OBJECTIVETo investigate the effect of operative time on laparoscopy-assisted distal gastrectomy (LADG) with D2 lymph node dissection and the influencing factors of operative time.

METHODSClinical data of 332 patients with gastric cancer undergoing LADG with D2 lymph node dissection from January 2007 to December 2010 were analyzed retrospectively. The average operative time was (205±56) minutes. Operative indices and postoperative recovery were compared between patients with operative time≥205 min (long-time group) and operative time<205 min (short-time group).

RESULTSThe mean blood loss [(81.0±65.7) ml vs. (65.8±55.0) ml], time to ambulation [(3.1±1.7) d vs. (2.3±1.2) d], time to first flatus [(3.8±1.1) d vs. (3.2±1.3) d], postoperative hospital stay [(14.2±6.3) d vs. (12.5±7.0) d], and postoperative complication [16.0% (19/119) vs. 8.5% (18/213)] between long-time group and short-time group were significantly different (all P<0.05), while there were no significant differences in transfused patients, time to resume soft diet, and mortality (all P>0.05). Multivariate logistic regression analysis revealed that BMI (P<0.01), lymph node metastasis (P<0.05), and surgeon experience (P<0.01) were independent risk factors for operation time.

CONCLUSIONSurgeons who have limited experience in LADG with D2 lymph node dissection should operate on patients with low BMI and less lymph node metastasis in order to reduce postoperative complications.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Operative Time ; Retrospective Studies ; Stomach Neoplasms ; surgery

OBJECTIVETo explore the feasibility and safety of extraluminal laparoscopic wedge resection(ELWR) surgery for gastrointestinal stromal tumors (GIST) in the stomach.

METHODSThe clinical data of 31 patients with gastric GIST undergoing ELWR from July 2007 to June 2011 were analyzed retrospectively.

RESULTSThere were 19 males and 12 females with a mean age of 65.5 years old. Locations of the tumor included fundus of the stomach (n=22) and anterior wall (n=9). The mean diameter was (3.3±1.5) cm (range 1.5 to 5 cm). All the procedures were performed successfully without conversion to open operation. The mean operative time of ELWR was (54.1±6.2) min (range 45 to 65 min), the mean intraoperative blood loss was (35.2±10.5) ml (range 15 to 55 ml), the mean recovery time was (1.5±0.2) d (range 3 to 6 d) and the mean postoperative hospital stay was (4.5±1.0) d. No patient experienced complications postoperatively. The entire cohort were followed up for 4 to 48 months (mean 18.8 months) and no recurrence or metastasis was found.

CONCLUSIONELWR for gastric GIST is technically feasible and safe.

Adult ; Aged ; Aged, 80 and over ; Female ; Gastrectomy ; methods ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome

OBJECTIVETo investigate the expression of microRNA-183 (miR-183) and Ezrin protein in stage II( gastric cancer (GC).

METHODSSpecimens of stage II( GC and paracancer tissues (5 cm away from the tumor tissues) were collected from 72 patients. Real-time PCR was used to detect the miR-183 expression. Immunohistochemistry was used to examine the Ezrin protein expression in the tumor tissue. The associations of miR-183 expression with the clinicopathologic features of stage II( GC and Ezrin expression were analyzed.

RESULTSmiR-183 expression was lower in stage II( gastric cancer tissues compared with the paracancer tissues samples(median relative expression, 0.676 vs. 1.000, P<0.05). Low expression of miR-183 was significantly associated with histological differentiation(0.429 vs. 0.907, P<0.05), lymph node metastasis(0.507 vs. 0.908, P<0.05). The survival was shorter in patient with low expression of miR-183(63.0±4.0) as compared to those with high expression of miR-183(75.2±3.8)(P<0.05). There was a negative correlation between the expression of miR-183 and Ezrin(r=-0.272, P<0.05).

CONCLUSIONSmiR-183 is down-regulated in stage II( GC, and associated with the differentiation, metastasis, and prognosis. Ezrin is a potential regulatory protein of miR-183.

Adult ; Aged ; Aged, 80 and over ; Cytoskeletal Proteins ; metabolism ; Female ; Humans ; Male ; MicroRNAs ; genetics ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms ; genetics ; metabolism ; pathology

OBJECTIVETo report the diagnosis and treatment experience of pediatric gastric cancer.

METHODSClinicopathological data of a girl with gastric carcinoma in December 2011 was analyzed retrospectively. The literatures were reviewed. The disease onset, clinical manifestations, treatment, and prognosis of the patient with gastric carcinoma were studied.

RESULTSThe patient was a 12-year-old girl, and the tumor was located in greater curvature. The girl underwent laparoscopy-assisted radical total gastrectomy (D2). Pathological examination showed gastric ulcerative signet-ring cell cancer (pT4N0M0, stage II b). The outcome at the recent follow up was satisfactory. Literature review demonstrated 15 cases of pediatric gastric carcinoma, of whom 7 were boys and 8 girls. Their average age was 12.7 years (2.5-17.8 years). Tumor locations included cardia (n=5), gastric body (n=1), gastric antrum or stomach corner (n=4), gastric antrum and gastric body (n=1), and unknown (n=4). Histology showed signet-ring cell cancer in 4 patients, poorly differentiated in 6, moderate to poorly differentiated and moderate differentiated adenocarcinoma in 2. Operation was performed in 11 cases and perioperative chemotherapy in 8 cases. Nine patients had follow-up. Four patients died within 6 months and other 4 patients survived for 6 months to one year. The survival time of one patient who underwent radical surgery and perioperative chemotherapy was 102 months.

CONCLUSIONSPediatric gastric carcinoma is extremely rare. It is highly malignant and associated with poor prognosis. Radical surgery is the most important treatment. Perioperative chemotherapy may improve the prognosis.

Adolescent ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; therapy

OBJECTIVETo investigate the clinicopathologic features and prognosis of gastric cancer in young patients (YGC) in order to improve the treatment outcome of YGC.

METHODSClinical data of 63 YGC patients (40 years of age and less) who underwent surgery from January 2004 to December 2006 were analyzed retrospectively. A total of 654 older gastric cancer patients (OGC, above 40 years) during the same period patients were selected and compared to the YGC patients.

RESULTSThe proportions of female patients, patients with a family history or with undifferentiated tumor in YGC were significantly higher than OGC (all P<0.05). The curative resection rate of YGC patients was 61.9% (39/63), significantly lower than that of OGC (93.1%, 595/654, P<0.01). A total of 653 (91.1%) patients were followed up, with a period of time of 1 to 84 months. The 5-year survival rates for YGC and OGC patients were 40.5% and 55.6% respectively, and the difference was statistically significant (P<0.05). Cox proportional hazards model showed that the depth of invasion, lymph node metastasis, and radical surgery were the independent factors associated with the prognosis of YGC (all P<0.05). The stratified analysis showed that the 5-year survival rates for YGC and OGC patients undergoing radical surgery were 63.2% and 56.7% respectively and the difference was not statistically significant (P>0.05). The 5-year survival rates for YGC and OGC patients undergoing palliative surgery were 4.2% and 22.2% respectively and the difference was statistically significan t(P<0.05).

CONCLUSIONGastric cancer in young patients is highly malignant, with lower rate of curative resection and poorer prognosis. The long-term outcome of YGC is similar to that of OGC if radical resection is possible.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; diagnosis ; pathology ; surgery ; Survival Rate ; Treatment Outcome ; Young Adult

RHD gene has different alternative transcripts. This study was aimed to construct expression vector of normal mRNA, DEL9 and DEL89 transcripts from RHD gene. Total RNA was extracted from Rh(D) positive umbilical blood cells of newborn. Intact RhD cDNA, DEL9 and DEL89 transcripts were obtained by one-step and two-step RT-PCR, respectively. The obtained products were cloned into pCR4 TOPO sequencing vector for choosing the right transcript. RHD gene was amplified again from the sequencing plasmid DNA, and then subcloned into pcDNA3.1/V5-His TOPO expression vector; DEL9 and DEL89 were cloned into the expression vector directly. Gene sequence and direction were identified by sequencing. The results showed that the sequence and direction of target genes were right, thus these 3 different expression vectors were correctly constructed. It is concluded that expression vector is constructed from different transcripts of RHD gene, which lays a foundation for further exploring the membranous protein expression of Rh(D) antigen.
Cloning, Molecular ; Gene Expression ; Genetic Vectors ; Humans ; Molecular Sequence Data ; RNA, Messenger ; genetics ; Rh-Hr Blood-Group System ; genetics ; Sequence Analysis, DNA

AIMTo study the chemical constituents of Tripterygium wilfordii Hook. F.

METHODSVarious column chromatographies with silica gel were used for the isolation and purification. The structures of compounds were established on the basis of its IR, MS, UV, 1H NMR, 13C NMR and HRMS, 1H-1H COSY, 1H-13C COSY and NOESY.

RESULTSFour diterpenoids were isolated: 16-hydroxytriptolide (I), triptolidenol (II), tripdiolide (III), 2-epitripdiolide (IV).

CONCLUSIONCompound IV is a new diterpenoid.

Diterpenes ; chemistry ; isolation & purification ; Molecular Structure ; Plant Roots ; chemistry ; Plants, Medicinal ; chemistry ; Tripterygium ; chemistry

Ex vivo maintainance of human stem cells is crucial for many clinical applications. Current culture conditions provide some level support but cytokines induce most quiescent stem cells to proliferate and differentiate. Better control of primitive cells is needed to extend the time and range of manipulation of such cells. A recently identified plant lectin Flt3 receptor-interacting lectin (FRIL) present may a special ability to preserve primitive CB progenitors for extended periods in culture without exogenous cytokines. But the mechanisms of FRIL preserving quiescent primitive cells are still unknown. Recently a novel protein HTm4 and its alternatively spliced variant HTm4S, which serve as hematopoietic cell cycle regulators, have been identified. In this report we studied the effect of FRIL on the in vitro maintenance of quiescent human cord blood stem cells and the expression of the novel hematopoietic cell cycle regulator HTm4 and HTm4S in progenitor cells cultured in FRIL. We analyzed the proliferation and the HPP-CFC proportion of CD34(+) cells treated with FRIL. The human HTm4 and HTm4S mRNA expression was detected by semi-quantitative RT-PCR, and the cell cycle status of CB CD34(+) cells was analyzed by FACS. The results showed that incubation of CD34(+) cells in FRIL resulted in a low proliferation of progenitor cells and fewer cycling cells, but FRIL selectively maintained a higher number of primitive cells with proliferative potential in suspension culture. CB CD34(+) cells cultured in FRIL showed significant diversity in the expression of HTm4 and HTm4S during 0~14 d. On d 0, HTm4 was detected at high level, downregulated on d 1, but upregulated during d 3 to d 14, and reaching the highest level on d 7. But the expression levels of HTm4S changed little in the cells cultured in FRIL except the obviously increased expression on d 7. Exogenous expression showed that HTm4 was localized around the karyon while HTm4S scatted in the cytoplasm, respectively, which may be responsible for their difference in function. Thus, FRIL can preserve quiescent primitive CD34(+), and FRIL's ability to preserve quiescent primitive cells in a reversible manner may significantly expand the time and range of ex vivo manipulations of human stem cells for clinical applications. In other words, HTm4 and HTm4S may play a crucial role in the cell cycle modulation of CD34(+) progenitor cells maintained with FRIL in vitro.
Antigens, CD20 ; biosynthesis ; genetics ; Antigens, CD34 ; metabolism ; Cell Cycle ; Cell Cycle Proteins ; biosynthesis ; genetics ; Cell Separation ; Cells, Cultured ; Fetal Blood ; cytology ; Hematopoietic Stem Cells ; cytology ; Humans ; Mannose-Binding Lectins ; pharmacology ; Membrane Proteins ; biosynthesis ; genetics ; Plant Lectins ; pharmacology

OBJECTIVETo investigate the impact of solitary lymph node (LN) metastasis on the prognosis of gastric cancer.

METHODSClinical data of 280 patients with gastric cancer who underwent D(2) radical resection from January 1995 to December 2003 were analyzed retrospectively. Among them, solitary LN metastasis was proven pathologically in 83 cases(solitary LN metastasis group), while node-negative metastasis proven in 197 cases (node-negative group). The 5-year survival rate was compared between two groups and between patients with and without skipping LN metastasis. The prognostic factors were evaluated by uncaria and multivaria analyses.

RESULTSThe 5-year survival rates in the solitary LN metastasis group and the node-negative group were 62.3% and 83.5% respectively with significant difference (P<0.05). The solitary LN metastasis was one of the independent prognostic factors. Logistic regression revealed that the invasion depth was an independent covariate for solitary LN metastasis. The proportion of skip metastasis was 22.9% in gastric cancer patients with solitary LN metastasis. The 5-year survival rates of the patients with and without skipping LN metastasis were 50.0% and 66.1% respectively, which was not significantly different (P>0.05).

CONCLUSIONSThe prognosis of patients with solitary LN metastasis is significantly poorer than those without lymph node metastasis. Due to the high incidence of skip LN metastasis in gastric cancer, D(2) radical resection should be performed to ensure oncological clearance.

Aged ; Factor Analysis, Statistical ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; pathology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; mortality ; pathology ; Survival Rate

OBJECTIVETo investigate the expression of tumor stem cell surface marker CD44 in gastric cancer and its clinical value.

METHODSExpressions of CD44 protein family, including CD44s, CD44v5 and CD44v6, in gastric cancer and peritumoral tissues specimens were detected by immunohistochemistry in 156 patients with gastric cancer from December 2006 to December 2007. Associations of CD44 family expressions with of clinicopathological parameters and prognosis in gastric cancer patients were examined.

RESULTSThe positive rates of CD44s expression in gastric cancer and peritumoral tissues were 50.0%(78/156) and 40.3%(63/156) respectively(P>0.05). The positive rates of CD44v5 and CD44v6 expression in gastric cancer were 49.3% and 63.4%, significantly higher than those in peritumoral tissues(7.6% and 0 respectively, all P<0.05). There were no positive correlations among the expression levels of CD44s, CD44v5 and CD44v6(all P>0.05). High expression rate of CD44s was associated with depth of invasion, lymph node metastasis and TNM stages. CD44v5 expression was only associated with depth of invasion. CD44v6 expression was associated with depth of invasion, lymph node metastasis, TNM stages and Lauren classification. The 5-year survival rates in the positive and negative groups of CD44s, CD44v5 and CD44v6 expressions were 35.8% and 52.5%(P<0.05), 38.9% and 49.3%(P>0.05), 26.2% and 75.4%(P<0.05) respectively. Only the CD44v6 expression was an independent prognostic factor for gastric cancer(RR=1.931, 95%CI:1.183-3.152).

CONCLUSIONCD44 plays an important role in invasion and lymph node metastasis, and may serve as potential predictors of prognosis in gastric cancer.

Biomarkers, Tumor ; metabolism ; Humans ; Hyaluronan Receptors ; metabolism ; Immunohistochemistry ; Lymphatic Metastasis ; Neoplasm Staging ; Neoplastic Stem Cells ; metabolism ; Prognosis ; Stomach Neoplasms ; metabolism ; pathology