Objective To detect the correlation of serum p53 antibody and p53 protein expression of cancer tissue in patients with colorectal cancer (CRC), and to evaluate if the serum p53 antibody might reflect the mutation of p53 gene in CRC. Methods One hundred and thirty-two patients with CRC and 36 patients with non-tumor disease were included in this prospective study. The presence of serum p53 antibody was determined by enzyme-linked immunosorbent assay (ELISA). Immunohistochemical analysis of tumors was performed to detect the accumulation of p53 protein. Results The positive rate of p53 antibody was 40.2% in patients with colorectal cancer and 2.9% in non-tumor patients,( P

Objective To explore the relationship between the expression levels of excision repair cross complementation group 1(ERCC1), breast cancer susceptibility gene 1(BRCA1), thymidylate synthase (TS) mRNA and clinicopathological features, prognosis in advanced colorectal cancer, and the correlation between the expression levels of ERCC1 and BRCA1. Methods The expression levels of ERCC1, BRCA1 and TS mRNA of postoperative paraffin embedded tissue were tested by real-time quantitative reverse transcription polymerase chain reaction (RT-PCR) in 49 advanced colorectal cancer cases. The results were analyzed by χ2 test of the correlation between the expression levels and clinicopathological characteristics. Patients were followed up by clinic or telephone. The prognosis was analyzed by small sample Kaplan-Meier survival analysis and Log-rank time series analysis, and P<0.05 was statistically significant. Results The expression level of ERCC1 mRNA in patients with colorectal carcinoma had no obvious correlation with the clinical and pathological characteristics such as gender, age, tumor location, lymph node metastasis, distant metastasis, CEA and differentiation degree (P>0.05). The expression level of BRCA1 mRNA had no significant correlation with the above clinical and pathological features (P>0.05) except distant metastasis (P=0.030) and differentiation degree (P=0.002). The expression level of TS mRNA had no significant correlation with the above clinical and pathological features (P>0.05) except distant metastasis (P=0.003). The expression level of ERCC1 and BRCA1 mRNA obviously correlated (P=0.002). The 1 year overall survival rate was 95.92%(47/49);the 2 year overall survival rate was 83.67%(41/49);and the 3 year overall survival rate was 73.47%(36/49). Overall survival and progression-free survival time in ERCC1 mRNA low expression group (47.8, 41.0 months) was higher than that in ERCC1 mRNA low expression group (27.3, 20.0 months) respectively (P=0.001, P=0.001). Overall survival and progression-free survival time in BRCA1 mRNA low expression group (43.7, 42.7 months) was higher than that in BRCA1 mRNA high expression group (29.3, 25.1 months) respectively (P=0.009, 0.006). Overall survival time in TS mRNA low expression group (39.8 months) was higher than that in BRCA1 mRNA high expression group (25.2 months). Conclusions The expression level of ERCC1 mRNA is not correlated with its clinical and pathological characteristics, but with its biological characteristics. BRCA1 and TS levels are correlated with invasion and metastasis. Low levels of ERCC1 and BRCA1 expression have a better prognostic effect on platinum based first-line chemotherapy for advanced colorectal cancer, and they are correlated. Low level of TS also has longer disease-free survival. Three joint detection could be used as a prognostic factor for colorectal cancer chemotherapy.

Objective:To establish an HPLC method to determine the entrapment efficiency of buthionine sulfoximine (BSO) nan-oparticles in different entrapping systems .Methods:Free BSO was separated from the loaded nanoparticles by high speed centrifugation in two entrapping systems and the entrapment efficiency of buthionine sulfoximine nanoparticles was determined by HPLC .A WondaSil C18 column (250 mm ×4.6 mm, 5 μm) was used and the mobile phase was methanol-water (20 ∶80).The flow rate was 0.4 ml· min-1 and the column temperature was 30℃.The detection wavelength was set at 210 nm and the volume of injection was 20 μl.Re-sults:BSO had a good linear relationship within the range of 2.0-320.0μg· ml-1(r=0.999 7).The average recovery was 101.05%and RSD was 0.74%(n=9).The average entrapment efficiency of HP/CaCO3/CaHPO4/BSO nanoparticles and HP/PS/CaCO3/BSO hydrid nanovesicles was 25.63% and 58.62%, respectively.Conclusion:The method has good repeatability and high accuracy and sensitivity, which is applicable to determine the entrapment efficiency of BSO nanoparticles .HP/PS/CaCO3/BSO hydrid nanovesicles entrapped system is superior to HP/CaCO3/CaHPO4/BSO nanoparticles entrapped system .

Objective:To evaluate the effects of neoadjuvant chemoradiotherapy on anal function after intersphincteric resection (ISR) with low rectal cancer. Methods:A total of 103 patients were classified into the chemoradiotherapy (CRT) group and control group according to whether they received neoadjuvant chemoradiotherapy. Anal function was assessed using vectorial manometry, Saito function questionnaires, and Wexner incontinence scores. Results:The resting vector volume and squeezing vector volume of the CRT group were significantly lower than those of the control group prior to the operation. Both groups showed decreasing manometric re-sults after ISR. However, all indices of the CRT group were significantly lower than those of the control group (P<0.05). At 6 and 12 months after operation, the Saito questionnaire results reveal poor function for the CRT group compared with the control group, except for dyschesia. After 24 months, the stool frequency, ability to distinguish between feces and flatus, fragmentation, and alimentary re-striction remained poor for the CRT group (P<0.05). Although both groups showed decreasing Wexner scores with time, the score of the CRT group remained significantly higher than that of the control up to 24 months after operation. Conclusion:Neoadjuvant chemo-radiotherapy significantly affects the anal sphincter function for intersphincteric resection with low rectal cancer. This effect continues for at least 2 years after operation.

Objective To investigate the outcome of low anterior resection of rectal cancer with double stapling technique.Methods A retrospective analysis of clinical records of 78 rectal cancer patients who had anal preservation operation using double stapling technique was performed.Results In all of the cases,the rectal closing and anastomosis were satisfactorily completed.All the resection margins were negative for tumor infiltration.There was no operative mortality or anastomosis leakage.Seventy-three(93.6%)cases were followed up for 9-65 months,pelvic recurrence occurred in 2 cases(2.7%),multiple metastasis of peritoneal cavity occurred in 1 case(1.4%),liver metastasis was found in 7 cases(9.6%),one patient suffered from local recurrence and Miles operation was performed 11 months later.Conclusions Double stapling technique can provide more chances for sphincter preservation operation in patients with lower rectal cancer.If the technique is properly used,it also may effectively reduce the rate of anastomosis leakage and other complications.

Objective To evaluate the results of anal function and oncologic effect of intersphincteric resection(ISR) for very low rectal cancer Methods Sixteen patients who had ISR from March 1999 to March 2006 in our hosptal.After complete dissection of the rectum and mesorectum down to the pelvic floor,the internal sphincter was separated from the external sphincter and puborectalis and resected together with the rectum,then the coloanal anastomosis was performed.On postoperative day 7,the anal contraction function training was started;on week 4,biofeedback training was started;on week 2,chemotherapy was used for Dukes B,C stage,and on week 4 radiotherapy was used.Results There was no operative mortality,and no anastomotic leakage.Colonic mucosa prolapse developed in two patients,two developed late strictures of the coloanal anastomosis and one had wound problem.At follow-up of 3 months to 7 years,there were 2 deaths from liver metastasis and 1 death from lung metastasis;no patient developed local recurrence.According to Williams continence status level,acceptable postoperative anal function were obtained in 62.5 %,80.0 %,and 84.6 % of patients at 3,6,and 12 months respectively.Conclusions ISR is safe for selected patients with very low rectal tumor,operative morbidity is low,and the curability rate and anal functional results are satisfactory.

The neurovascular bundle (NVB) starts at the lateral angle of the seminal vesicle (the initial part), passes posterolateral of the prostate gland (the main part), and ends at the cavernous body of the penis (the cavernous part). In low rectal surgery, different transabdominal and transanal perspectives result in different NVB injury risks. In the perspective of transabdominal operation, the separation between the initial part of NVB and Denonvilliers fascia and the anatomical variation of the two lateral sides of Denonvilliers fascia increases the risk of NVB injury, and conformation separation may take into account the convenience of separationand the protection of NVB. In the perspective of transanal operation, when separating the main part with NVB and mesorectum, the perspective of the transanal, unidirection traction and excessive dissection increase the risk of NVB main exposure. Clear anatomical identification helps the protection of NVB in the transanal operation. At present, the medical evidence on the difference of NVB injury in different perspectives of transabdominal and transanal approach is still in need of relevant clinical researches.

Whether the transanal total mesorectal resection (taTME) techniques increase the risk of anastomotic failure is inconclusive. This paper discusses the anastomotic problems of taTME from different aspects including anatomical factors and technical characteristics. In terms of the anatomic and physiological characteristics of the lower rectum, the Hiatal ligament and the density of the perirectal space is a disadvantage to the anastomosis of taTME, while the prolapse of the rectum may be a beneficial factor. Due to the unique technical characteristics of taTME, the main reason affecting its anastomosis at present is that the caudal space at the distal end is not sufficiently mobilized, especially for male and lower anastomosis. In addition, stapled anastomosis at the level of anorectal ring may cause more problems, while manual anastomosis at the lower level may bring better results.

Whether the transanal total mesorectal resection(taTME)techniques increase the risk of anastomotic failure is inconclusive. This paper discusses the anastomotic problems of taTME from different aspects including anatomical factors and technical characteristics. In terms of the anatomic and physiological characteristics of the lower rectum,the Hiatal ligament and the density of the perirectal space is a disadvantage to the anastomosis of taTME,while the prolapse of the rectum may be a beneficial factor. Due to the unique technical characteristics of taTME,the main reason affecting its anastomosis at present is that the caudal space at the distal end is not sufficiently mobilized,especially for male and lower anastomosis. In addition,stapled anastomosis at the level of anorectal ring may cause more problems, while manual anastomosis at the lower level may bring better results.

The neurovascular bundle (NVB) starts at the lateral angle of the seminal vesicle (the initial part), passes posterolateral of the prostate gland (the main part), and ends at the cavernous body of the penis (the cavernous part). In low rectal surgery, different transabdominal and transanal perspectives result in different NVB injury risks. In the perspective of transabdominal operation, the separation between the initial part of NVB and Denonvilliers fascia and the anatomical variation of the two lateral sides of Denonvilliers fascia increases the risk of NVB injury, and conformation separation may take into account the convenience of separationand the protection of NVB. In the perspective of transanal operation, when separating the main part with NVB and mesorectum, the perspective of the transanal, unidirection traction and excessive dissection increase the risk of NVB main exposure. Clear anatomical identification helps the protection of NVB in the transanal operation. At present, the medical evidence on the difference of NVB injury in different perspectives of transabdominal and transanal approach is still in need of relevant clinical researches.