Cardia ; Gastric Fundus ; Humans ; Stomach Neoplasms ; surgery

Diabetes surgery is a new concept in recent years, which means controlling blood sugar or curing diabetes through some surgical methods. From the commencement of bariatric surgery in the 1950s to the discovery of the special function of decreasing blood sugar after these surgeries in 1970s, and then the fast developing of diabetes surgery in the past 30 years, now there seems be a different answer to the question that if we can cure diabetes. In this article, we review the historical evolution, surgical procedure, potential mechanism and outlook of diabetes surgery.
Bariatric Surgery ; methods ; Diabetes Mellitus, Type 2 ; surgery ; Humans

Objective To explore the possible mechanisms of Galectin - 1(Gal - 1)protein in promoting the invasion and migration of gastric cancer cells. Methods After treated with different concentrations(0,1,5 μg/ mL)of Gal - 1 protein, the Trans - well model was used to analyze the invasion and migration ability of gastric cancer. WB and gelatin zymography method were used to detect the MMP - 9 expression and active form change in gastric cancer cells after Gal - 1 stimulate, in order to explore the possible molecular mechanisms of Gal - 1 protein in promoting the invasion and migration of gastric cancer cells. Results In cell migration assay,the number of gastric cancer cells BGC - 823 treated with 1and 5 μg/ mL Gal - 1 stimulate were 117 ± 8. 19 and 167 ± 7. 55,higher than that treated with 0 μg/ mL(P < 0. 05). The number of gastric cancer cells 7 901 treated with 1and 5 μg/ mL Gal - 1 stimulate were 151 ± 5. 13 and 190. 3 ± 6. 8,higher than that treated with 0 μg/ mL(P < 0. 05). In cell invasion assay,the number of gastric cancer cells BGC - 823 treated with 1and 5μg/ mL Gal - 1 stimulate were 51 ± 3. 6 and 76. 7 ± 9. 07,higher than that treated with 0 μg/ mL(P < 0. 05). The number of gastric cancer cells 7 901 treated with 1and 5 μg/ mL Gal - 1 stimulate were 74. 0 ± 7. 21 and 105. 3 ± 11. 37,higher than that treated with 0 μg/ mL(P < 0. 05). The migration and invasion level were significantly increased in gastric cancer cells after Gal - 1 stimulate. The MMP - 9 expression level and active form change in gastric cancer cells were also increased after Gal - 1 stimulate. Conclusion Gal - 1cound significantly promote gastric cancer cell migration and invasion by up - regulated the MMP - 9 expression and active its enzyme activity.

OBJECTIVETo investigate the expression of vascular endothelial growth factor C (VEGF-C) and survivin protein in human gastric carcinoma,and to evaluate their clinical implications.

METHODSThe expressions of VEGF-C and survivin protein in tumor tissues,matched para- tumor tissues from 97 cases with gastric cancer and normal tissues form 20 normal controls,were determined by immunohistochemistry. Their relationships with clinicopathological parameters were analyzed.

RESULTSThe positive rate of VEGF-C and survivin protein in tumor tissues (66.0% and 57.2%) was significantly higher than those in matched para-tumor tissues normal tissues (P< 0.05). There were no significant differences in VEGF-C expression considering tumor size,localization,histological grade,venous invasion,and distant metastasis (P > 0.05), while its expression was correlated with serosal infiltration, lymphatic invasion, lymph node metastasis and TNM stage III-IV (P< 0.05). The survivin expression was significantly related with serosal infiltration,lymphatic invasion, regional lymph node metastasis,distant metastasis, and TNM stage III- IV (P< 0.05), but not with histological grade, localization,venous invasion,and tumor size (P > 0.05). The 1, 3 and 5-year survival rates of the patients with positive VEGF-C or survivin protein were significantly lower than those of the patients with negative VEGF-C or survivin (P< 0.05), respectively. In additional,the expression of VEGF-C was positively correlated with survivin expression in gastric carcinoma (P< 0.01).

CONCLUSIONThe expressions of VEGF-C and/or survivin may be indicators for poor prognosis of gastric carcinoma.

Adult ; Aged ; Carcinoma ; metabolism ; pathology ; Female ; Follow-Up Studies ; Humans ; Inhibitor of Apoptosis Proteins ; Male ; Microtubule-Associated Proteins ; biosynthesis ; Middle Aged ; Neoplasm Staging ; Prognosis ; Stomach Neoplasms ; metabolism ; pathology ; Vascular Endothelial Growth Factor C ; metabolism

OBJECTIVETo investigate the relationship between the expression of vascular endothelial growth factor (VEGF) and fms-like tyrosine kinase (Flt-1) mRNA and tumor progression, microvessel density and survival time in gastric carcinoma.

METHODSIn situ hybridization and immunohistochemical techniques were used to detect the gene expression of VEGF, Flt-1 and CD34 in 118 gastric carcinoma specimens.

RESULTSIn situ hybridization revealed that positive expression rates of VEGF and Flt-1 mRNA in gastric carcinoma were 54.24% and 55.9% respectively. There was a significant correlation between the expression of VEGF and Flt-1 mRNA and growth pattern, the depth of tumor invasion, vessel invasion, lymph node and distant metastasis (P < 0.01). The mean tumor microvessel densities (MVD) in patients of stage T3-T4 or those with vessel invasion, lymph node and distant metastases were significantly higher than those of stage T1-T2 and without metastases (P < 0.01). MVD value was correlated with the expression levels of VEGF and Flt-1 mRNA (P < 0.01). The mean survival time and survival rate of patients with positive mRNA expression and mean MVD value >or=54.9/mm2 were significantly lower than those of patients with negative mRNA expression and mean MVD value < 54.9/mm2.

CONCLUSIONSThe expression of VEGF and Flt-1 can promote tumor angiogenesis and contribute to tumor invasion and metastasis in gastric carcinoma. VEGF and Flt-1 may serve as valuable indicators of biological behaviour, prognosis and target of gene therapy in gastric carcinoma.

Adult ; Aged ; Female ; Humans ; In Situ Hybridization ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; RNA, Messenger ; genetics ; Stomach Neoplasms ; metabolism ; pathology ; Vascular Endothelial Growth Factor A ; metabolism ; Vascular Endothelial Growth Factor Receptor-1 ; metabolism

OBJECTIVETo investigate the efficacy of uncutted Roux-en-Y esophagojejunostomy with jejunal pouch (URYJP) after total gastrectomy.

METHODSTotal gastrectomy was performed on 168 patients of gastric cancer, and 3 methods were used for reconstruction: the uncutted Roux-en-Y esophagojejunostomy with a jejunal pouch was performed on 69 patients(group A),Roux-en-Y esophagojejunostomy with the P-type jejunal pouch on 50 patients(group B),and Roux-en-Y esophagojejunostomy with the Orr-type jejunal pouch on 49 patients (group C). The alimentary tract reconstruction time, morbidity and mortality were compared. The 121 cases that survived for more than 1 year were analyzed for quality of life(QOL),including body weight, intake quantity, prognosis nutritional index (PNI), and Visick scores 6 and 12 months after the operations.

RESULTSAll the patients recovered quickly and no anastomosis leakage or duodenal fistulas were found. It took (30+/-7) minutes to finish the reconstruction in group A, which was significantly shorter than that in group B [(57+/-6) minutes] or in group C [(48+/-6) minutes]. There were no significant differences among 3 groups in the incidence of alkaline reflux gastritis. The incidence of Roux stasis syndrome was 2.2% in group A, which was significantly lower than 17.9% and 19.4% in group B and C. Weight loss and food intake gain in group A was superior to those in group B and C 6 months and 12 months postoperatively. As compared with prognosis nutritional index(PNI) postoperatively, those of 3 groups decreased significantly 6 months postoperatively. At 12 months after operation, the PNI of group A returned to the level before operation, while PNI of both group B and C remained significantly lower than those before operation (both P < 0.05). The Visick score of group A was superior to those of group B and C 6 months and 12 months postoperatively.

CONCLUSIONSThe new uncutted Roux operation with jejunal pouch can prevent alkaline reflux gastritis and Roux-en-Y stasis syndrome. It may be a standard procedure for reconstruction after total gastrectomy.

Adult ; Aged ; Aged, 80 and over ; Anastomosis, Roux-en-Y ; methods ; Female ; Gastrectomy ; Humans ; Jejunum ; surgery ; Male ; Middle Aged ; Postoperative Period ; Stomach Neoplasms ; surgery

BACKGROUNDThe ideal post-gastrectomy reconstruction procedure should maintain the normal digestive function and restore intestinal transit to improve the patient quality of life. The aim of this study was to evaluate the effects of integral continual jejunal interposition after subtotal gastrectomy on the nutritional status, glucose levels, and gastric-intestinal motility.

METHODSThe study investigated the effects of the integral continual jejunal interposition, the Billroth I and Billroth II operations, and the isolated jejunal interposition following subtotal distal gastrectomy on the blood glucose, insulin, routine blood parameters, liver function, and myoelectrical activity in Beagle dogs.

RESULTSThe weights of the dogs decreased during the first post-operative weeks. Dogs in the integral continual jejunal interposition, Billroth I, and Billroth II groups gained significantly more weight by 8 weeks. The prognosis nutrition index of the dogs decreased in the first 2 post-operative weeks and increased significantly by 4 weeks in the integral continual jejunal interposition and Billroth I groups. The group with duodenal exclusion (Billroth II) had significantly higher glucose levels compared to the normal control group. The insulin curve was much higher in dogs that underwent the Billroth I, continual jejunal interposition, and isolated jejunal interposition than the Billroth II and normal groups. The frequencies of fasting and postprandial jejunal pacesetter potentials (PPs) were greater in the continual jejunal interposition and Billroth I groups than that in the isolated jejunal interposition and Billroth II groups. The percentage of aboral propagation of PPs was greater in the continual jejunal interposition group than the Billroth I, isolated jejunal interposition, and Billroth II groups.

CONCLUSIONContinual jejunal interposition after subtotal gastrectomy avoids jejunal transection, maintains the duodenal passage and food storage bags, and reduces the influence of blood glucose and insulin.

Animals ; Dogs ; Gastrectomy ; methods ; Gastroenterostomy ; methods ; Jejunum ; pathology ; surgery ; Reconstructive Surgical Procedures ; methods

OBJECTIVETo investigate the clinicopathological characteristics, surgical treatment and prognosis of gastrointestinal stromal tumors(GIST).

METHODSThe clinicopathological data of 84 patients with GIST undergone resection between April 1997 and June 2008 were analyzed retrospectively, and the prognosis was evaluated.

RESULTSOut of 84 cases, 42 tumors located in stomach, 24 in small intestine, 18 in other sites. Tumor sizes ranged from 0.5 to 25 cm(average 5.6 cm). Positive rate of CD117 expression determined by immunohistochemical methods was 96.4%. Seventy-nine cases underwent complete tumor resection, while 5 cases received palliative resection or biopsy. Seventy-eight patients were followed up and their 1-, 3-, 5-year survival rates were 92.0%, 79.2%, 72.0% respectively. The Fletcher's classification of malignancy risk groups for GIST was related to the survival rates(P=0.001). The differences of survival rate among very low risk group, low risk group and high-risk group were significant(P=0.003, P=0.000).

CONCLUSIONSComplete tumor resection in the initial operation of GIST should be emphasized. The Fletcher's classification of malignancy risk groups for GIST is related to the survival rate. Extended surgical resection is required for GIST of higher malignancy risk.

Adult ; Aged ; Aged, 80 and over ; Female ; Gastrointestinal Stromal Tumors ; mortality ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate

OBJECTIVETo explore the clinical effect of continual jejunal interposition in digestive tract reconstruction after subtotal gastrectomy.

METHODSThirty-four patients with distal gastric cancer were divided randomly into two groups. In group A, the digestive continuity was reconstructed by continual jejunal interposition in 16 patients after subtotal gastrectomy. In group B, the digestive tract of other 18 cases were reconstructed by Billroth II procedure. The postoperative comp1ications, nutritional status, food intake and gastroscopic results were compared.

RESULTSThere were no complications such as anastomotic leakage or obstruction in the two groups. The Visick scoring of group A was better than that of group B, and the difference was significant one year after operation (mu= 1.98, P< 0.05). All patients retrieved 85% of preoperative food intake per meal in group A, while only l4 patients got such results in group B. The weight loss was significantly higher in group B than that in group A(t = - 2.181, P= 0.037) after operation. The serum albumin level after operation in group A was significantly higher than that in group B (t=2.125, P=0.041), the level one year after operation in group A was also significantly higher than that before operation (t= - 2.175, P= 0.011). Gastroscopy one year after operation revealed fluent stoma,no bile reflux,and no congestion and edema in stomal mucosa and interposed jejunum in group A, while bile retention in 11 cases (61.1%), stomal inflammation in 13 cases (72.2%), and stomal ulcer in 2 cases (11.1%) in group B.

CONCLUSIONContinual jejunal interposition after subtotal gastrectomy can recover physiological continuity of digestive tract and improve the quality of 1ife without reflux gastritis.

Digestive System Surgical Procedures ; methods ; Female ; Gastrectomy ; methods ; Humans ; Jejunum ; surgery ; Male ; Middle Aged ; Stomach Neoplasms ; surgery

OBJECTIVETo establish serum protein fingerprint model for early diagnosis of pancreatic cancer with surface enhanced laser desorption/ionization time of flight-mass spectrometry (SELDI-TOF-MS) and bioinformatics techniques.

METHODSA total of 73 samples were analyzed in this study, including 31 cases of pancreatic cancers, 22 cases of pancreatitis and 20 healthy individuals. Samples were first analyzed by SELDI-TOF-MS and two patterns of differentiation model were constructed with support vector machine arithmetic method.

RESULTSThe pattern 1 model differentiating pancreatic cancer patients from healthy individuals had a specificity and a sensitivity of both 100.0%. The pattern 2 model differentiating pancreatic cancer from pancreatitis had a specificity of 95.5% and a sensitivity of 93.5%.

CONCLUSIONSELDI-TOF-MS technique combined with bioinformatics can facilitate to identify biomarkers for pancreatic cancer.

Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor ; blood ; Blood Proteins ; analysis ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms ; blood ; diagnosis ; Protein Array Analysis ; methods ; Sensitivity and Specificity ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; methods ; Support Vector Machine