vincristine:R2=0.99, F=349.19, P<0.05;ar?turmerone:R2=0.89, F=25.41, P<0.05). The fifty percent inhibitory concentra?tions(IC50s)of ATD, vincristine and ar?turmerone against A375 cells were 15.96 ± 0.02μmol/L, 77.00 ± 0.04μmol/L and 356.95 ± 0.01μmol/L respectively. When the drug concentrations were 5 and 10μmol/L, the proliferation of HSFs was inhibited by 8%± 0.06%and 25%± 0.02%respectively by ATD, by 49%± 0.09%and 34%± 0.07%respectively by ar?turmerone, and by 33%± 0.04%and 29%± 0.08%respectively by vincristine, and the proliferation of A375 cells was inhibited by 26%± 0.06%and 39%± 0.02%respectively by ATD, by 6%± 0.09%and 10%± 0.07%respectively by ar?turmerone, and by 8% ± 0.04% and 17% ± 0.08% respectively by vincristine, with the inhibitory effects of the three drugs being significantly different from that of dimethyl sulfoxide(all P<0.05). ATD showed stronger inhibitory effects on the proliferation of A375 cells, but weaker cytotoxic effects on HSFs compared with ar?turmerone and vincristine(all P<0.05). Meanwhile, ATD, vincristine and ar?turmerone all induced the apoptosis of A375 cells(P<0.05), and caspase?3 activity increased with the increase in drug concentrations(ATD:R2=0.98, F=162.30, P<0.05;vincristine:R2=0.96, F=94.39, P<0.05;ar?turmerone:R2=0.95, F=57.35, P<0.05). The effect of ATD on caspase?3 activity was strongest, followed by that of vincristine and ar?turmerone. As flow cytometry showed, all the three drugs induced cell apoptosis to different degrees, and ATD showed a relatively strong effect on cell apoptosis, especially late apoptosis, compared with the other two drugs. In the ATD group, the number of A375 cells in G1 phase gradually increased, while that in G2 phase and S phase significantly decreased with the increase in drug concentrations. Conclusions ATD exhibited proliferation?inhibiting and apoptosis?inducing effects on A375 cells, and the effects were stronger than those of vincristine and ar?turmerone. It is quite possible that ATD affects cell proliferation and differentiation by activating caspase?3 and arresting cell cycle in the G1 phase.

OBJECTIVETo investigate the application of home enteral nutrition (HEN) in patients with advanced gastric cancer and its impact on the quality of life.

METHODSData of 60 consecutive patients with advanced gastric cancer, who could not underwent operation and had relapse metastasis, from June 2010 to June 2012 were retrospectively analyzed. According to familial nutritional pattern, these 60 patients were divided into HEN group (25 cases) receiving home enteral nutritional support and control group (35 cases). HEN patients were supported through jejunostomy tube or nasal gastric tube. Control patients were supported through total parental nutrition or purely eating respectively. All the patients received intravenous chemotherapy and evaluated by Karnofsky index and Spitzer system in the first, third, sixth and twelfth month. In the sixth month, patients were also examined by EORTC QLQ-C30.

RESULTSNo significant differences were found between the two groups according to 8 elements containing age, sex, BMI, etc. A total of 53 patients died within one year, including 21 in HEN group and 32 in control group. The Karnofsky scales showed that HEN group scored meanly 57.4, 39.6 and 28.2 in the third, sixth and twelfth month respectively, which were significantly higher than those of control group (45.3, 29.2 and 20.1, P=0.041, P=0.012 and P=0.015 respectively). The Spitzer scales showed that HEN group scored meanly 5.12, 4.04 and 2.54 on average in the third, sixth and twelfth month respectively, which were significantly higher than those of control group (4.32, 3.01 and 1.97, P=0.048, 0.035 and P=0.024 respectively). The EROTC QLQ-C30 scales showed that HEN group scored higher than control group in functional scales (P<0.05), and lower in the symptom scales of short breathing, pain and tired (P=0.025, P=0.044, P=0.036 respectively), while higher in diarrhea (P=0.047).

CONCLUSIONSThe quality of life of patients with advanced gastric cancer declines gradually with the nutritional status deteriorating. HEN can be applied to improve the nutritional status and quality of life.

Objective:To introduce the operation process of laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction, and evaluate its feasibility, safety during perioperative period, and advantages of anastomosis.Methods:A total of 56 patients with gastric cancer who underwent laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction were selected as study subjects from Zhejiang Provincial People′s Hospital between May 2022 and June 2023. Gender, age, body mass index (BMI), tumor location, tumor stage, tumor type and other related indicators were collected. The main parameters during the operation process were collected, including operation time, anastomosis time, intraoperative blood loss, postoperative recovery status, exhaust time, feeding time, complications related to anastomosis, and length of hospital stay. The differences between other digestive tract reconstruction methods such as Overlap method, reverse puncture method, and handmade anastomosis were compared and analyzed.Results:A total of 56 patients with gastric cancer were included in this study. The anastomosis time of the tubular instrument group was (42.3±15.7)min, which was superior to the handmade anastomosis group ( P<0.05). The operation time of the tubular instrument group was (176.3±25.8)min, which was superior to other methods (all P<0.05). The intraoperative blood loss of the tubular instrument group was (75.68±20.34)ml, which was less than other methods (all P<0.05). The exhaust time of the tubular instrument group was (2.6±0.2)d, which was similar to the Overlap method ( P>0.05), but earlier than the handmade anastomosis method and the reverse puncture method (all P<0.05). The incidence of anastomotic leakage in the tubular instrument group was similar to the handmade anastomosis method, the reverse puncture method, and the Overlap method (all P>0.05). There were no significant differences in postoperative hospital stay, incision infection rate, and other complications related to anastomosis between groups (all P>0.05). Conclusions:The tubular instrument anastomosis method has a shorter operation time and a smaller incision compared to traditional laparotomy surgery. It has the advantages of laparoscopic assistance with intuitive and clear visualization during the operation, while also taking into account the convenience and safety of direct visualization under laparoscopy. It is a surgical method worthy of promotion.

The incidence rate and mortality rate of gastrointestinal malignant tumor are high all over the world, which seriously affects human life and health. With the continuous popularization and deepening of the concept of transformation therapy, many clinical practices, especially some multicenter clinical studies, have proved that there are still opportunities for the treatment of some advanced tumors and can obtain good survival benefits. Moreover, in recent years, a series of changes have taken place in the fields of tumor cognition, surgical technology, diagnosis, chemotherapy and biological immunotherapy, resulting in changes in the choice of tumor treatment. This paper briefly reviews the transformation treatment of advanced gastrointestinal malignant tumors in liver metastasis, lymphatic metastasis and peritoneal metastasis in recent years, in order to make the transformation treatment more scientific and standardized in practice by summarizing the relevant research results at home and abroad.

Objective:To investigate the clinical effect of enteral nutrition support in the transformation therapy of advanced gastric cancer.Methods:Eighty-two patients with advanced gastric cancer treated by transformation in Zhejiang Provincial People′s Hospital from September 2019 to August 2021 were analyzed retrospectively. 41 patients in the observation group were treated with enteral nutrition support on the basis of routine transformation treatment; 41 patients in the control group received only routine transformation treatment. The nutritional related indexes such as prealbumin, total serum protein and albumin and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + were detected before treatment and on the 7th day after the end of 3-cycle transformation treatment, and the above indexes and transformation success rate of the two groups were compared. Results:There was no significant difference in prealbumin, total serum protein, albumin, CD4 + , CD8 + , CD4 + /CD8 + between the two groups before treatment (all P>0.05). On the 7th day after three cycles of transformation treatment, the above indexes in the observation group were higher than those in the control group, with significant difference (all P<0.05). The success rate of transformation in the observation group was higher than that in the control group ( P<0.05). Conclusions:The rational use of enteral nutrition support in the transformation treatment of patients with advanced gastric cancer can significantly improve the nutritional status and immune function of patients, increase the tolerance to chemotherapy and improve the success rate of transformation.