Objective:To evaluate the value of implementing a modified reverse puncture procedure for esophagojejunostomy during totally laparoscopic total gastrectomy.Methods:This was a descriptive case series. Relevant clinical data, including the operative procedure, recovery, and pathological findings of 35 patients with gastric cancer who had undergone esophagojejunostomy with a modified reverse puncture technique during totally laparoscopic total gastrectomy in the Department of Gastrointestinal Surgery, Fujian Provincial Hospital, from June 2022 to January 2023, were prospectively collected and retrospectively analyzed. The age of all patients in the group was (64.9±8.0) years old, with 22 males (62.9%) and a body mass index of (23.2±2.4) kg/m 2. The tumors were located in the upper and middle parts of the stomach in 24 cases (68.6%) and in the junction of the esophagus and stomach in 11 cases (31.4%). Important technical aspects of the modified reverse puncture procedure are as follows. (1) Site of the esophageal incision: a transverse incision is made across the right lateral wall of the esophagus at the expected site of esophageal disjunction. (2) Technique for inserting an anvil: after threading a silk thread through the tip of anvil, the end of the thread is knotted and fixed as the traction thread, after which an anvil is inserted into the esophagus through the esophageal incision, leaving the end of the traction line exposed. Next, a 60-mm linear cutter is placed through the right midclavicular trocar to straighten the opened esophagus vertically, after which the rod of the anvil is pulled out of a small incision that has been made in the esophagus by pulling the traction thread, thus completing anvil placement. (3) Jejunal binding: the jejunum on the central bar of the stapler is fastened with silk thread to the stump of the jejunum, and then tied to the output loop of the jejunum with a gauze strip. Results:All 35 surgeries were successful, with no mortality or conversion to laparotomy. The operation time, anvil insertion time, and digestive tract reconstruction time were (232.7±34.4), (8.5±1.4), and (40.5±4.8) minutes, respectively. The intraoperative blood loss was 100 (20–250) mL and the incision was (5.3±0.9) cm long. The upper surgical margin was negative in all patients and the mean distance between the upper and tumor margins was (3.5±1.2) cm. The mean number of lymph nodes dissected per patient was 33.9±7.1. The times to initial ambulation, initial passage of flatus , postoperative fluid intake, and length of postoperative hospital stay were (3.2±1.1), (3.7±1.5), (4.6±2.3), and (9.8±3.2) days, respectively. Postoperative complications occurred in five patients: one case of anastomotic leak, two of anastomotic stenosis, one of pulmonary infection, and one of incomplete intestinal obstruction, all of which were successfully managed conservatively.Conclusion:Esophagojejunostomy using a modified reverse puncture technique during totally laparoscopic total gastrectomy is safe and feasible for gastric cancer, requiring only a small incision and achieving higher upper esophageal resection margins and good postoperative recovery, and therefore warrants further implementation.

Objective:To evaluate the value of implementing a modified reverse puncture procedure for esophagojejunostomy during totally laparoscopic total gastrectomy.Methods:This was a descriptive case series. Relevant clinical data, including the operative procedure, recovery, and pathological findings of 35 patients with gastric cancer who had undergone esophagojejunostomy with a modified reverse puncture technique during totally laparoscopic total gastrectomy in the Department of Gastrointestinal Surgery, Fujian Provincial Hospital, from June 2022 to January 2023, were prospectively collected and retrospectively analyzed. The age of all patients in the group was (64.9±8.0) years old, with 22 males (62.9%) and a body mass index of (23.2±2.4) kg/m 2. The tumors were located in the upper and middle parts of the stomach in 24 cases (68.6%) and in the junction of the esophagus and stomach in 11 cases (31.4%). Important technical aspects of the modified reverse puncture procedure are as follows. (1) Site of the esophageal incision: a transverse incision is made across the right lateral wall of the esophagus at the expected site of esophageal disjunction. (2) Technique for inserting an anvil: after threading a silk thread through the tip of anvil, the end of the thread is knotted and fixed as the traction thread, after which an anvil is inserted into the esophagus through the esophageal incision, leaving the end of the traction line exposed. Next, a 60-mm linear cutter is placed through the right midclavicular trocar to straighten the opened esophagus vertically, after which the rod of the anvil is pulled out of a small incision that has been made in the esophagus by pulling the traction thread, thus completing anvil placement. (3) Jejunal binding: the jejunum on the central bar of the stapler is fastened with silk thread to the stump of the jejunum, and then tied to the output loop of the jejunum with a gauze strip. Results:All 35 surgeries were successful, with no mortality or conversion to laparotomy. The operation time, anvil insertion time, and digestive tract reconstruction time were (232.7±34.4), (8.5±1.4), and (40.5±4.8) minutes, respectively. The intraoperative blood loss was 100 (20–250) mL and the incision was (5.3±0.9) cm long. The upper surgical margin was negative in all patients and the mean distance between the upper and tumor margins was (3.5±1.2) cm. The mean number of lymph nodes dissected per patient was 33.9±7.1. The times to initial ambulation, initial passage of flatus , postoperative fluid intake, and length of postoperative hospital stay were (3.2±1.1), (3.7±1.5), (4.6±2.3), and (9.8±3.2) days, respectively. Postoperative complications occurred in five patients: one case of anastomotic leak, two of anastomotic stenosis, one of pulmonary infection, and one of incomplete intestinal obstruction, all of which were successfully managed conservatively.Conclusion:Esophagojejunostomy using a modified reverse puncture technique during totally laparoscopic total gastrectomy is safe and feasible for gastric cancer, requiring only a small incision and achieving higher upper esophageal resection margins and good postoperative recovery, and therefore warrants further implementation.

Objective:To investigate the role of advanced oxidation protein products (AOPPs) in epithelial - mesenchymal transition (EMT) of small intestinal epithelial cells, and provide basis for the study of mechanism of intestinal fibrosis (IF) in intestinal bowel disease (IBD) .Methods:The small intestinal crypt epithelial cells IEC-6 were cultured in vitro. AOPPs was made by hypochlorous acid oxidation of rat serum albumin (RSA) in vitro. IEC-6 cells were divided into blank control group, AOPPs group and RSA group. The different concentrations (50, 100, 200, 400 μg/ml) of AOPPs were used to interfere with IEC-6 cells respectively in AOPPs group, 50, 100, 200, 400 μg/ml RSA were used to interfere with IEC-6 cells respectively in RSA group and no intervention in blank control group. The morphological changes of IEC-6 cells were observed and apoptosis was detected by flow cytometry in 3 groups 24 h after intervention. When the apoptosis rate was highest, the concentration of AOPPs were analyzed statistically and used to interfere IEC-6 for 48 and 72 h. The difference of apoptosis rate were analyzed between the different times. The mRNA expression of E-cadherin, Fibronectin, Snail, Slug and Collagen Ⅰ were detected in blank control group, AOPPs group and RSA group by fluorescence quantitative PCR.Results:AOPPs could induce the apoptosis of IEC-6 cells with time- and concentration-dependent effects ( P<0.05) . The apoptosis rate was (17.30 ± 1.03) %, which reached the peak by the intervention of 400 μg/ml AOPPs for 72 h. AOPPs significantly decreased the mRNA expression of E-cadherin in IEC-6 cells, significantly increased the mRNA expression of Fibronectin and CollagenⅠ, and significantly increased the mRNA expression of transcription factor Snail and Slug (all P<0.05) . Conclusions:AOPPs can promote the ECT of small intestinal epithelial cells and play a role in IF of IBD by inducing the apoptosis of IEC-6 cells, inhibiting of the transcription of E-cadherin, up-regulating the gene expression of the transcription factors Snail and Slug, while increasing the gene expression of Fibronectin and CollagenⅠ.

Objective:To investigate the role of advanced oxidation protein products (AOPPs) in epithelial - mesenchymal transition (EMT) of small intestinal epithelial cells, and provide basis for the study of mechanism of intestinal fibrosis (IF) in intestinal bowel disease (IBD) .Methods:The small intestinal crypt epithelial cells IEC-6 were cultured in vitro. AOPPs was made by hypochlorous acid oxidation of rat serum albumin (RSA) in vitro. IEC-6 cells were divided into blank control group, AOPPs group and RSA group. The different concentrations (50, 100, 200, 400 μg/ml) of AOPPs were used to interfere with IEC-6 cells respectively in AOPPs group, 50, 100, 200, 400 μg/ml RSA were used to interfere with IEC-6 cells respectively in RSA group and no intervention in blank control group. The morphological changes of IEC-6 cells were observed and apoptosis was detected by flow cytometry in 3 groups 24 h after intervention. When the apoptosis rate was highest, the concentration of AOPPs were analyzed statistically and used to interfere IEC-6 for 48 and 72 h. The difference of apoptosis rate were analyzed between the different times. The mRNA expression of E-cadherin, Fibronectin, Snail, Slug and Collagen Ⅰ were detected in blank control group, AOPPs group and RSA group by fluorescence quantitative PCR.Results:AOPPs could induce the apoptosis of IEC-6 cells with time- and concentration-dependent effects ( P<0.05) . The apoptosis rate was (17.30 ± 1.03) %, which reached the peak by the intervention of 400 μg/ml AOPPs for 72 h. AOPPs significantly decreased the mRNA expression of E-cadherin in IEC-6 cells, significantly increased the mRNA expression of Fibronectin and CollagenⅠ, and significantly increased the mRNA expression of transcription factor Snail and Slug (all P<0.05) . Conclusions:AOPPs can promote the ECT of small intestinal epithelial cells and play a role in IF of IBD by inducing the apoptosis of IEC-6 cells, inhibiting of the transcription of E-cadherin, up-regulating the gene expression of the transcription factors Snail and Slug, while increasing the gene expression of Fibronectin and CollagenⅠ.

OBJECTIVE: To investigate the safety of the controllable ileostomy with pipe in view of histology. METHODS: Twenty-eight Beagle dogs undergoing controllable ileostomy with pipe were studied. The special fistula tube with balloon was placed into the hole locating at the cecal root opposing the mesenteric side, and fixed by double knot compression method. RESULTS: The fistula tube was removed 14 days after surgery, then the safety of the procedure was preliminarily evaluated by gastrointestinal radiography and anatomical observation. The small intestine tissue at the compression suture was used as the experimental segment, and the small intestine tissue at the proximal non-compression suture was used as the control segment. The histological staining and the immunohistochemical staining of S-100 protein, c-kit protein and α-smooth muscle actin(α-SMA) protein between two segment were compared, while quantitative comparison of myenteric plexus, intestinal Cajal cell(ICC) and smooth muscle cells in intestinal wall was carried out. After removal of fistula tube at 14 days postoperative, the dogs were normal in feeding and defecation. The digestive tract radiography showed that the intestine was patent without obvious stenosis and obstruction. The dogs were dissected 21 days after operation. The abdominal sinus ostium was well healed and the internal sinus was well formed. Under gross inspection, blood supply, morphology and motor function of experimental intestine segment were similar from the proximal and distal segments of control intestine. S-100 immunohistochemical staining showed that the morphology and distribution of S-100 protein positive cells and "blank area" cells in the experimental and control segments were consistent. Myenteric plexus counting showed that the experimental segment was 3.62±1.82/field and the control segment was 3.27±1.62/field, whose difference was not statistically significant(t=1.30, P=0.20). Immunohistochemical staining of c-kit showed that the distribution of c-kit positive cells in both segments was consistent. Counting of the number of ICCs in myenteric plexus revealed that experimental segment was 2.96±2.57/plexus, and control segment was 2.49±1.80/plexus without significant difference(t=1.81, P=0.07). Immunohistochemical staining of α-SMA showed that the morphology and distribution of smooth muscle cells in whole intestinal wall(muscle layer, longitudinal muscle, ring muscle) in experimental and control segments were consistent. The average absorbance(A) value of α-SMA staining in ring muscle layer was detected and quantified. The experimental segment was 0.15±0.03 and control segment was 0.14±0.04 without significant difference(t=1.16, P=0.25). CONCLUSION The technique of controllable ileostomy with pipe is safe in view of histology, which may replace the traditional protective ileostomy.
Animals ; Dogs ; Ileostomy ; methods ; standards ; Intestine, Small ; surgery ; Models, Animal ; Proto-Oncogene Proteins c-kit ; metabolism ; Treatment Outcome

OBJECTIVETo study the management for the perineal incision after laparoscopic-assisted abdominoperineal resection for rectal cancer.

METHODSClinical data of 87 patients undergoing laparoscopic Miles operation for lower rectal cancer from June 2009 to February 2014 were collected and studied. Presacral space drainage group: presacral space drainage tube was applied in 42 patients. Combined drainage group: presacral space drainage tube combined with subcutaneous vacuum pressure suction was applied in 45 cases. In combined drainage group, except the presacral drainage tube, another drainage tube was placed subcutaneously and connected to a negative pressure ball, which was fixed on the lateral anterior of perineal wound by the further incision and drainage. After subcutaneous tube was placed for 2 weeks, as drainage fluid was limpid and <15 ml/d for 3 days, meanwhile no obvious pelvic fluid was detected by ultrasound, and the wound healed quite well without redness and edema, then the subcutaneous tube with the negative pressure ball could be removed.

RESULTSThere were 51 males and 36 females with the mean age of 26-78(56.9±10.8) years old. The laparoscopic Miles operation was successfully completed in all the cases without death and complications. The drainage tube was placed for 4-13(8.0±2.5) days in presacral space drainage group, and for 4-14(6.7±2.4) days in combined drainage group. The subcutaneous tube was placed for 14-24(15.8±3.0) days. The primary healing rate of perineal wound in presacral space drainage group and combined drainage group was 66.7%(28/42) and 91.1%(41/45) respectively, while the perineal wound infection rate was 21.4%(9/42) and 4.4%(2/45) respectively, whose differences between two groups were both significant (χ=7.911, P=0.005 and χ=5.674, P=0.017).

CONCLUSIONPresacral space drainage tube combined with subcutaneous vacuum pressure suction in laparoscopic-assisted abdominoperineal resection for rectal cancer has better efficacy and lower infection rate for perineal incision, which is worth wide application.

AIM:To investigate the relationship between the expression of adducin 3 (ADD3) and its splicing isoforms and colorectal cancer (CRC).METHODS:The expression of ADD3, ADD3-Ia and ADD3-Ib in 50 pair of CRC tissues , 20 pairs of colorectal polyp tissues , and 2 CRC cell lines SW480 and SW620 before and after oxaliplatin or fluoroura-cil intervention were detected by real-time PCR.The cell activity was determined by MTT assay , the cell migration ability was evaluated by wound-healing assay , and the cell invasion ability was measured by Transwell assay .RESULTS:The expres-sion levels of ADD3 and ADD3-Ib were decreased in the CRC tissues as compared with the normal mucous (P<0.01), and ADD3-Ia/Ib ratio was increased in the CRC tissues (P<0.01).The expression level of ADD3-Ia was higher in T3-4 group than that in T1-2 group (P<0.05).Reduced expression of ADD3, ADD3-Ia and ADD3-Ib in colorectal polyps was observed compared with the normal tissues (P<0.01).Compared with the SW480 cells, the expression levels of ADD3-Ia and ADD3-Ib were lower (P<0.05) and the ADD3-Ia/Ib ratio was higher (P <0.01) in the SW620 cells.After treated with oxalipla-tin or fluorouracil, the cell activity, migration and invasion in the SW620 and SW480 cells were weakened accompanied by the increases in the expression levels of ADD 3, ADD3-Ia and ADD3-Ib to various certain extents .CONCLUSION:In CRC there is a tendency that ADD3-Ib reduction leads to ADD3 decrease, accompanied by an increased ADD3-Ia/Ib ratio.The expression changes of ADD 3 and its splicing isoforms in the CRC may be relevant to its invasion ability .

OBJECTIVETo investigate the expression of transcriptional coactivator with PDZ-binding motif(TAZ) in colon cancer tissues and its association with clinicopathological parameters and prognosis of patients.

METHODSThe expression of TAZ protein was detected in 56 resected colon cancer tissues and matched tumor-adjacent tissues using immunohistochemistry. The positive expression rate of TAZ was compared between patients with different clinicopathological features. The association between TAZ expression and prognosis was analyzed.

RESULTSExpression of TAZ protein located in the nucleolus. The positive expression rate of TAZ in colon cancer tissues was significantly higher than that in matched tumor-adjacent tissues(73.2% vs. 12.5%, P=0.000). Clinicopathological evaluation suggested that the expression of TAZ protein was associated with tumor size(P=0.009), depth of infiltration(P=0.026), lymph node metastasis (P=0.007) and TNM staging(P=0.004). Colon cancer patients with negative expression of TAZ showed a better 5-year survival as compared with those with positive expression of TAZ (66.7% vs. 22.9%, P=0.0017). Multivariate Cox regression analysis revealed that positive TAZ expression was an independent factor for predicting poor prognosis in colon cancer (HR:3.532, 95% CI: 1.3-9.9, P=0.016).

CONCLUSIONThe expression of TAZ protein is up-regulated in colon cancer tissues and its high expression is associated with poor prognosis of colon cancer patients.

OBJECTIVETo investigate miR-146a expression in colonic cancer and its clinical implications.

METHODSQuantitative real-time PCR was employed to detect the levels of miR-146a expression in colonic cancer tissues, pair-matched adjacent normal tissues and different colonic cancer cell lines. MTT essay was used to evaluate the proliferation of colonic cancer SW260 cells transfected with miR-146a mimics, and the cell cycle and apoptosis of the cells were analyzed with flow cytometry.

RESULTSCompared with the normal tissues, 38 of the 43 colonic cancer samples showed down-regulated miR-146a expression, which was associated with poor tumor differentiation. The expression of miR-146a in the tumor tissues was significantly correlated with tumor size and clinical stages. The patients with high miR-146a expression levels had significantly longer total survival time than those with low expression of miR-146a. In SW260 cell cultures, transfection with miR-146a mimics significantly inhibited cell growth (P<0.05) and increased the cell apoptosis rate (11.9% vs 5.9%) but produced no obvious effect on cell cycle.

CONCLUSIONSmiR-146a may serve as a potential therapeutic target for colonic cancer for its role in inhibiting colonic cancer cell proliferation.