Objective To explore the effects of obesity on the survival,growth and proliferation of gastric cancer and apoptosis by in vivo experiments so as to clarify the relationship between obesity and gastric cancer. Methods High fat diet-induced obese mice model was established.MFC cells were inoculated subcutaneously into mice to establish xenograft tumor model;then tumor growth and peritoneal metastasis were observed for 2 weeks. At the end of in vivo experiments,serum insulin and visfatin concentrations were assayed by ELISA,and blood glucose was determined by glucometer.MFC cell proliferation and apoptosis,as well as the number and size of adipocytes in xenograft tumor tissues were analyzed by immunohistochemistry, TUNEL and HE staining, respectively.Results High fat diet-induced obese mice model was successfully established within 12 weeks,and 66.7% of mice in the model were obese.Obese mice had distinct metabolic changes manifested as weight gain,high blood glucose,high serum visfatin,hyperinsulinemia and insulin resistance.All mice survived and developed no metastasis.The tumors from obese mice had a larger volume,heavier weight and greater intra-tumoral adipocytes, and exhibited higher proliferation and reduced apoptosis rate compared to those of non-obese and lean mice.Both serum insulin and visfatin concentrations correlated positively with tumor proliferation and negatively with tumor apoptosis.In addition,tumor weight showed a significantly positive correlation with mice body weight.Effects of diet-induced obesity on gastric cancer were not related to the influence of diet,but to the degree of obesity. Conclusion The altered adipocytokine milieu and insulin resistance observed in obesity may lead directly to alterations in tumor microenvironment,thereby promoting the survival and growth of gastric cancer.

Objective To investigate the effect of β-elemene on SGC7901 gastric cancer cell line and the potential proteins involved. Methods Human SGC7901 gastric cancer cells were treated with different concentrations ofβ-elemene.Cell viability was assessed.A proteomic method,isobaric tags for relative and absolute quantitation (iTRAQ),was employed to detect the proteins altered by β-elemene.Protein expression was validated by Western blot.Results β-elemene inhibited the viability of SGC7901 gastric cancer cells in a dose-dependent manner.Altogether,147 upregulated proteins and 86 downregulated proteins were identified in response to β-elemene treatment in SGC7901 gastric cancer cell line.Among them,the expressions of p21-activated protein kinase-interacting protein 1 (PAK1IP1 ),Bcl-2-associated transcription factor 1 (BTF)and topoisomerase 2-alpha (TOPIIα)were validated by Western blot and the trends were consistent with iTRAQ results.Top pathways involved inβ-elemene treatment in SGC7901 gastric cancer cell line included ribosome signaling,peroxisome proliferator-activated receptors (PPARs)signaling pathway,regulation of actin cytoskeleton,phagosome,biosynthesis and metabolism of some amino acids.Conclusion Our results suggest a promising therapeutic role of β-elemene for gastric cancer.The differentially expressed proteins give us better insights into the potential mechanisms involved in gastric cancer treatment using β-elemene.

Laparoscopic radical gastrectomy is currently recognized as the standard surgical procedure for radical gastric cancer. The dissection of the sixth group of lymph node, that is the inferior pylorus region lymph node, should be performed step-by-step according to standard procedures, and surgeon on left position of patient is more conducive to the lymph node dissection of this area. The 4K laparoscopic system can increase the resolution of the surgical field of view, which provide the surgeon with a clear surgical field of vision, thereby improving the accuracy of operation, achieving the best requirements of lymph node dissection and avoiding side injury and complica-tions. The authors investigate infrapyloric lymph node dissection with the surgeon on left position in 4K laparoscopic radical gastrectomy.

OBJECTIVETo investigate the effects of β-elemene in suppressing the proliferation and apoptosis of SGC7901 gastric cancer cells in vitro and explore the underlying mechanisms.

METHODSUsing MTT assay, flow cytometry, and clonogenic survival assay, we assessed the effects of β-elemene on the viability, apoptosis, cell cycle distribution, and clonogenic survival of gastric cancer SGC7901 cells and gastric mucosal epithelial GES-1 cells. Western blotting was employed to determine the changes in the protein expression profiles in SGC7901 cells in response to β-elemene treatment.

RESULTSβ-elemene significantly suppressed the cell viability and increased the apoptosis of SGC7901 cells, and these effects were less obvious in GES-1 cells. β-elemene decreased clonogenic survival of SGC7901 cells, increased the proportion of G2/M phase cells, decreased the expression of Bcl-2, and increased the expression of Bax and cleaved caspase-3. β-elemene did not obviously affect the expression of total p21-activated protein kinase 1 (Pak1) but decreased the level of phospho-Pak1 (Thr423) and phospho-ERK1/2 (Thr202/Tyr204) in SGC7901 cells.

CONCLUSIONβ-elemene inhibits the proliferation and induces apoptosis of gastric cancer cells possibly by inhibiting Pak1/ERK signaling and regulating apoptosis-associated proteins such as Bcl-2 and Bax.

Apoptosis ; Apoptosis Regulatory Proteins ; metabolism ; Cell Cycle ; Cell Division ; Cell Line, Tumor ; drug effects ; Cell Proliferation ; Cell Survival ; Humans ; Sesquiterpenes ; pharmacology ; Signal Transduction ; Stomach Neoplasms ; pathology

Laparoscopic proximal gastrectomy (LPG) can be selected for the treatment of early upper gastric carcinoma, but gastroesophageal reflux after operation would seriously affect the quality of life of patients. Esophagogastric anastomosis with double flap technique is a digestive tract reconstruction method using the anastomosis between the esophagus and the anterior wall of the stomach. Compared with other digestive tract reconstruction methods, esophagogastric anastomosis with double flap technique can maintain the postoperative body mass of patients in good condition, improve the nutritional status and the long-term quality of life of patients. Esophagogastric anasto-mosis with double flap technique has good anti reflux effects and retain the possibility of endoscopic examination and treatment. By reviewing literatures at home and abroad, and combined with clinical experiences, the authors discuss current status and digestive tract reconstruction methods of LPG, and deeply investigate the application prospect of esophagogastric anastomosis with double flap technique.

Objective:To analyze the policy tools designed for function orientation and development of China′s infectious disease hospitals, in order to provide references for formulating and optimizing the functional implementation and sustainable development policies of these hospitals.Methods:Consulting the website of Peking University Law and official websites on health, and using such keywords as " medical institutions, infectious diseases, hospitals for infectious diseases, public health emergencies, specialized hospitals", and searching the national policy texts on the functions and development of infectious disease hospitals issued from December 1991 to January 2023. By means of Rothwell and Zegveld′s policy tool classification method, Nvivo 11 Pro software was used to analyze the text content from the dimensions of demand-type, supply-type, and environmental-type policy tools.Results:A total of 41 policy texts were included and 204 codes were obtained through text analysis. Of all the tools, environmental and supply-oriented policy tools were used the most, being 104 (50.99%) and 95 (46.56%) respectively, while demand-oriented policy tools were used the least, only 5 (2.45%). Of all the environmental-oriented policy tools, " goal planning" was the most used, being 34 (16.67%), while " publicity and guidance" was less used, only 4 (1.96%). Among the supply-oriented policy tools, " clarifying the reporting and handling service functions of public health emergencies" was the most widely used, being 34 (16.67%), while " Informationization" and " infrastructure construction" was less used, being 8 (3.92%) and 6 (2.94%) respectively. Few of the demand-oriented policy tools were in use, as " government purchase" and " medical insurance support" were both 2 (0.98% each), and " social medical care" was only 1 (0.49%).Conclusions:The distribution of three types of policy tools for function and development of infectious disease hospitals is unbalanced, the use of environmental and supply-oriented policy tools is excessive and internal structure is unbalanced. The proportion of environmental-oriented policy tools needs to be adjusted, and the frequency of use of supporting tools such as relevant standards, norms, incentives, supervision and publicity should be increased. Supply-oriented policies need to be further optimized, especially in terms of personnel training, funding, information technology and infrastructure construction. Demand-oriented policy tools are seriously underused and need to be further developed.

Objective:To investigate the application value of biological muscle flap in laparo-scopic radical proximal gastrectomy with esophagogastric anastomosis.Methods:The retrospec-tive and descriptive study was conducted. The clinicopathological data of 10 patients with adeno-carcinoma of esophagogastric junction who were admitted to The First Affiliated Hospital of Xi′an Jiaotong University from May 2023 to August 2023 were collected. All patients were males, aged (65±5)years. All patients underwent laparoscopic radical proximal gastrectomy and esophagogastric anastomosis with digestive tract reconstruction using the esophagogastric biological muscle flap. Observation indicators: (1) surgical situations and early complications; (2) follow-up and late com-plications. Measurement data with normal distribution were represented as Mean± SD, and measure-ment data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Surgical situations and early complications. All 10 patients success-fully completed the surgery without conversion to open surgery, and the operation time was (166±18)minutes. Cases with digestive tract reconstruction as end-to-side anastomosis and Overlap anas-tomosis were 1 and 9, respectively. The time of digestive tract reconstruction, the number of lymph node dissected, volume of intraoperative blood loss, time to postoperative first anal exhaust, time to postoperative first intake of liquid food, duration of postoperative hospital stay were (40±12)minutes, 24±6, (41±9)mL, (3.4±0.5)days, (4.1±1.0)days, (8.3±0.7)days in the 10 patients. Of 4 cases with postoperative early complications, 1 case developed pulmonary infection (Clavien-Dindo grade Ⅱ) on the second day after surgery, with pulmonary infection absorbed after 5 days of antibiotic treat-ment. Two cases experienced chest distress and shortness of breath on the third day after surgery, with the diagnosis of a small to moderate amount of pleural effusion after chest B-ultrasound examination. After pleural puncture and active treatment, the symptoms of them were improved and the pleural effusion disappeared. There was 1 case with choking sensation when eating solid food, which was started from the third week after surgery. Upper gastrointestinal imaging revealed mild anastomotic stenosis of Clavien-Dindo grade Ⅰ in the patient, who was improved after conservative treatment. On the 7th day after surgery, all 10 patients underwent upper gastrointestinal angiography, and no anastomotic leakage or stenosis occurred. There was no sign of contrast agent reflux in the supine position and 30° head down position. (2) Follow-up and late complications. All 10 patients were followed up for 59.5(range, 31.0-127.0)days. The esophageal reflux scale score of 10 patients was 1.4±0.3. During the follow-up, 1 case underwent gastroscopy on 40 days after surgery, which showed reflux esophagitis with Los Angeles grade as B and the Clavien-Dindo grade as Ⅰ. There was no clinical symptom such as heartburn or acid reflux. Results of 24-hour pH monitoring showed that the patient experienced 24 instances of reflux in an upright position and 15 instances of reflux in a supine position, with no prolonged reflux. The total reflux time within 24 hours was 75 minutes. The DeMeester score was 38.3. Results of esophageal pressure measurement showed that the esophageal contraction morphology was normal, but the anastomotic opening was not well relaxed. The rest of 9 cases had no complication such as reflux esophagitis.Conclusion:Biological muscle flap applied in the laparoscopic radical proximal gastrectomy with esophagogastric anastomosis is safe and feasible, with satisfied short-term efficacy.

OBJECTIVETo study radiation-enhancing effects on human gastric cancer MKN28 cell line and underlying mechanisms of β-elemene.

METHODSInhibition of MKN28 cell proliferation at different concentrations of β-elemene was assessed using the methyl thiazolyl blue colorimetric method (MTT method), with calculation of IC50 value and choice of 20% of the IC50 as the experimental drug concentration. Irradiation group and β-elemene+irradiation group were established, and the cell survival fraction (SF) was calculated from flat panel colony forming analysis, and fitted by the 'multitarget click mathematical model'. Draw the survival curve and get the radiobiological parameters D0, Dq, SF2, N and SER. Flow cytometry (FCM) was used to detect changes in the cell cycle and cell apoptosis rates was detected by Annexin-V/PI assay.

RESULTSβ-elemene exerted inhibitory effects on proliferation of gastric cancer MKN28 cells, with an IC50 of 45.6 mg/L and we chose 8 mg/L as the experimental concentration. The cell survival fraction of MKN28 cells with irradiation decreased significantly after treated with β-elemene; D0, Dq decreased, SER = 1.3. After combined treatment of β-elemene+irradiation, the results of FCM showed that cells could be arrested in the G2/M phase and the cell apoptosis increased significantly.

CONCLUSIONSβ-elemene can enhance the radiosensitivity of gastric cancer MKN28 cell line. Mechanistically, β-elemene mainly influences the cell cycle distribution of MKN28 cells by inducing G2/M phase arrest, inhibits the repair of sublethal damage and induces cell apoptosis to enhance the killing effects of radioactive rays.

Apoptosis ; drug effects ; Cell Cycle ; drug effects ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Cell Survival ; drug effects ; Humans ; Radiation Tolerance ; drug effects ; Sesquiterpenes ; pharmacology ; Stomach Neoplasms ; pathology

【Objective】 To investigate the predictive value of visceral fat area （VFA） in patients with gastric cancer after radical gastrectomy. 【Methods】 A retrospective analysis was performed on 195 patients who underwent radical gastrectomy in the Department of General Surgery， The First Affiliated Hospital of Xi’an Jiaotong University from January 2014 to December 2017. CT image data and clinicopathological data within 1 week before surgery were collected. VFA was calculated by software， and the patients were divided into VFA-H group （n=96） and VFA-L group （n=99）. The relationship between VFA in different groups and long-term prognosis was compared. 【Results】 CT examination results showed that VFA value was （111±62） cm²， and BMI was positively correlated with VFA value （r=0.640， P<0.001）. ROC curve showed that VFA was more valuable in predicting the prognosis of gastric cancer （AUC=0.703， P<0.001） and better than BMI. Cox regression analysis of prognostic factors in gastric cancer patients： Univariate analysis showed that age， tumor length， TNM stage and VFA were the influencing factors for prognosis， while multivariate analysis showed that TNM stage III and VFA-L were independent risk factors for prognosis of gastric cancer patients. 【Conclusion】 VFA has a good predictive ability and can be used to evaluate the prognosis of gastric cancer patients after operation.