Anastomotic leakage is a serious complication in colorectal surgery;The healing of intestine is still the hot spot of current research.Methods of estimating intestinal healing mainly include mechanical,biochemical,immunohistochemical and hitological Method.The estimating parameters mainly Comprise bursting pressure,breaking strength,the amount of collangen and matrix metalloproteinase(MMP),and the scale for histology.The measurement of collagen and MMP is the nost import ant index for estimating healing of intestinal anastomoses.Collagen is the most abundant extracellular matrix protein that determines the mechanical stability of the connective tissue during wound healing.Collagen degradation is usually the result of the synergistic action of several MMPs.

Objective To compare the healing ability differences between left colonic anastomosis and right colonic anastomosis in rats, in order to find a theoretical basis for the surgical management of colon resection. Methods Forty male Wistar rats were randomly divided into two groups: group A (end-to-end anastomosis of right colon, n=20), and group B (end-to-end anastomosis of left colon, n=20). Half of the rats in each group were sacrificed on the fourth day after operation, and the rest on the seventh day. The expressions of matrix metalloproteinase-1 (MMP-1), MMP-13 and collagen type Ⅰ were shown by immunohistochemical staining, and the histopathologic changes at the anastomosis were also demonstrated. Results The expression of MMP-1, MMP-13 at left colonic anastomosis was higher than that of MMP-1, MMP-13 at right colonic anastomosis, the expression of collagen type Ⅰ was lower than that of collagen type Ⅰ at right colonic anastomosis on the fourth day (P<0.05); The expression of MMP-1 at left colonic anastomosis was higher than that of MMP-1 at right colonic anastomosis, the expression of collagen type Ⅰ was lower than that of collagen type Ⅰ at right colonic anastomosis on the seventh day (P<0.05). Conclusions The healing ability of right colonic anastomosis is higher than that of left colonic anastomosis.

BACKGROUND:Stromal cel derived factor-1 is a smal molecular protein with a wide range of biological activity that can cause immune cel chemotaxis, and it also has a chemotactic effect on bone marrow stem cels and periodontal ligament cels.
OBJECTIVE:To investigate the effect of stromal cel derived factor-1 with different concentrations on the proliferation of bone marrow stem cels and to probe the best concentration.
METHODS:Bone marrow stem cels from beagle dogs were culturedin vitro and stimulated by different concentrations of stromal cel derived factor-1 (100, 200, 300 μg/L). MTT was used to detect the influence of stromal cel derived factor-1 on the proliferation of bone marrow stem cels so as to screen the best concentration of stromal cel derived factor-1. Then, stromal cel derived factor-1 at the best concentrations was used to intervene the bone marrow stem cels, and MTT was used again to detect the proliferation of bone marrow stem cels.
RESULTS AND CONCLUSION:Stromal cel derived factor-1 at concentrations of 100, 200, 300 μg/L could promote the proliferation of bone marrow stem cels, and the effect was more notable at 200 and 300 μg/Lbut withno significant difference. Therefore, 200 μg/L was considered to be the best concentration of stromal cel derived factor-1 for intervention of bone marrow stem cels. Compared with the blank control group, 200 μg/L stromal cel derived factor-1 could significantly promote the proliferation of bone marrow stem cels. Taken together, stromal cel derived factor-1 can promote the proliferation of bone marrow stem cels, and its best concentration is 200 μg/L.

AIM:To prepare the Lyophiled Royal Jelly Soft Capsule and study its stability and Influential factors.METHODS:The suspending agent and processing method were optimized using sedimentation volume rate as the index.Soft capsules were prepared and product stability under high temperature and high humidity environment was studied according to the determination of the content of 10-HAD by HPLC.RESULTS:The finished product yield in pilot test was more than 90%,the soft capsule products stored in cold were stable,while those stored under room temperature or high temperature and high humidity were unstable with a noticeable decrease in quality.Water content in capsule shell affects the 10-HDA content of the finished product.CONCLUSION:The preparative process is feasible and the products should be storaged in cold enviroment.

Objective To explore the effect of TNF-αon expression of TROP-2 and to explore the role of TROP-2 in the metastasis and invasion of colon cancer HCT-116 cells. Methods HCT-116 cells were cultured and treated with 0, 10, 20, 30, 50, 100 and 200μg/L TNF-α. Cell viability was assessed by MTT. The expression of TROP-2 was determined by western blot. The effects of 20μg/L TNF-αon cell migration and invasion were investigated by wound healing assay and Transwell method. Small interfering RNA (siRNA) was used to knock down endogenous TROP-2 expression. The transcrip?tion and translation levels of TROP-2 were detected by qPCR and Western blot respectively. The migratory and invasive ca?pability of HCT-116 cells transfected with TROP-2 siRNA were checked by wound healing assay and Transwell method re?spectively. Results There is no significant change of cell viability between HCT-116 cells treated with 0,10, 20, 30 and 50μg/L TNF-α, but cell viability of HCT-116 decreased significantly with treatment of 100μg/L and 200μg/L TNF-α. Low concentration of TNF-α(≤50μg/L) led to increase of TROP-2 protein expression that peaks when 20μg/L TNF-αwas add?ed. High concentration of TNF-α(100, 200μg/L) result in decrease of TROP-2 protein. TROP-2 siRNA significantly down-regulated the expression of TROP-2 at both mRNA and protein levels in colon cancer HCT-116 cells. Compared with con?trol group, silencing TROP-2 by TROP-2 siRNA inhibited the migratory and invasive capability of HCT-116 cells. Wound healing rate and the number of transwell cell both decreased in siRNA group compared with those of control group ( P <0.05). Conclusion The mechanism that low concentration of TNF-α promoted HCT-116 cells migration and invasion might be through up-regulating the expression of TROP-2.

BACKGROUND:Studies have found that epithelial-mesenchymal transition is closely related with tumor invasion, metastasis, and drug resistance, but studies on the role of epithelial-mesenchymal transition in the transformation process of gastric cancer cels SGC7901 to gastric cancer stem-like cels are rarely reported.
OBJECTIVE: To explore the effect of epithelial-mesenchymal transition in the transformation process of gastric cancer cels SGC7901 to gastric cancer stem-like cels.
METHODS:Vincristine-induced SGC7901 cels were cultured and screened to prepare gastric cancer stem-like cels. CD44 phenotype, morphological changes, stem cel-related markers, and epithelial-mesenchymal transition related molecules were detected.
RESULTS AND CONCLUSION:After passage, vincristine-induced SGC7901 cels presented with morphological changes, and clonal cel spheres generated after serum-free suspension culture. Meanwhile, the proportion of SGC7901 cels positive for CD44 was decreased. Expression levels of SOX2, OCT4, Snail1 mRNA, Twist mRNA and Vimentin mRNA were significantly higher in the gastric cancer stem-like cels than SGC7901 cels, but the expression level of E-caderin was lower in the gastric cancer stem-like cels than SGC7901 cels. These findings indicate that gastric cancer cels SGC7901 can be successfuly transformed into gastric cancer stem-like cels, and the epithelial-mesenchymal transition is involved in this transforming progress.

Objective To retrospectively analyze the therapeutic effect of ligaturing pericardial blood vessel combined splenectomy for treating children with gastrointestinal bleeding and hypersplenism secondary to cavernous transformation of portal vein (CTPV).Methods Retrospectively analyzed 30 cases of children with CTPV admitted by Beijing Children's Hospital in General Surgery Department from Jan.2005 to Dec.2012,and evaluated the clinical efficacy of ligaturing pericardial blood vessel combined splenectomy for treating children with gastrointestinal bleeding and hypersplenism secondary to CTPV.Results All of 30 cases admitted operation without serious complication.All children admitted follow-up from 6 to 60 months.Seven cases of 22 patients with gastrointestinal bleeding relapsed bleeding post operation and were cured by conservative treatment.Four cases of 7 relapsing bleeding children had NSAID.All cases of 8 children with simple hypersplenism suggested normal results of blood routine post operation,2 children occurred bloody stools who were cured by conservative treatment.None of patients had serious infection correlating with splenectomy.The size of spleen of patients with gastrointestinal bleeding is larger than patients with simple hypersplenism.Conclusions (1) Ligaturing pericardial blood vessel combined splenectomy is a good choice for children with gastrointestinal bleeding and hypersplenism secondary to CTPV.(2) NSAID may increase the recurrence rate of gastrointestinal bleeding post operation.(3) There may be a negative correlation between the size of spleen and the risk of gastrointestinal bleeding for children with CTPV.

Objective To examine whether the boundary patterns of the superior mesenteric artery (SMA) in the preoperative contrasted enhanced computer tomography (CE-CT) could predict poor postoperative prognosis.Methods From January 2010 to December 2015,104 patients of pancreatic head ductal adenocarcinoma received radical pancreaticoduodenectomy by a single group of surgeons.All patients underwent CE-CT before operation.The clinicopathological characteristics and the prognosis were comparatively analyzed among the patients with different SMA boundary patterns.Results The patients with obscure SMA boundary in CE-CT had a lower overall survival rate (P =0.012) and a higher liver metastasis rate (P ＜ 0.01) compared to the patients with clear SMA boundary.38.2％ of patients with obscure SMA boundary died within 6 months,69.1％ of them died within 12 months while the mortality rate was 6％ within 6 months and 29.2％ within 12 months in patients with clear SMA boundary.Only 2.2％ of patients with clear SMA boundary presented liver metastasis within 6 months,but that was 53％ in patients with obscure SMA boundary.18.4％ of patients developed liver metastasis within 12 months in patients with clear SMA boundary,whereas the rate was 82％ in patients with obscure SMA boundary.Furthermore,the tissues around the SMA presented a higher CT value in any phase in patients with obscure SMA boundary than in patients with clear SMA boundary (P ＜ 0.01).Conclusions The patterns of the SMA boundary in CE-CT is a potential prognostic factor in pancreatic head ductal adenocarcinoma after radical operation,and the obscure SMA boundary may be associated with early liver metastasis and high mortality.

OBJECTIVETo summarize the reason and treatment of redo surgery in Hirschsprung disease for postoperative distension and constipation.

METHODSFrom January to December 2014, 35 patients with constipation and distention after pull-through done elsewhere were referred to our institution. The reasons procedures and outcomes of redo surgery were a retrospectively analyzed.

RESULTSThe indication of reoperation in 21 cases was pathological problems, including residual aganglionosis, retained transition zone bowel, and in 13 cases was anatomical problems, including retained dilated segment, obstructive Soave cuff. One case had both pathological and anatomical problems. Among them, 5 cases belonged to total colonic aganglionosis. All the cases received conservative treatment for about 6 months before reoperation. Five cases had enterostomy before redo pull through surgery. Thirty cases underwent Soave surgery with or without laparoscopy or laparotomy. Twenty-six cases underwent transabdominal Soave surgery, 3 cases transanal Soave surgery, 1 case transanal Soave surgery with laparoscopy. Other surgery included Ikeda surgery, excision of diaphragm or scar, and anoplasty. Postoperative complications were found in 3 patients. One had rectovesical fistula and was cured after operation. Two cases had anastomotic leakage and then underwent diverting ileostomy. Thirty-three cases had a mean follow-up of 59 months. During the follow-up, 32 cases had no distension and constipation. Two cases presented occasional dirty pants, 2 cases frequent soiling, 1 case daily soiling.

CONCLUSIONSReasons of distension and constipation in Hirschsprung's disease after surgery are pathological and anatomical problems. Operation procedure is chosen based on reasons. Transabdominal Soave surgery is safe and effective.

Anastomotic Leak ; Cicatrix ; Constipation ; Digestive System Surgical Procedures ; Hirschsprung Disease ; Humans ; Ileostomy ; Laparoscopy ; Laparotomy ; Postoperative Complications ; Postoperative Period ; Reoperation ; Retrospective Studies

Objective To investigate the correlation between interleukin-6 (IL-6) and future liver remnant (FLR) growth after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 15 patients who underwent ALPPS at the First Affiliated Hospital of Guangxi Medical University between March 2017 and May 2018 were collected.Observation indicators:(1) intraoperative situations in the first staged ALPPS and the second staged ALPPS;(2) postoperative situations:① postoperative complications and duration of hospital stay,② results of pathological examination;(3) IL-6 concentration in the peripheral blood before and after operation;(4)follow-up situations.Follow-up using outpatient examination,telephone interview and internet was performed to detect life quality and survival of patients.Imaging examination was done to detect tumor recurrence and metastasis.Follow-up was done up to May 2018.Measurement data with normal distribution or similar normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Repeated measures data were analyzed by the repeated measures ANOVA.Correlation comparison was done using Pearson bivariate correlation test.Results (1) Intraoperative situations.① The first staged ALPPS:15 patients had liver parenchymal transection via anterior approach combined with selective hepatic vascular exclusion,without allogenic blood transfusion.The operation time,volume of intraoperative blood loss,FLR at postoperative 16 days,interval time to the second staged ALPPS,growth rate of liver volume,ratio of FLR and standard liver volume (SLV) were respectively 324 minutes (range,240-387 minutes),356 mL (range,200-600 mL),(582± 134) cm3,24 days (range,9-34 days),35％±20％ and 53％±7％.② The second staged ALPPS:of 15 patients,13 underwent the second staged ALPPS successfully including 11 undergoing middle hepatic vein preserved right hepatectomy and 2 undergoing expanded right hemihepatectomy or right trisegmentectomy,1 underwent transcatheter arterial chemoembolization (TACE) due to FLR/SLV =31％,1 was detected yellow-white nodules at left lobe and confirmed as hepatocellular carcinoma by frozen section pathological examination,and then improved and discharged after 5-FU abdominal local chemotherapy combined with postoperative TACE.The operation time,volume of intraoperative blood loss of 13 patients undergoing the second staged ALPPS were 324 minutes (range,140-515 minutes) and 639 mL(range,100-1 400 mL).Two patients had blood transfusion including 1 with 800 mL of fresh frozen plasma and 4.0 U of red cells and 1 with 600 mL of plasma and 9.5 U of de-leucocytes and red cells.(2) Postoperative situations.① Postoperative complications and duration of hospital stay:15 patients had no perioperative death,9 and 6 were detected grade A and grade B liver failure respectively,15 had grade Ⅰ complications of Clavien-Dindo classification and no patient had grade Ⅱ and above complications,10 had pleural effusion including 1 with volume of effusion ＞500 mL.Of 13 patients undergoing the second staged ALPPS,4 and 9 were detected grade A and grade B liver failure respectively,8 and 5 had grade Ⅰ and Ⅱ complications of Clavien-Dindo classification and no patient had grade Ⅲ and above complications,11 had few pleural effusion with volume of effusion ＜500 mL.Patients with grade B liver failure and grade Ⅱ complications were recovered and discharged after treatments of liver protection,gastric protection,reinforced dressing change,continuous use of Alb,fresh frozen plasma transfusion.The patient with volume of pleural effusion ＞ 500 mL was improved after closed thoracic drainage and other patients with pleural effusion were improved after symptomatic and supportive treatment.Duration of total hospital stay was 31 days (range,22-49 days) in 15 patients.② Results of pathological examination:13 patients undergoing complete ALPPS were diagnosed as hepaticocellular carcinoma with R0 resection and without cancer cells involving surgical margin,including 7 with grade Ⅱ portal vein tumor thrombus.Ishak score for postoperative pathological fibrosis and liver cirrhosis was 7.7±1.4 in 15 patients,including 1 case of 5,1 case of 6,2 case of 7,6 case of 8,5 case of 9.(3) IL-6 concentration in the peripheral blood before and after operation:IL-6 concentration in the peripheral blood before surgery was (8±3)ng/L in 15 patients,and (207±150)ng/L,(104±65)ng/L,(45±38)ng/L,(26±9)ng/L,(18±10)ng/L at 1,3,5,7,10 days after the first staged ALPPS,showing a statistically significant difference in changing trend before and after surgery (F=25.877,P＜0.05) and statistically significant differences in paired comparison between 1,3,5,7,10 days after the first staged ALPPS and before surgery respectively (P＜0.05).There was correlation between IL-6 concentration in the peripheral blood at 1,3 days after the first staged ALPPS and growth of FLR (r=0.766,0.881,P＜0.05),and also between IL-6 concentration in the peripheral blood at 1,3 days after the first staged ALPPS and growth rate of FLR (r =0.810,0.879,P＜ 0.05).(4) Follow-up:15 patients were followed up for 1-14 months with a median time of 7 months.Of the 15 patients,1 without the second staged ALPPS died of multiple organ dysfunction syndrome at 7 months after the first staged ALPPS,14 survived and took care of theirselves in daily life during follow-up with improved life quality,including 1 detected multiple lung metastases at 12 months after complete ALPPS with mild increased AFP and 13 undetected new lesions in the remnant liver on contrast-enhanced CT and liver contrast-enhanced ultrasonography with normal AFP.Conclusion The peak of IL-6 concentration in peripheral blood at 1,3 days after the first staged ALPPS is significantly correlated with the hyperplasia of FLR,which may be used to predict the hyperplasia of FLR.