ObjectiveTo investigate the efficacy of laparoscopic spleen-preserving hilar lymph nodes dissection based on splenic hilar vascular anatomy.MethodsFrom July 2010 to March 2011,the clinical data of 39 patients with advanced proximal gastric cancer who underwent laparoscopic spleen-preserving hilar lymph nodes dissection at the Union Hospital of Fujian Medical University were retrospectively analyzed.Different types of vascular anatomy were analyzed,and different methods of lymph node dissection in the splenic hilus were adopted accordingly.ResultsThe operation was successfully performed on all the patients,with no conversion to open surgery or splenectomy due to splenic vascular or parenchyma injury.There were 4 types of splenic artery running,including type Ⅰ (25 patients),type Ⅱ (8 patients),type Ⅲ (4 patients) and type Ⅳ (2 patients).There were 2 types of the end branches of splenic artery,including concentrated type (28 patients) and dispersion type (11 patients).The splenic lobial vessels of all the patients were anatomically classified and divided into 4 types,including a single branch of splenic lobial vessels in 3 patients,2 branches in 24 patients,3 branches in 11 patients and multibranches in 1 patient.The mean number of short gastric vessels was 3.2 ± 1.4 (range,2-6).The time for dissection of the lymph nodes in the splenic hilum,number of lymph nodes dissected in the splenic hilum,volume of operative blood loss,duration of hospital stay and incidence of complications were ( 30 ±7)minutes,2.8 ±2.1,(20 ±7)ml (range,0-55 ml),(10 ± 1) days and 10％ (4/39).All patients were followed up until March,2012. One patient had hepatic metastasis,and no patient died postoperatively.ConclusionFamiliar with the variation of splenic hllar vascular anatomy is helpful in mastering and promoting laparoscopic spleen-preserving hilar lymph nodes dissection.

Objective To explore the efficacy and feasibility of laparoscopy-assisted radical total gastrectomy in the treatment of cancer of the cardia and fundus. Methods The clinical data of 176 patients with cancer of the cardia and fundus who received total gastrectomy at the Union Hospital of Fujian Medical University from April 2007 to April 2009 were retrospectively analysed. Among the patients, 81 received laparoscopic total gastrectomy ( LATG group) and 95 received open total gastrectomy ( OTG group). The patients' intra- and postoperative conditions, clearance of lymph nodes, morbidity and mortality were analysed using the chi-square test and t test. Results All the operations were successfully carried out. The intraoperative blood loss was (98 ± 84) ml in the LATG group and (339±245) ml in the OTG group. Three patients in the LATG group and 19 in the OTG group received blood transfusion. The time to first flatus and postoperative hospital stay were (3.9 ± 1.1) days and (13 ± 5) days in the LATG group, and (5.0 ± 1.6) days and (15 ± 5) days in the OTG group, respectively.There were significant differences in the time to first flatus and postoperative hospital stay between the LATG group and OTG group (t = 4.16, x2 = 6.82, t = 4. 57, 2. 83, P ＜ 0. 05). The mean number of lymph nodes dissected was 28 ± 12 in the LATG group and 29 ± 11 in the OTG group, with no significant differences between the two groups (t = 0. 42, P ＞0.05). The number of lymph nodes dissected in patients with T1, T2 and T3 stages were 21 ±8, 25 ±7 and 29 ± 11 in the LATG group, and 29 ± 12, 31 ±9 and 28 ± 11 in the OTG group, respectively,with no significant differences between the two groups (t = 1.53, 1.90, 0. 65, P ＞ 0.05). The morbidity and mortality rates of the LATG group were 11%( 9/81 ) and 0, and 19% ( 18/95 ) and 1% ( 1/95 ) in the OTG group, with no significant differences between the two groups (x2 = 2.07, 1.18, P ＞ 0.05). Conclusion The efficacy of laparoscopy-assisted radical total gastrectomy is similar to that of open gastrectomy. Laparoscopy-assisted radical total gastrectomy is a safe and feasible procedure that leads to quick postoperative recovery.

OBJECTIVETo explore the role of P38 signaling pathway in neonatal rat astrocyte swelling and the expression of aquaporin-4 (AQP4) after oxygen-glucose deprivation (OGD) and recovery (OGD/R).

METHODSPrimarily cultured neonatal rat astrocytes were subject to OGD for 5 h followed by oxygen-glucose recovery in the presence or absence of the P38 inhibitor SB203580 (10 µmol/L). The astrocytes were investigated at 0.5, 2, 8 and 24 h after oxygen-glucose recovery for morphological changes and cell injuries using lactate dehydrogenase (LDH) assay. The expressions of P38, P-P38, and AQP4 mRNAs and proteins in the astrocytes were detected using RT-PCR and Western blotting.

RESULTSOGD/R caused significantly enhanced expression of P-P38 protein, and this effect was blocked by SB203580. AQP4 mRNA and protein expression declined transiently at 0.5 h after OGD and increased gradually to reach the peak level at 8 h (P<0.05). Application of the SB203580 significantly lowered OGD-induced AQP4 mRNA and protein up-regulation (P<0.05). Astrocyte swelling occurred after OGD/R but was obviously lessened by SB203580. LDH release increased markedly after OGD/R, and was attenuated by treatment with SB203580 (P<0.01).

CONCLUSIONP38 signaling pathway participates in astrocyte swelling after OGD/R, and blocking this pathway can attenuate AQP4 up-regulation and ameliorate the cell swelling.

Animals ; Animals, Newborn ; Aquaporin 4 ; metabolism ; Astrocytes ; metabolism ; pathology ; Brain Edema ; metabolism ; pathology ; Cell Hypoxia ; Glucose ; pharmacology ; MAP Kinase Signaling System ; physiology ; Oxygen ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; metabolism

Objective To investigate the impact of preoperative comorbidities on the abdominal complications after laparoscope-assisted total gastrectomy (LATG) for gastric cancer.Methods The retrospective casecontrol study was conducted.The clinical data of 1 657 gastric cancer patients who underwent LATG at the Fujian Medical University Union Hospital between January 2008 and December 2015 were collected.There were 175 patients with postoperative abdominal complications,including 78 without preoperative comorbidities and 97 with preoperative comorbidities (52 with 1 comorbidity,30 with 2 comorbidities and 15 with more than 3 comorbidities).Analysis method and observation indicators:(1) risk factors analysis of abdominal complications after LATG;(2) risk assessment of abdominal complications after LATG:independent influencing factors of risk factors analysis were expressed as dependent variables,alignment diagram was built and then consistency index was calculated;(3) comparisons of abdominal complications among the patients with different kinds of comorbidities after LATG;(4) multivariate analysis of abdominal complications in patients with comorbidities after LATG;(5)follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival of patients up to May 2016.The univariate analysis and multivariate analysis were respectively done using the chi-square test and Logistic regression model.The survival rate was calculated by the Kaplan-Meier method.Results (1) Risk factors analysis of abdominal complications after LATG:results of univariate analysis showed that age,body mass index (BMI),number of preoperative comorbidities,operation time and estimated volume of intraoperative blood loss were related factors affecting abdominal complications of patients after LATG (X2 =4.487,16.602,10.361,4.567,7.482,P＜0.05).Results of multivariate analysis showed that BMI,number of preoperative comorbidities and estimated volume of intraoperative blood loss were independent factors affecting abdominal complications of patients after LATG [OR =1.966,1.204,1.423,95％confidence interval (CI):1.355-2.851,1.014-1.431,1.013-1.999,P＜0.05].(2) Risk assessment of abdominal complications after LATG:BMI,number of preoperative comorbidities and estimated volume of intraoperative blood loss were expressed as dependent variables,and the alignment diagram on risk prediction of abdominal complications after LATG was built,with a consistency index of 0.703.(3) Comparisons of abdominal complications among the patients with different kinds of comorbidities after LATG:numbers of patients without comorbidity,with 1 comorbidity,2 comorbidities and ≥3 comorbidities were detected in 21,8,13,3 patients with intra-abdominal infection and 13,10,9,5 patients with anastomotic leakage and 6,3,6,2 patients with intra-abdominal bleeding,respectively,with statistically significant differences (X2 =10.677,10.436,9.245,P＜0.05).(4) Multivariate analysis of abdominal complications in patients with comorbidities after LATG:BMI ≥25 kg/m2 and estimated volume of intraoperative blood loss ＞ 82 mL were independent risk factors affecting abdominal complications of patients with preoperative comorbidities after LATG (OR =2.104,1.771,95％ CI:1.307-3.387,1.146-2.738,P＜0.05).(5) Follow-up situations:of 1 657 patients,1 568 were followed up for 4-99 months,with a median time of 47 months.Ninety-seven patients with preoperative comorbidities undergoing LATG had postoperative abdominal complications and were followed up.During follow-up,5-year survival rate of patients was 58.1％,and 5-year survival rate of 97 patients with preoperative comorbidities undergoing LATG and with postoperative abdominal complications was 57.4％.Conclusion Preoperative comorbidities are independent factors affecting abdominal complications of patients after LATG.

Objective To observe the effects of different modes treadmill training on cognitive func-tion and transforming growth factor β1 ( TGF-β1 ) expression in cerebral cortex of rats. Methods Two months old rats were divided into the control group,piecewise training group and intermittent training group ( n=10 in each group) . The training was performed five times a week for 6 weeks. Learning and memory a-bility of all rats was detected by water maze at 6 weeks after the training. TGF-β1 expression and localization in cerebral cortex was tested by QRT-PCR and immunofluorescence, respectively. Results The platform time in piecewise group ((30±28) s) and intermittent group ((25±23)s) was both significantly shorter than that in control group ((58±50)s). In the space exploration,the time around Ⅳ quadrant platform in piecewise group((23.6±3.9)s) and intermittent group ((24.3±8.9)s) was significantly higher than that in the control group((17.7±2.0)s). The expression of TGF-β1 mRNA in cerebral cortex in intermittent group (0.0067±0.0043)was obviously higher than that in piecewise group (0.0035±0.0006) and control group (0.0041±0.001). TGF-β1 was located in cell membrane and cytoplasm,and the relative optical density of intermittent group (0.0045±0.0017) was significantly higher than that of control group (0.0019±0.0004) and staging group (0.00175±0.00045). Conclusion (1)Learning and memory function both were im-proved after treadmill six weeks with piecewise and intermittent training models. ( 2) The level of TGF-β1 gene and protein was significantly increased after interval training in cortex of rats.

Objective:To observe the influence of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) 4 inhibitors on epithelial-mesenchymal transition (EMT) of human retinal pigment epithelial (RPE) cells induced by bevacizumab.Methods:The cultured ARPE-19 cells were divided into blank control group, bevacizumab group, bevacizumab+ VAS2870 group and bevacizumab+ GKT137831 group.Cells were cultured with 0.25 g/L bevacizumab, 0.25 g/L bevacizumab plus 3 μmol/L VAS2870 (a NOX4 inhibitor), 0.25 g/L bevaczumab plus 20 μmol/L GKT137831 (a NOX4 inhibitor) for 72 hours according to grouping.No intervention was administered to the blank control group.The mRNA and protein expression levels of NOX4 and EMT markers including fibronectin (FN), vimentin, α-smooth muscle actin (α-SMA) and tight junction related protein zonula occludens-1 (ZO-1) were measured by real-time PCR and Western blot assay, and the expression levels in different intervention groups were compared.The expressions of NOX4 and EMT markers were verified by immunofluorescence staining.Results:There were statistically significant differences in the relative mRNA and protein expression levels of FN, vimentin, α-SMA, ZO-1 and NOX4 among blank control group, bevacizumab group, bevacizumab+ VAS2870 group and bevacizumab+ GKT137831 group (mRNA: F=97.07, 195.40, 722.40, 38.56, 70.81; all at P<0.001.Protein: F=23.09, 64.58, 58.19, 26.97, 63.19; all at P<0.001). The relative mRNA and protein expression levels of FN, vimentin, α-SMA and NOX4 were significantly higher and the relative mRNA and protein expression level of ZO-1 was significantly lower in bevacizumab group than those in blank control group (all at P<0.05). The relative mRNA and protein expression levels of FN, vimentin, α-SMA and NOX4 were significantly lower and the relative mRNA and protein expression levels of ZO-1 were significantly higher in bevacizumab+ VAS2870 and bevacizumab+ GKT137831 groups than those in bevacizumab group (all at P<0.05). The immunofluorescence intensity of FN, vimentin and α-SMA was stronger and the immunofluorescence intensity of ZO-1 was weaker in bevacizumab group than blank control group.The immunofluorescence intensity of FN, vimentin and α-SMA were weaker and the immunofluorescence intensity of ZO-1 was stronger in bevacizumab+ VAS2870 group and bevacizumab+ GKT137831 group than those in bevacizumab group. Conclusions:NOX4 is involved in the bevacizumab-induced EMT of human RPE cells, the degree of which can be reduced by NOX4 inhibitors.

OBJECTIVETo investigate the efficacy of laparoscopic surgery in the treatment of gastrointestinal stromal tumors (GIST) in different anatomical locations.

METHODSClinical data of 133 patients with primary gastric GIST undergoing laparoscopic resection at our department from January 2006 to December 2014 were retrospectively analyzed. These patients were divided into favorable site group (F group, 90 cases), including gastric fundus, anterior wall and greater curvature of gastric body, and unfavorable site group (UF group, 43 cases),including gastroesophageal junction, posterior wall and lesser curvature of gastric body,antrum and pylorus, according to the 2014 version National Comprehensive Cancer Network Clinical Guidelines. Short-term and long-term efficacy between the two groups was compared.

RESULTSThere were no significant differences between the two groups in the general clinicopathological parameters (all P>0.05). The operation time of F group and UF group was (107.3±52.3) min and (119±53.4) min respectively (P=0.21). The blood loss in F group and UF group was (35.2±34.2) ml and (35.2±31.2) ml respectively (P=1.00). In addition, there were no significant differences in time to first fluid diet, time to first flatus, postoperative hospital stay and hospitalization expenses between the two groups(all P>0.05). In F group and UF group, morbidity of postoperative complication was 6.7%(6/90) and 4.7%(2/43) respectively (P=0.72), morbidity of category I(-II( complication was 4.4%(4/90) and 2.3%(1/43) respectively (P=0.66),and morbidity of category III(-IIII( complication was 2.2%(2/90) and 2.3% (1/43) respectively (P=1.00). Median follow-up time of all the cases was 36(1 to 84) months. The 5-year overall survival rates of F group and UF group were 93.8% and 95.2% respectively, and 5-year relapse-free survival rates were 81.1% and 89.4% respectively, without significant differences(both P>0.05).

CONCLUSIONLaparoscopic operation for gastric GIST in unfavorable sites can yield similar short- and long-term outcomes compared with those in favorable sites.

Adult ; Esophagogastric Junction ; Gastrectomy ; Gastrointestinal Stromal Tumors ; surgery ; Humans ; Laparoscopy ; Length of Stay ; Neoplasm Recurrence, Local ; Operative Time ; Postoperative Complications ; Postoperative Period ; Pylorus ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Survival Rate ; Treatment Outcome

OBJECTIVETo explore the prognostic assessment value of preoperative blood platelet-lymphocyte ratio (PLR) in patients with gastric mixed adenoneuroendocrine carcinoma (gMANEC) treated with radical surgery.

METHODSClinical and pathological data of 84 gMANEC patients who underwent radical resection from 2006 to 2016 in Department of Gastric Surgery, Fujian Medical University Union Hospital were analyzed retrospectively. Receiver operating characteristic (ROC) curve analysis was performed to determine the cutoff value of the PLR for predicting prognosis. The Cox proportional hazards regression model was used to identify prognostic factors of gMANEC.

RESULTSAll the patients underwent D2 lymph node dissection, including 26 cases of distal subtotal gastrectomy and 58 cases of total gastrectomy. The postoperative pathological TNM stage system(pTNM) demonstrated that the patients of stage I(, II(, and III( were 9(10.7%), 14(16.7%), and 61(72.6%) cases, respectively. The median follow-up time was 40(3 to 96) months. The recurrence rate was 41.7%(35/84). The median time to recurrence was 10 (1 to 40) months, and 82.9%(29/35) patients experienced recurrence within the first 2 years after operation. The median overall survival time was 27(3 to 39) month, and the median recurrence-free survival time was 21 (1 to 96) months. The 1-, 3-, and 5-year overall survival(OS) rates were 87.6%, 56.6%, and 47.4%, respectively, and the 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 70.5%, 50.7%, and 44.9%, respectively. The best cutoff value of the PLR for predicting prognosis was 133 through ROC curve, which categorized all the patients into low PLR group (≤133) comprising 28 patients and high PLR group (>133) comprising 56 patients. The tumor recurrence rate was significantly higher in high PLR group (50.0%, 28/56) than that in low PLR group(25.0%, 7/28)(P=0.028). The live metastasis rate was significantly higher in high PLR group(35.7%, 20/56) than that in low PLR group(10.7%, 3/28)(P=0.015). Cox regression analysis showed that only pTNM stage (P=0.003) was independent prognostic factors of OS, while both pTNM stage (P=0.000) and blood PLR (P=0.015) were independent prognostic factors of RFS.

CONCLUSIONgMANEC patients with high preoperative PLR tend to present recurrence and metastasis, especially to present live metastasis, so they should be kept under surveillance more frequently after surgery.

Blood Platelets ; Carcinoma ; Female ; Gastrectomy ; Humans ; Lymph Node Excision ; Lymphocyte Subsets ; Lymphocytes ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neuroendocrine Tumors ; pathology ; therapy ; Prognosis ; Proportional Hazards Models ; ROC Curve ; Retrospective Studies ; Stomach Neoplasms ; pathology ; therapy

OBJECTIVETo explore the feasibility and efficacy of laparoscopic D2 radical gastrectomy in patients with gastric neuroendocrine carcinoma (GNEC).

METHODSClinical data of 84 patients with GNEC undergoing laparoscopic D2 radical gastrectomy in Union Hospital from January 2006 to December 2012 were analyzed respectively. Among these patients, 44 cases underwent laparoscopic D2 gastrectomy (LAG group) and 40 cases underwent open gastrectomy (OG group). The short- and long-term outcomes, 3-year survival and recurrence-free survival were compared between two groups.

RESULTSThe LAG group and OG group did not differ significantly in terms of clinicopathologic characteristics. All the patients completed operations successfully and no patients in the LAG group ware converted to laparotomy. The operative time was similar (P>0.05). As compared to OG group, LAG group had less intra-operative blood loss [(85±21) ml vs. (192±89) ml, P=0.003], lower ratio of transfusion [2.3%(1/44) vs. 15.0%(6/40), P=0.048], shorter time to ambulation after surgery [(2.5±1.1) days vs. (3.5±1.1) days, P=0.001], faster postoperative gastrointestinal function recovery [(2.9±1.1) days vs. (5.1±1.0) days, P=0.001], shorter time to resume soft diet [(4.1±1.2) days vs. (5.7±1.3) days, P=0.001] and shorter postoperative hospital stay [(12.0±3.4) days vs. (15.0±5.5) days, P=0.002]. No significant difference was observed in average dissected lymph node number between LAG and OG group (35.0±16.4 vs. 31.6±12.1, P=0.204). Morbidity of postoperative complication of LAG group and OG group was 11.4%(5/44) and 17.5%(7/40) respectively (P=0.422). The overall 3-year survival rate was 54.0% for all the patients, while 3-year survival rate was 56.3% in LAG group and 51.4 % in OG group (P=0.478). In addition, there was no significant difference in recurrence-free survival between the two group (33.0 months vs. 31.5 months, P=0.703).

CONCLUSIONCompared with open gastrectomy, laparoscopic D2 radical gastrectomy has the advantages of faster recovery and less blood loss, and similar short-term and long-term outcomes in treatment of patients with GNEC, thus it is a safe and feasible treatment for GNEC.

Blood Loss, Surgical ; Carcinoma, Neuroendocrine ; surgery ; Female ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Lymph Node Excision ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; Postoperative Period ; Stomach Neoplasms ; surgery ; Survival Rate ; Treatment Outcome

Objective: To investigate the clinical efficacy of Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer. Methods: The retrospective cross-sectional study was conducted. The clinicopathological data of 47 patients with gastric cancer who were admitted to Fujian Medical University Union Hospital from September 2016 to June 2018 were collected. There were 37 males and 10 females, aged from 23 to 75 years, with an average age of 60 years. Patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) postoperative pathological examination; (4) follow-up. Follow-up was conducted by outpatient examination and telephone interview to detect postoperative survival of patients up to September 2018. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were expressed by M (range). Count data were represented as absolute numbers. Results: (1) Intraoperative situations: 47 patients underwent Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer, without conversion to open surgery. The operation time, hilar lymph node dissection time, volume of intraoperative blood loss, number of lymph node dissected, number of splenic hilar lymph node dissected, number of metastatic lymph nodes, number of metastatic splenic hilar lymph node were (225±36) minutes, (20±6) minutes, (40±27) mL, 40 (range, 17-112), 2 (range, 0-10), 2 (range, 0-29), 0 (range, 0-3). (2) Postoperative situations: time to first out-of-bed activities, time to first anal flatus, time to gastric tube removal, time to initial liquid diet intake, time to initial semi-liquid diet intake, time to drainage tube removal, and duration of postoperative hospital stay were (2.0±0.3)days, (3.4±0.9)days, (3.4±1.1)days, (4.8±1.0)days, (6.7±1.5)days, (8.5±2.5)days, and (12.0±8.3)days, respectively. Of 47 patients, 3, 2, 1, 1, and 1 were detected pulmonary infection, abdominal bleeding, anastomotic fistula, postoperative intestinal obstruction, and abdominal infection. There were 1, 5, and 2 patients with complications in grade Ⅰ, Ⅱ, and Ⅲ of Clavien-Dindo classification. There was no death in the postoperative 30 days. Two patients with abdominal bleeding were cured by intervene therapy, and patients with other complications were cured by conservative treatment. (3) Postoperative pathological examination: tumor diameter, cases with nodal or vascular or neural invasion, cases with differentiated and undifferentiated tumor (histological differentiation), cases in T1, T2, T3, T4 stages (T staging), cases in N0, N1, N2, N3 stages (N staging), cases in Ⅰ, Ⅱ, Ⅲ stages (TNM staging) were (4.2±1.6)cm, 26, 31, 16, 5, 22, 17, 3, 18, 9, 8, 12, 13, 20, 14, respectively. (4) Follow-up: 47 patients were followed up for 3-25 months, with a median time of 9 months. During the follow-up, 3 of 47 patients died of tumor recurrence, 1 had tumor-bearing survival, and 43 had tumor-free survival. Conclusion Da Vinci robotic total gastrectomy combined with spleen-preserving splenic hilar lymphadenectomy for gastric cancer is safe and feasible.