Objective To analyze the active principle of Melagenine and its effect on melanocytes of guinea epidermis.Methods The content of endothelins and sialic acid of Melagenine were determined by radioimmunoassay and spectrophotometer.The skin of the back of guinea pigs was treated with Melagenine and irradiated with infrared-ray.Then the biopsy specimens were taken from the treated and untreated back skin,sections and supe-rthin sections were prepared for special staining and TEM examination,respectively,the number melanocytes and melanin content index(MCI)were measured.Results The contents of en-dothelins and sialic acid in melagenine were210.5?30.1pg/mL and147.9?12.1?g/mL,respectively;the number of melanocytes,the keratinocytes with melanin granules and the melanin content index were all in-creased significantly in the treated skin.Conclusions There are endothelins,carbohydrates and glycolipids in melagenine,endothelins can promote the proliferation of melanocytes,while carbohydrates and glycolipids can enhance intercellular recognition and adhesion.The result of the study shows that melagenine promotes the proliferation of melanocytes and synthesis of melanin in the skinof guinea pigs.

Objective To investigate the diagnostic value of multiplex polymerase chain reaction (m-PCR) for diagnosing second infection of severe acute pancreatitis ( SAP), and to provide evidence for anti-infection treatment of SAP .Methods From January 2011 to December 2014 , thirty five patients of SAP were enrolled .Seven to fourteen days after SAP onset , patients′blood samples were taken and the presence of infection was determined by mP-CR.In the meantime, peripheral blood or the paracentesis fluid was cultured , and the result of culture was regard as golden standard to diagnose infection .Rseults The m-PCR could simultaneously detect 9 kinds of intestinal resident pathogenic bacteria , and the lower limit of detection was 10~1 000 copies.The detection rates were as follows (cultivation vs. m-PCR):staphylococcus aureus 6 vs 5 cases, staphylococcus epidermidis 11 vs 9 cases, enterococcus faecalis 2 vs 3 cases, enterococcus faecium 6 vs 7 cases, escherichia coli 19 vs 17 cases, klebsiella pneumoniae 2 vs 3 cases, pseudomonas aeruginosa 6 vs 4 cases, acinetobacter baumannii 2 vs 2 cases, malt narrow food aeromonas 4 vs2 cases.The 7th~14th days after SAP onset, the blood or paracentesis fluid culture was positive in 27 patients,and negative in 8 cases. And the m-PCR results were positive in 30 patients, and negative in 8 cases.The m-PCR results were positive in 30 patients, negative in 5 patients.The m-PCR results were positive in 3 patients who had negative culture results.In the remaining 32 cases, the results were consistent between the two detection methods .When the culture result was regarded as golden standard , the sensitivity, specificity and accuracy of m-PCR were 100%, 62.5%and 91.43%, respectively.The positive predictive value and the negative predictive value were 90%and 100%, respectively.It took (26 ±15) hours on average to obtain the result of culture method , and it took (102 ±32) hours on average to obtain the confirmative results .It took (12 ±8) hours on average to obtain the result of the m-PCR method.The time course of m-PCRwas significantly shorter than that of the traditional culture method, and the difference was statistically significant (P<0.05).Conclusions The m-PCR method can be used to monitor the bacterial infection in patients with SAP .The m-PCR method is a highly sensitive and rapid detection approach , which is worth of clinical application .

Gastric cancer with liver metastasis (GCLM) is the leading cause of death in patients with advanced gastric cancer. Multiple metastasis was common in GCLM and usually complicated with lesions outside the liver, especially peritoneal metastasis. Most of liver metastasis lesions could not be resected radically. Currently, main treatments for GCLM included radical operation, palliative resection of gastric cancer, ablation of metastatic lesions, intervention and systemic chemotherapy. Based on the current progress in the treatment for GCLM and our clinical experience, the general status of patients, the type of gastric cancer and the degree of liver metastasis should be analyzed, and a cooperative multidisciplinary team (MDT) should be applied to conduct and to choose active and suitable comprehensive treatment for GCLM patients based on individualized therapy principle.
Humans ; Liver Neoplasms ; secondary ; therapy ; Stomach Neoplasms ; pathology ; therapy

OBJECTIVETo assess the value of gastric and hepatic surgical treatment in gastric cancer patients with liver metastasis and its prognostic implication.

METHODSLiterature search was performed in pubmed, Embase, Ovid, Springer-Link, Web of Science, CNKI, CBMdisc for clinical research published before March 2013 that compared gastrectomy alone to gastrectomy and hepatectomy. Inclusion criteria and exclusion criteria were performed. Quality assessment was based on NOS scale. Stata12.0 was used for statistical analysis.

RESULTSNine studies including 431 patients were enrolled for analysis, among whom 189 underwent gastrectomy and hepatectomy and 242 underwent gastrectomy alone. Gastrectomy and hepatectomy group had better survival(HR=0.50, 95%CI:0.34-0.72, z=3.66, P=0.000). There was a subgroup analysis. Gastrectomy with hepatectomy group had significant advantages in prognosis in four foreign studies(HR=0.28, 95%CI:0.18-0.44, z=5.77, P=0.000). There was no significant difference in five domestic studies (HR=0.74, 95%CI:0.55-1.00, z=1.95, P=0.051).

CONCLUSIONGastrectomy and hepatectomy in gastric cancer patients with liver metastasis improves long-term survival in select patients.

Gastrectomy ; Hepatectomy ; Humans ; Liver Neoplasms ; secondary ; surgery ; Prognosis ; Stomach Neoplasms ; pathology ; surgery

OBJECTIVETo evaluate the efficacy of different treatments for synchronous liver metastasis from gastric cancer.

METHODSClinicopathological and follow-up data of 271 patients with synchronous liver metastasis from gastric cancer between January 1998 and November 2012 were analyzed retrospectively. Among 271 patients, 34 received surgery alone, 95 received chemotherapy alone, and 120 received combined therapy. The prognosis was compared.

RESULTSThe median survival time was 8 months (3-41 months) in the surgery group and the cumulative 1-, 3- and 5-year survival rates were 32.4%, 2.9% and 0. The median survival time was 7 months (3-50 months) in the chemotherapy group and the cumulative 1-, 3- and 5-year survival rates were 21.1%, 1.1% and 0 respectively. The median survival time was 11 months (3-84 months) in the combined group and the cumulative 1-, 3- and 5-year survival rates were 50.0%, 5.0% and 0.8% respectively. The differences among groups were all statistically significant (all P<0.05). Extent of lymph node metastasis, therapeutic strategies, and liver metastasis management were significantly independent prognostic factors for synchronous liver metastasis from gastric cancer.

CONCLUSIONSComprehensive treatment based on operation may improve the long-term survival of patients with synchronous liver metastasis from gastric cancer.

Humans ; Liver Neoplasms ; secondary ; therapy ; Lymphatic Metastasis ; Prognosis ; Retrospective Studies ; Stomach Neoplasms ; pathology ; therapy ; Survival Rate ; Treatment Outcome

OBJECTIVETo compare the clinical efficacy with meta-analysis between robot-assisted gastrectomy(RAG) and laparoscopy-assisted gastrectomy (LAG) for gastric cancer.

METHODSA literature search was performed in PubMed, Embase, Cochrane Library, Web of Science, Wanfang Data, CNKI(Chinese National Knowledge Infrastructure), and CBM(China Biological Medicine) databases for clinical researches published before July 2015 that compared RAG with LAG. Operative time, estimated blood loss, harvested lymph nodes, proximal margin, distal margin, hospital stay, conversion and complications were compared using weighted mean differences(WMD) and odds ratios (OR).

RESULTSSixteen studies were included in the analysis, comprising 5 764 patients(1 593 RAGs, 4 171 LAGs). RAG was associated with longer operative time (WMD=49.68, 95% CI: 35.54 to 63.82, P=0.000), less estimated blood loss (WMD=-26.10, 95% CI: -42.90 to -9.31, P=0.002), and shorter hospital stay(WMD=-0.72, 95% CI: -1.35 to -0.09, P=0.024). Conversion, mortality, complications, proximal margin, distal margin and harvested lymph nodes of RAG were similar to LAG. In meta-analysis results of distal gastrectomy and early-stage gastric cancer, RAG had more harvested lymph nodes (distal gastrectomy: WMD=2.23, 95% CI: 0.33 to 4.13, P=0.021; early-stage gastric cancer: WMD=2.58, 95% CI: 1.05 to 4.12, P=0.001).

CONCLUSIONSRAG can be performed safely with less estimated blood loss and more harvested lymph nodes as compared to LAG. Radical resection can be achieved by RAG.

China ; Gastrectomy ; methods ; Humans ; Length of Stay ; Lymph Nodes ; Operative Time ; Robotic Surgical Procedures ; methods ; Stomach Neoplasms ; surgery

Objective To summarize the technique and clinical experience of hybrid procedure under cardiopulmonary bypass (CPB) in children with muscular ventricular septal defect (mVSD). Methods From January 2006 to June 2010, 45 cases of mVSD underwent hybrid procedure with CPB. mVSDs were closed with devices under direct vision in 45 cases. Of them, there were 20 males and 25 females. They ranged from 52 days to 12 years [mean (2.05 ±2.48) year] in age and from 3 to 30 kg [(11.93 ±7.70)kg] in body weight. Preoperatively, most of children were highly susceptible to respiratory tract infections. The hybrid approach was used in all patients with CPB under the guidance of transesophageal echocardiography (TEE). The diameter of mVSDs ranged from 2 to 7 mm under TEE. Of 45 cases, 40 patients had increased rates of pulmonary blood flow. 29 patients had left axis deviation and 12 cases had sinus arrhythmia on electrocardiography (ECG). 19 had other congenital heart lesions, including transposition of great arteries in 1 case, tetralogy of Fallot in 2, pulmonary artery stenosis in 3, patent ductus arteriosus in 6, atrial septal defects in 6) and aorta coactation in 1. The quantity of VSDs were from 1 to 7 (single, in 7; two, in 24 case; three, in 8 case; four, in 5 case and seven, in lease. 37 patients were combined with pulmonary hypertension in our cohort. 38 patients with another large VSD and 19 with other congenital heart lesions were required surgical repair at sometime. Results The hybrid procedures were undertaken in all 45 cases of this cohort. All cases were successful and no deaths occurred during operation. A total of 48 devices were implanted in 45 patients, including single devices in 42 cases (device size ranged from 4 to 10 mm) and two devices in 3 cases (device size ranged from 4 -7 mm). The average time on CPB was (58.28 ±20.70) min , while aortic crossclamp time was(34. 94 ± 14.75) min. In addition, the time on mechanical ventilation postoperatively ranged from 2 hours to 6 days. Compared to the older children, 20 infante aged less than 8 monhad a significant difference in cardiac function in the early postoperative period. One infant was given up treatment because of serious infection. Anather cases recovered with the use of supportive treatment, such as using vasoactive agents, digoxin, inhaling nitric oxide, diuresis, and so on. The enteric-coated aspirin was given at dose of 5 mg ? kg -1. day -1 for a period of 3 to 6 months as usual postoperatively. All patients attended follow-up at 1 week, 1 month, 3 months, 6 months, 1 year and 2 years post-procedure. No major complications were encountered during this period. All cases were no instance of migration of any of the devices, residual shunt, aortic regurgitation, atrioventricular valve dysfunction, Ⅲo atrial-ventricular conduction block, new arrhythmia, and so on. There are no death in long-term follow-up. Conclusion Hybrid procedure is safe and effective for the closure of congenital heart defects in children.

Objective:To explore the efficacy and safety of intraoperative hyperthermic intraperitoneal chemotherapy combined with total laparoscopic D2 radical gastrectomy in the treatment of gastric cancer.Methods:The clinical data of 127 patients with gastric cancer who were admitted to the Central Hospital of Hanzhong in Shaanxi Province from August 2017 to July 2019 were retrospectively analyzed. All patients underwent total laparoscopic D2 radical gastrectomy, of which 58 patients underwent total laparoscopic D2 radical gastrectomy combined with intraoperative hyperthermic intraperitoneal chemotherapy (observation group), and 69 patients underwent total laparoscopic D2 radical gastrectomy (control group). Observation indicators included surgical and postoperative recovery situations and postoperative tumor-related indicators. Follow-up was performed by using outpatient examination and telephone interview, and the content of follow-up included patient's adjuvant chemotherapy, tumor recurrence and metastasis, and surgery-related complications.Results:In the observation group, the intraoperative blood loss was (199±48) ml, the number of lymph node dissection was 35±8, the total hospitalization cost was (53 261±4 316) yuan, alanine aminotransferase was (30±10) U/L, and creatinine was (124±26) μmol/L; in the control group, the intraoperative blood loss was (184±46) ml, the number of lymph node dissection was 34±13, the total hospitalization cost was (52 146±4 817) yuan, alanine aminotransferase was (31±10) U/L, and creatinine was (128±33) μmol/L; there were no significant differences between the two groups ( t values were 1.833, 0.618, 1.363, 0.721, and 0.856, all P > 0.05). In the observation group, the operating time was (352±44) min, carcinoembryonic antigen (CEA) at 1 month after operation was (3.9±2.1) ng/ml,CEA at 6 months after operation was (12.7±7.2) ng/ml, tumor abnormal protein (TAP) at 1 month after operation was (75±36) μm 2,TAP at 6 months after operation was (131±33) μm 2; in the control group, the operating time was (308±58) min,CEA at 1 month after operation was (8.3±4.5) ng/ml, CEA at 6 months after operation was (15.8±4.2) ng/ml, TAP at 1 month after the surgery was (88±24) μm 2, TAP at 6 months after operation was (149±37) μm 2; there were significant differences between the two groups ( t values were 4.792, 7.185, 2.832, 2.284, and 2.984, all P<0.05). One hundred and twenty seven patients were followed up for 12-24 months. Fifty-one and 58 patients in the observation group and control group received postoperative adjuvant chemotherapy, and there was no significant difference between the two groups ( χ2 = 0.389, P = 0.533). Tumor recurrence was respectively detected in 0 and 6 patients in the observation group and control group at 6 months after operation; tumor recurrence was respectively detected in 2 and 11 patients in the observation group and control group at 1 year after operation; the differences in the recurrence rates between the two groups were statistically significant (both P < 0.05). Conclusion:Intraoperative hyperthermic intraperitoneal chemotherapy combined with total laparoscopic surgery for gastric cancer does not increase the patient's perioperative risk and the incidence of postoperative complications, and it can reduce the risk of postoperative recurrence and improve the short-term efficacy.

OBJECTIVETo systemically evaluate the relationship between the expression of insulin-like growth factor receptor type I (IGF-1R) and prognosis in gastric cancer (GC) patients.

METHODSA literature search was conducted from PubMed, EMBASE, Web of Science, CNKI, Wanfang and VIP databases to retrieve the clinical studies relevant to IGF-1R expression and its prognostic value in GC patients. Meta-analysis was performed using STATA 12.0 software. The methodology was assessed according to the European Lung Cancer Working Party Quality Scale for Biological Prognostic Factors for Lung Cancer. The quality of studies was assessed using the Newcastle-Ottawa scale.

RESULTSFour eligible studies including 685 patients were enrolled for this meta-analysis. Analysis results suggested that up-regulation of IGF-1R in GC patients was significantly associated with TNM staging (OR=5.20, 95%CI:1.12 to 24.15, P=0.035), lymph node metastasis(OR=8.24, 95%CI:2.68 to 25.34, P=0.000) and distant metastasis(OR=17.34, 95%CI:6.52 to 46.15, P=0.000). Moreover, up-regulated IGF-1R expression was significantly associated with poor overall survival of gastric cancer patients(HR=2.63, 95% CI:1.29 to 5.40, Z=2.64, P=0.008).

CONCLUSIONHigh IGF-1R expression may be an adverse prognostic factor in gastric cancer patients.

Objective: To investigate the value of enhanced recovery after surgery (ERAS) in D2 radical resection of distal gastric cancer under total laparoscopy and its effect on inflammatory factors. Methods: The clinical data of 50 patients with distal gastric cancer at Hanzhong Central Hospital from March 2016 to October 2017 were retrospectively analyzed. The patients were divided into the observation group (25 cases) and the control group (25 cases). The observation group received totally laparoscopic radical D2 gastrectomy for distal gastric cancer under the guideline of ERAS; the control group received totally laparoscopic radical D2 gastrectomy for distal gastric cancer under the guideline of the traditional method. The changes of perioperative related indexes, postoperative recovery and postoperative inflammatory indexes were compared between the two groups. Results: All 50 patients successfully completed the operation. The operation time was (287.2±52.3) min and (296.8±57.9) min, respectively of the observation group and the control group; the number of lymph node dissection was (34.0±11.0) and (34.6±14.3), respectively of the observation group and the control group. There were no significant differences in the above indexes between the two groups (all P > 0.05). The hospitalization time, the hospitalization cost, the postoperative time of getting out of bed of the observation group was (22.0±2.8) d, (61 044.4±4 692.7) yuan, (12.8±1.8) h. The hospitalization time, the hospitalization cost, the postoperative time of getting out of bed of the control group was (23.9±1.9) d, (63 875.81±4 392.6) yuan, (23.7±8.2) h. And there were statistically significant differences between the two groups (all P < 0.05). The pain score on the 1st day was (5.0±0.8) score and (6.4±1.0) score, and on the 4th day was (2.7±0.9) score and (3.9±0.9) score, respectively of the observation group and the control group, and there was a statistical difference (all P < 0.05). There was no statistical difference in the 7th day pain score between the two groups (P > 0.05). There were no statistically significant differences in the tumor necrosis factor α, interleukin-6 (IL-6), C-reactive protein and procalcitonin on the day before the operation of both groups (all P > 0.05); the levels of above four factors in the observation group were lower than those in the control group on the 1st, 4th and 7th day after the operation, and the differences were statistically significant (all P < 0.05). Conclusion The application of ERAS in totally laparoscopic radical resection of gastric cancer can improve the postoperative condition, significantly reduce the inflammatory reaction of patients, which has a certain value of improving the quality of life of patients.