Objective To investigate the effects of estrogen on mismatch repiar gene expression in colonic mucosa in vivo. Methods A total of 42 healthy individuals underwent colonoscopy were enrolled in the study. Half an hour before colonoscopy examination, blood sample was taken for determining the serum estradiol (E2) level. N ormal colonic mucosal tissues determined by naked eye under colonoscopy examination were taken in the right hemi colon to detect HMLH1 and hMSH2 gene expression by semi-quantitative RT-PCR and immunohistochemistry staining. Then the correlation of serum E2 levels with hMLH1 and hMSH2 expression in colonic mucosa was analyzed. Results A bimodal curve was presented for the correlation between serum E2 level in healthy individuals and hMLH1 expression in colonic mucosa. A strong positive correlation of E2 level with hMLH1 expression in normal colonic mucosa was observed when serum E2 level was more than 45 pg/ml (For mRNA, P=0. 003, r=0. 701; for immunohistochemistry positivity index, P=0. 000, r=0. 874).However there was no correlation between E2 level and hMSH2 expression. Conclusion High serum E2 level might increase the hMLH1 gene expression in colonic mucosa in vivo.

Objective To identify clinicopathological features of high MSI (MSI-H).Methods We enrolled 150 patients,standard microsatellite loci (BA T25,BA T26,D2S123,D5S346,D17S250) were amplified by polymerase chain reaction(PCR) with fluorescent primers,and the PCR products were analyzed by GeneMapper software;age at diagnosis,gender and site were obtained;various pathological features were observed by light microscopy;the expression of tumor infiltrating lymphocytes (CD4~+ and CD8~+) was detected by immunohistochemistry.Using a stepwise logistic regression model,a formula was generated that could be used to calculate the probability of a colorectal carcinoma being MSI-H based on pathological features.Results Among 150 cancers,MSI-H was 13.33%.Independent identifiers inclucle poor differentiation,histologic heterogeneity,Crohn's-like reaction and tumor-infiltrating lymphocytes,logistic regression formula shows a sensitivity of 70.0% and a specificity of 99.2% and a accurate ratio of 95.3% for MSI-H.Conclusion MSI-H phenotype cancer is a type of nonfamilial colorectal cancer with specific pathological features,Clinicopathological features can efficiently identify MSI-H colorectal cancers.

Objective To evaluate the effect of various methods of fecal exfoliated cell testing for screening of colorectal cancer.Methods The stool samples from 814 patients who underwent colonoscopy were collected for fecal exfoliated cell testing using diarrhea feces,twice naturally evacuated feces,magnetic separation or naturally evacuated combined with diarrhea feces.The fecal exfoliated cells were isolated and examined cytologically.The DNA quantitative analysis and gene detection were carried out.Fecal occult blood test was simultaneously performed in twice naturally evacuated feces and naturally evacuated combined with diarrhea feces.Results The sensitivity and specificity of exfoliated cells testing for colorectal Cancer was 66.27%(112 of 169 cases of colorectal cancer)and 99.56%(225 of 226 normal subjects),respectively.There was no correlation of positive rate with differentiations of colorectal cells or Duke's stages(P＞0.05).The nuclear DNA quantitative analysis showed that the sensitivity for detecting cancer was 76.09%for twice naturally evacuated feces and 68.29%for naturally evacuated combined with diarrhea feces,which was superior than diarrhea feces(26.31%)and magnetic separation (43.24%).The positive rate of genes detected in carcinoma tissues concordant with fecal exfoliated cells testing were 83.33%(25/30)for p53,9/10 for APC and 9/10 for K-ras.The sensitivity of cytology was higher than gene detection.The sensitivity of cancer detection was higher in combining exfoliated cells test with fecal occult blood test(93.10%)than exfoliated cells test(73.56%)or fecal occult blood test (80.46%)alone(P＜0.05).Conclusions Fecal exfoliated cells test is an effective method for screening of colorectal cancer.It is the best option for detecting cancer by twice tests of fecal exfoliated cells with liquid-based thin-layer cytological test,and combined with fecal occult blood test.

Objective To study the relationship between the CT value and injury of ultrastructure in posttraumatic acute diffuse brain swelling(PADBS). Methods The change of CT value of brain tissue was analyzed at posttrauma and preoperation in 9 patients, in combination with the ultrastructure in brain parenchyma in 36 specimen taken from operations. The relationship between the descend of CT value and ultrastructure injury was analysed.Results The CT value of brain in preoperation was lower than it in posttrauma first scanning(2.5～4.3 HU).The capillary distention and stenosis and the diffuse edema in pericapillary and intercellular were observed under transmission electron microscopy(TEM). The nucleolus of neuronal cells displaced to membrane or disappeard. Chromation agglutionation, nuclear membrane circuity, perinuclear diffuse lipid drops and blankspace were detected. The mitochondrion swelling, mitochondrial crest blurring or effacement, rough endoplasmic reticulum distension and its’ granules detachmen were also seen under TEM. Axolemma edema, microfilaments and microtubules derangement in axis-cylinder were found too. The similar phenomena existed in astrocyte.Conclusion The descent of CT value in PADBS was relevant to the aggravation of vasogenic cerebral edema, cytotoxic cerebral edema and ultrastructure injury in brain parenchyma.

Objective To explore the correlation between COX-2 and Ki-67 expression and microvessel density in primary gastric cancer tissue and clinicopathological parameters and to investigate their effect on postoperative gastric cancer recurrence. Methods Forty-eight postoperative recurrent gastric cancer patients were enrolled in this study, their clinicopathologic characters of primary tumors were analyzed retrospectively and compared with 48 cases without recurrence. Expression of COX-2 and Ki-67 and microvessel density ( MVD) in gastric cancer tissue were detected by immunohistochemical method. Risk factors correlated with tumor recurrence were studied by univariate and multivariate analysis. Results Expression of COX-2, Ki-67 label index (LI) and MVD were correlated with each other, and they were all correlated with depth of invasion and TNM stages in gastric cancer tissue. Patients with pelvic metastatic lymph node, cancer invasion to serosa, of Borrmann III or IV, high COX-2 and MVD expression are on high risk of recurrence (P

Objective To investigate the correlation between clinicopathologic factors and peritoneal dissemination from gastric cancer, and the impact of palliative resection on the prognosis of patients with gastric cancer complicated by peritoneal dissemination. Methods Based on our database built in 1994, the clinicopathologic data and the result of follow-up of all gastric cancer patients were analyzed retrospectively using the software of SPSS. Results One hundred and five out of 792 (13. 3% ) patients with primary gastric cancer were found complicated with peritoneal dissemination. The clinicopathologic factors in patients with peritoneal dissemination were significantly correlated with primary tumor penetrating through serosa, lymph node metastasis, primary tumor involving whole stomach, undifferentiated carcinoma, Borrmann IV and female gender (P

Objective To investigate the efficacy of sunitinib in the treatment of patients with imatinibresistant advanced gastrointestinal stromal tumor (GIST).Methods The clinical data of 45 patients with imatinib-resistant advanced GIST who received the treatment of sunitinib (37.5 mg/d) at the First Affiliated Hospital of Sun Yat-Sen University from March 2008 to June 2012 were retrospectively analyzed.The mutation of c-kit and platelet-derived growth factor receptor α (PDGFRα) was detected,and the efficacy of imatinib was assessed after the treatment for 3 months,and factors influencing the survival were analysed.The survival rate was calculated using the Kaplan-Meier method,survival analysis was done using the one-way analysis of variance,and multivariate analysis was done using the COX regression model.Results The median time of treatment with sunitinib for the 45 patients was 11.0 months (range,4-37 months).The complete remission rate,partial response rate,rate of stabilized condition and disease progression rate were 15.6％ (7/45),8.9％ (4/45),46.7％ (21/45) and 28.9％ (13/45) after the treatment with sunitinib for 3 months.All the patients with clinical (imaging) complete remission received surgery for metastatic lesions or B-ultrasound guided ablation for single liver metastasis before the treatment with sunitinib.The most common grade 3 or 4 adverse reactions of sunitinib were hand-foot syndrome and anemia.C-kit and PDGFRα mutational analysis were carried out.C-kit exon 9 mutation was detected in 9 patients,c-kit exon 11 mutation in 21 patients,and no mutation was detected in 12 patients.The median progression-free survival time was 8.0 months (range,4.1-11.9 months),and the median overall survival time was 25.0 months (range,13.4-36.6 months).The results of univariate analysis showed that the primary lesion sites and mutational status of primary lesions were factors influencing the progression-free survival and overall survival (x2=5.967,6.622 ; 7.965,8.765,P ＜ 0.05).The results of multivariate analysis showed that only the mutational status of c-kit of primary lesions was the independent factor influencing the progression-free survival and overall survival (Wald =6.540,7.205,P ＜ 0.05).The progression-free survival and overall survival of patients with c-kit exon 9 mutation and patients with no gene mutation were significantly longer than patients with c-kit exon 11 mutation (x2 =7.965,8.765,P ＜ 0.05).Conclusion Sunitinib with a dosage of 37.5 mg/d could effectively treat patients with imatinib-resistant advanced GIST.A better survival is observed in patients with c-kit exon 9 mutation or with no gene mutation when compared with patients with c-kit exon 11 mutation.

ObjectiveTo explore risk factors of colorectal cancer with synchronous liver metastases and its prognosis. Methods From Aug 1994 to Feb 2004, 106 colorectal cancer patients with synchronous hepatic metastases were enrolled. Fifteen clinicopathological parameters were collected for mono-variable and multi-variable analysis. Treatment result was analyzed by Kaplan-Meier method and COX regression. Results Bowel obstruction, ascites, pelvic nodules, peritoneal invasion, serosal infiltration, organs involvement, tumor size, circumference of bowel invasion, depth of invasion were all individually relevant with synchronous hepatic metastasis. Logistic regression demonstrates depth of invasion, serosal infiltration, pelvic nodules and ascites were most important factors resulting in synchronous hepatic metastases. Radical resection(57 cases), palliative resection(39 cases) and laparotomy only(10 cases) resulted respectively in mean survival time and median survival time of 41.0 and 34.0 months,23.6 and 18.0 months,16.5 and 12.0 months,respectively (all P=0.0095).Surgery, location of tumor and pelvic nodules were independent prognostic factors. Conclusions Synchronous liver metastasis may present when primary tumor infiltrates serosa, or pelvic nodules and ascites are present. Radical excision significantly improves survival rate.

Objective To study the feasibility, safety and clinical effects of spleen and splenic vessel-preserving distal pancreatectomy. Methods A retrospective study was performed in 26 patients undergoing distal pancreatectomy for benign or low grade malignant disease with splenectomy (n = 13) or splenic preservation (n = 13 ) at the First Hospital of Sun Yat-sen University and Guangdong General Hospital from May 2002 to April 2009. Results All 26 pancreatectomy with splenectomy or splenic preservation were performed successfully. There was no statistically significant difference between two groups in average operative time[(172±47) min vs. (157±52) min, P ＞ 0.05 ], intraoperative estimated blood loss [( 183 ± 68 ) ml vs. ( 160 ± 51 ) ml, P ＞ 0.05 ], incidence of noninfectious and infection complication and postoperative hospital stay [(10.1±2.2) d vs. ( 12. 1 ± 4. 6 ) d, P ＞ 0.05 ]. The platelet counts examined one week after operation were significantly higher in the distal pancreatectomy with splenectomy group than that in spleen-preserving group [(37.3 ± 12.8)×109/L vs. (54.7 ± 13.2) × 109/L, P＜0.05 ]. Conclusions Spleen-preserving distal pancreatectomy appears to be a feasible and safe procedure in selected cases of benign or low-grade pancreatic malignant disease necessitating a distal pancreatectomy.

OBJECTIVETo investigate the feasibility and short-term efficacy of laparoscopic resection of primary local gastric and intestinal gastrointestinal stromal tumors(GIST).

METHODSClinicopathological data of 26 patients with GIST, 20 located at the stomach and 6 at the intestine, undergoing laparoscopic complete resection from October 2010 to April 2013 were retrospectively analyzed.

RESULTSHand-assisted laparoscopic surgery was performed in 3 patients with gastric GIST, while the other 23 underwent regular laparoscopic surgery. All the procedures were performed successfully without conversion to open operation. According to tumor location and growth types, gastric local resection was performed in 18 cases, distal gastrectomy in 2 cases and intestinal segmental resection in all 6 cases of intestinal GIST. The mean diameter of tumor was (4.5±1.6) cm. The mean operational time was(96.2±28.2) min, with a mean blood loss of (49.6±38.6) ml. Postoperative bowel function recovery time was (2.3±0.7) d and the length of postoperative hospital stay was (6.8±1.9) d. Bleeding from gastrointestinal tract developed in 1 patient after resection of intestinal GIST. Postoperative pathology indicated very low risk of GIST in 1(3.8%), low risk in 13(50.0%), intermediate in 9(34.6%) and high risk in 3(11.5%) patients, respectively. After a follow-up ranging form 3 to 32 months, no recurrence or death was found.

CONCLUSIONLaparoscopic surgery of primary local GISTs from stomach or intestine is safe and feasible in selected patients, with less invasiveness, rapid recovery, and favorable short-term outcomes.

Gastrectomy ; Gastrointestinal Stromal Tumors ; surgery ; Hand-Assisted Laparoscopy ; Humans ; Intestinal Neoplasms ; surgery ; Laparoscopy ; Length of Stay ; Neoplasm Recurrence, Local ; Operative Time ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome