Objective To detect the methylation status of ppENK and its role in the pathogenesis of pancreatic carcinoma.Methods The ppENK methylation status in human tissues of pancreatic cancer,pancreatic carcinoma cell lines and normal pancreas was detected by methylation-specific RT-PCR(MSP).The association of methylation status of ppENK gene with clinicopathological parameters was analyzed. The expression of ppENK mRNA was detected by RT-PCR.Two pancreatic carcinoma cell lines (PANC1,AsPC1 ) were treated with demethylating agent (5-aza-dC).The cell growth was measured by MTT.Apoptosis and cell cycle was analyzed by flow cytometry.The expression of DNMT3a was measured by Western blot.Results ppENK mRNA was expressed in normal pancreas.And methylation of ppENK was not detected in normal pancreas.Methylation of ppENK was detected in 90.3％ (28/31) of pancreatic carcinoma tissue,and there were no correlation between methylated ppENK with clinicopathological features of pancreatic carcinoma.There was no ppENK mRNA expression in SW1990,PANC1,PC3,AsPC1,PuPan-1,and ppENK was methylated.Methylated ppENK was associated with no ppENK mRNA expression.After 5-Aza-dC treatment,PANC1,AsPC1 was demethylated and ppENK mRNA expression was reversed.The proliferation of PANC1 and AsPC1 was inhibited in a dose dependent manner.The apoptotic rates of PANC1 and AsPC1 were increased [ (31.57 ± 6.76)％ts (3.21 ±1.43)％,P =0.002,(16.6 ±8.22)％ vs (3.82 ±1.71)％,P=0.058];the expression of DNMT3a protein was decreased; the PANC1 cells of G1 phase significantly increased [ (67.87 ± 2.72 ) ％ vs (54.57 ± 7.18) ％,P =0.040 ],but PANC1 cells of S phase significantly decreased [ ( 22.37 ± 4.31 )％ vs (33.73 ± 4.63)％,P =0.036 ].But the percentage of G1,S phase in AsPC1 cell line was not significantly changed ( P =0.236,0.075 ).ConclusionsppENK demethylation is an important molecular event in inducing ppENK expression inhibition,which can inhibit pancreatic cancer proliferation,promote apoptosis,arrest cell cycle at G1 and decrease the expression of DNMT3a protein.

Objective To evaluate the impact of early enteral nutrition (EEN) compared with parenteral nutrition (PN) on patients after hepatectomy. Methods Seventy-eight patients undergoing liver resection were randomized prospectively into two groups: EEN group receiving early enteral nutrition (n=35) and PN group receiving parenteral nutrition (n=43). The patients in both groups received isocaloric and isonitrogenous nutritional formulas 24 h after operation and the formulas were stopped on postoperative day 7. The general conditions, liver function tests, clinical complications,and clinical nutritional variables at three time points that included preoperative phase, postoperative day 1 (POD 1) and postoperative day 8 (POD 8) were observed. Results No significant differences were found in length of hospital stay, liver function and clinical nutritional variables between the 2 groups. In the EEN group, the serum prealbumin level almost returned to the preoperative level on POD 8. The nutritional complication rate of the EEN group was increased significantly but it was milder than that of the PN group. The time of gut function recovery in the EEN group was shorter than that of the PN group. The costs of nutritional drugs showed a significant decrease in the EEN group.Conclusion Early enteral nutrition is safe, rational and effective in patients who have undergone hepatectomy. Early enteral nutrition is better than parenteral nutrition in promoting liver function recovery, liver protein synthesis, postoperative recovery of gut function and decreasing costs of nutritional drugs.

Objective To evaluate the effects of branched-chain amino acids-enriched early parenteral and enteral nutrition on the liver function and serum aminograms in cirrhotic rats after partial hepatectomy. Methods In this prospective randomized controlled study, 24 cirrhotic rats, induced by thioacetamide, were randomized into three groups: enteral nutrition (EN) group, EN + branched-chain amino acid (BCAA) group, and parenteral nutrition (PN) + BCAA group. After receiving partial hepatectomy, rats in all three groups were nutritionally supported with equal amount of calorie and nitrogen contents from the 1st postoperative day ( PO day 1 ) to PO day 5. On PO day 6, parameters including body weight, liver functions, prealbumin, transferring, and serum aminograms were measured or determined, and the level of liver albumin mRNA was detected by reversal transcription-polymerase chain reaction and morphological examinations such as HE staining and immunohistochemical staining, which were assessed by index of Ki67 protein index. Results Body weight was significantly decreased in all three groups on PO day 6 (P ＜0.05 ). Compared with EN + BCAA group, serum aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase after partial hepatectomy were significantly higher in PN + BCAA group (P ＜0.05 ). Serum alkaline phosphatase level was significantly higher in PN + BCAA group than in EN group ( P ＜0. 05). The level of prealbumin was significantly lower in PN + BCAA group when compared with EN group or EN +BCAA group ( both P ＜ 0. 05 ), although no such significant difference was noted in terms of transferrin ( P ＞0. 05 ). The levels of leucine and isoleucine elevated while those of tyrosine, phenylalanine, arginine and tryptophan declined in PN + BCAA group or EN + BCAA group when compared with EN group ( P ＜ 0. 05 ). Aminograms were not significantly different between EN + BCAA group and PN + BCAA group ( P ＞ 0. 05 ). Levels of total amino acid and aromatic amino acid (AAA) were significantly lower while BCAA and ratio between BCAA and AAA (BCAA/AAA) were significantly higher in PN + BCAA group or EN + BCAA group than in EN group (P ＜ 0. 05 ).Significantly lower level of albumin mRNA and index of Ki67 were observed in PN + BCAA group than in EN group or EN + BCAA group (P ＜ 0.05 ) on PO day 6. Conclusions BCAA-enriched EN or PN reverses amino acid disequilibrium and restores BCAA/AAA in cirrhotic rats after partial hepatectomy. Compared with PN, EN is superior in improving postoperative liver function, promoting protein synthesis, and speed up tissue regeneration in the postoperative liver. However, it still can not restore serum albumin in a short term.

Objective To investigate the efficacy and safety of compound azintamide on dyspepsia symptoms. Methods One hundred and eighty dyspepsia patients were divided into two groups according to dyspepsia symptom related with gastrointestinal disease ( group A) or biliary system disease (group B),whose dyspepsia symptom were not improved by the Domperidone 10 mg tid for 2 weeks. Two tablets of compound azintamide were administered orally following a meal, tid for 2 weeks. The changes of symptoms score of upper abdominal distention, upper abdominal pain or discomfort anorexia and effective rate as well as adverse events were recorded. Results Compound azintamide greatly improved the symptoms of upper abdominal distention, upper abdominal pain or discomfort and anorexia. All symptoms scores were significantly decreased after 2 weeks of compound azintamide (P < 0.01). The effective rate of each symptom and total symptoms score were more than 84.9% and 92.5%. One patient reported mild rash at the fourteenth days, which disappeared 3 days later. Conclusion Compound azintamide showed effective and safety in treatment of patient with dyspepsia symptoms when Domperidone therapy is not satisfactory.

Preoperative mechanical bowel preparation (MBP) has been established as a standard procedure for elective colorectal surgery in most surgical centers since 1950s. However, the routine use of MBP for elective colorectal surgery is still in debate, as the researches on the evaluation of MBP have been carried out in recent 20 years. By searching and analyzing the existing evidence, we conclude that MBP should be routinely abandoned for elective open colorectal surgery, but should be routinely used for elective laparoscopic rectal surgery, and it still awaits large-scale RCTs for further evaluation of MBP for elective laparoscopic colonic surgery.
Colon ; Colorectal Surgery ; Elective Surgical Procedures ; Humans ; Laparoscopy ; Preoperative Care

Before the "mesorectal" theory was proposed, the traditional anatomy believed that the "pelvirectal space" belonged to the anal canal and perirectal space, which was independent of the rectal structure, located on both sides of the rectum, above the levator ani, and below the peritoneal reflexion, and was composed of a large amount of fatty tissue filling. With the development of the theory of membrane anatomy and the clarification of the concept of "rectal mesentery", combined with the author's clinical experience, we found that the above-mentioned fat is actually the fat within the mesorectum, as well as the fat tissue of lateral lymph nodes (LLN) such as the internal iliac lymph nodes (No.263) and obturator lymph nodes (No.283) on both sides of the rectal mesentery, rather than the so-called fat tissue within the interstitial space. Therefore, the author believes that the pelvirectal space does not exist. In the anatomical location equivalent to the pelvic rectal space, there is the "superior levator ani space" based on the membrane anatomy theory. From the pelvirectal space to the superior levator anal space, it reflects our further understanding of the anatomy of the rectal mesentery.

Before the "mesorectal" theory was proposed, the traditional anatomy believed that the "pelvirectal space" belonged to the anal canal and perirectal space, which was independent of the rectal structure, located on both sides of the rectum, above the levator ani, and below the peritoneal reflexion, and was composed of a large amount of fatty tissue filling. With the development of the theory of membrane anatomy and the clarification of the concept of "rectal mesentery", combined with the author's clinical experience, we found that the above-mentioned fat is actually the fat within the mesorectum, as well as the fat tissue of lateral lymph nodes (LLN) such as the internal iliac lymph nodes (No.263) and obturator lymph nodes (No.283) on both sides of the rectal mesentery, rather than the so-called fat tissue within the interstitial space. Therefore, the author believes that the pelvirectal space does not exist. In the anatomical location equivalent to the pelvic rectal space, there is the "superior levator ani space" based on the membrane anatomy theory. From the pelvirectal space to the superior levator anal space, it reflects our further understanding of the anatomy of the rectal mesentery.

Objective To evaluate the effectiveness and safety of different Chinese patent medicine in improving blood lipid and microcirculation in coronary heart disease patients with phlegm-blood stasis syndrome based on network meta-analysis.Methods The randomized controlled trials(RCTs)of different Chinese patent medicine in the treatment of blood lipid and microcirculation in coronary heart disease patients with phlegm-blood stasis syndrome were collected by searching CNKI,Wanfang,VIP,SinoMed,PubMed,EMbase,Cochrane Library,and Web of science databases from the establishment of the database to April 3,2023.Literature quality evaluation and network meta-analysis were conducted using Review Manager 5.4 and Stata15.1 software.Results Thirty-seven RCTs were included,with a total sample size of 4 064 cases,involving 15 different Chinese patent medicines.The network meta-analysis showed that the efficacy of Chinese patent medicine combined with conventional Western medicine is often better than that of conventional Western medicine alone.There are no serious adverse reactions.The top three Chinese patent medicines with cumulative probability of total clinical efficacy were Guanmai Zaitong soft extract,Gualoupi Injection and Quyu Xiaoban Capsule.In terms of improving triglyceride(TG)and low-density lipoprotein(LDL-C),the top three Chinese patent medicines were Gualoupi Injection,Huxinkang Tablet and Guanxin Shutong Capsule.In terms of improving plasma viscosity and fibrinogen,the top three Chinese patent medicines were Ginkgo Damo Injection,Gualoupi Injection and Guanxin Shutong Capsule.In terms of improving endothelial function[nitric oxide(NO)and endothelin-1(ET-1)],the top three Chinese patent medicines were Ginkgo Damo Injection,Danlou Tablet and Tongmai Yuxin Pill.In terms of reducing inflammation hypersensitivity C-reactive protein(hs-CRP),the top three Chinese patent medicines were Ginkgo Damo Injection,Huxinkang Tablet and Guanxin Shutong Capsule.Conclusion The current evidence shows that the combination of TCM,which is used for the treatment of phlegm-blood stasis syndrome,with conventional Western medicine in the treatment of coronary heart disease has advantages in improving clinical efficacy,blood lipids and microcirculation.TCM especially for the treatment of phlegm-blood stasis syndrome shows more obvious advantage,such as Guanmai Zaitong soft extract and Gualoupi injection,which can be taken into consideration as part of the clinical guidelines.However,due to the limited number and quality of the included literatures,the research results still need to be verified by more high-quality,multi-center,double-blind randomized trials.The purpose is to provide more reliable evidence-based medical reference.

The laparoscopic approach is rapidly becoming the preferred method of treatment for patients with early gastric cancer due to advantages of minimally invasive surgery. As laparoscopic experience has accumulated, laparoscopy-assisted distal gastrectomy (LADG) with D2 lymphadenectomy has become a valuable alternative for the treatment of patients with advanced gastric cancer. However, laparoscopic gastric surgery is demanding from a technical point of view, especially when a D2 lymphadenectomy is performed. Surgeons seeking to undertake LADG are concerned about unpredictable intraoperative bleeding that may occur during LADG. Comprehensive knowledge of the perigastric vascular anatomy is essential for LADG with D2 lymphadenectomy.
Gastroenterostomy ; Humans ; Laparoscopy ; Lymph Node Excision ; Stomach Neoplasms ; blood supply ; pathology ; surgery

Objective To determine the utility of computed tomographic (CT) enteroclysis for characterization of the status of the anastomotic site in patients with Crohn's disease (CD) who have previously undergone ileocolic resection. Methods Totally 31 CD patients who had previously undergone ileocolic resection were enrolled in the study. After having been orally administered with isosmotic mannitol, the patients received CT scanning including plain scan, arterial phase scan, and portal venous phase scan. The abnormal CT findings were analyzed based on portal venous phase images. CT enteroclysis findings in 31 patients were evaluated by two radiologists in consensus. Endoscopic findings, histopathologic findings, and/or the Crohn's disease activity index (CDAI) were used as the reference criteria. Associations between CT enteroclysis findings and anastomotic site status were assessed. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CT enteroclysis for the diagnosis of normal anastomosis versus anastomotic recurrence were estimated. Results Twenty-six cases and 5 cases were diagnosed as disease recurrence and normal anastomosis, respectively. In the disease recurrence group, 11 patients (42%) had lymphadenopathy (diameter＞ 1 cm) and 8 patients (31%) had peri-anastomotic fistulas, which were absent in normal anastomosis group, but the difference was not significant Anastomotic wall thickening more than 6 mm, marked mucosal enhancement, stratification, and peri-anastomotic stranding were found in 16 (62%), 19 (73%), 14 (54%), and 20 (77%) cases, respectively, in disease recurrence group, which were absent in normal anastomosis group ( all P ＜ 0.05 ). When the diagnosis of anastomotic recurrence was based on more than two of the following six variables, including lymphadenopathy, peri-anastomotic fistulas, anastomotic wall thickening more than 6 mm, marked mucosal enhancement, stratification, and peri-anastomotic stranding, its sensitivity, specificity, postive predictive value, negative predictive value, and accuracy yielded 88%, 100%, 100%, 63%, and 90%, respectively. The diagnostic accuracy of anostomotic stenosis with CT was only 53%. Conclusion CT enteroclysis yields objective and relatively specific morphologic criteria that help differentiate between recurrent disease and normal at the anastomotic site after ileocolic resection for CD.