Colorectal cancer is one of the most common malignancies in human, and colorectal liver metastasis (CLM) is one of the most common leading causes of death in these patients. In recent years, along with the update of diagnosis and treatment concept and advancement of operative technique, more and more patients with CLM get surgical treatment opportunities and the outcomes are improved. In clinical practice of CLM, depending on evidence-based medicine, standardized diagnosis and treatment is particularly important, which includes diagnosis and treatment by multidisciplinary team, accurate evaluation of the resectability of CLM, standardized surgical resection and essential comprehensive treatment.
Colorectal Neoplasms ; pathology ; Evidence-Based Medicine ; Hepatectomy ; Humans ; Liver Neoplasms ; diagnosis ; secondary ; surgery ; therapy ; Prognosis

Objective To establish and optimize a sensitive and specific quantitative realtime polymerase chain reaction(PCR)method for detection of hepatitis B virus covalently closed circular DNA(HBV cccDNA)in liver tissue. Methods Specific primers and probes were designed to detect HBV DNA(tDNA)and cccDNA. A series of plasmids(3.44 × 100-3.44 × 109 copies/μl)containing a full double-stranded copies of HBV genome(genotype C)were used to establish the standard curve of real-time PCR. Liver samples of 33 patients with HBV related hepatocellular carcinoma(HCC), 13 Chronic hepatitis B patients(CHB)and 10 non-HBV patients were collected to verify the sensitivity and specificity of the assay. A fraction of extracted DNA was digested with a Plasmid-Safe ATP-dependent Dnase(PSAD)for HBV cccDNA detection and the remaining was used for tDNA and β-globin detection. The amount(copies/cell)of HBV cccDNA and tDNA were measured by a real-time PCR, using β-globin housekeeping gene as a quantitation standard. Results The standard curves of real-time PCR with a linear range of 3.44 × 100 to 3.44 × 109 copies/μl were established for detecting HBV cccDNA and tDNA, and both of the lowest detection limits of HBV cccDNA and tDNA were 3.44 × 100 copies/μl. The lowest quantitation levels of HBV cccDNA in liver tissues tested in 33 HBV related HCC patients and 13 CHB patients were 0.003 copies/cell and 0.031copies/cell, respectively. HBV cccDNA and tDNA in liver tissue of 10 non-HBV patient appeared to be negative. The true positive rate was increasing through the digestion of HBV DNA by PSAD, and the analytic specificity of cccDNA detection improved by 7.24 × 102 times. Liver tissues of 2 patients were retested 5 times in the PCR for detecting cccDNA and the coefficience of variations on cycle threshold (Ct)were between 0.224%-0.609%. Conclusion A highly sensitive and specific quantitative real time PCR method for the detection of HBV cccDNA in liver tissue was established and could be used for clinical and epidemiological studies.

The mechanism of apoptosis induced by SIRT1 deacetylase inhibitors in both human breast cancer MCF-7 and MCF-7 doxorubicin-resistant cells was studied. MTT assay was used to detect growth-inhibitory effect on the cells. Protein expression was detected by Western blotting. Chromatin condensation was detected by a fluorescent microscope after Hoechst 33342 staining. Cell cycle distribution was analyzed with flow cytometry. Apoptotic cells were detected with Annexin V staining. Nicotinamide (NAM) and Sirtinol, two SIRT1 deacetylase inhibitors, exhibited the similar growth-inhibitory effects on MCF-7/DOX cells and MCF-7 cells, but no potentiation of DOX activities. The arrest at G2/M phase was detected by flow cytometry in both MCF-7 and MCF-7/DOX cells after NAM treatment. Activation of caspase pathway in MCF-7 cells, such as the cleavages of PARP, caspase-6, -7, -9, were observed after exposure to NAM 50 mmol x L(-1), accompanied by the occurrence of chromatin condensation and Annexin V positive cells. However, the cleavages of PARP, caspase-6 and -7 in MCF-7/DOX cells delayed after exposure to NAM for 24 h and obviously increased at 48 h with appearance of chromatin condensation and Annexin V positive cells. SIRT1 deacetylase inhibitors show no cross resistance to MCF-7 drug-resistant cells, and the similar growth-inhibitory actions of them to MCF-7 sensitive and drug-resistant cells by which it is mediated by activation of apoptotic caspase pathway.
Apoptosis ; drug effects ; Benzamides ; pharmacology ; Breast Neoplasms ; metabolism ; pathology ; Caspases ; metabolism ; Cell Cycle ; drug effects ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Doxorubicin ; pharmacology ; Drug Resistance, Multiple ; drug effects ; Drug Resistance, Neoplasm ; drug effects ; Enzyme Inhibitors ; pharmacology ; Female ; Humans ; Naphthols ; pharmacology ; Niacinamide ; pharmacology ; Sirtuin 1 ; antagonists & inhibitors

OBJECTIVETo evaluate and compare the effect of naso-intestinal tube decompression and octreotide in conservative management of early post-operative inflammatory ileus (EPII).

METHODSFrom March 2005 to January 2009, forty-five patients diagnosed with EPII, who failed to improve with conventional conservative management including nasogastric tube decompression, were enrolled in this study. All patients were prospectively nonrandomized into naso-intestinal tube group (n = 23) or Octreotide group (n = 22). The outcomes were compared between nasogastric tube, naso-intestinal tube and Octreotide groups.

RESULTSAll the forty-five patients with EPII refractory to conservative management with nasogastric decompression were treated successfully with the naso-intestinal tube decompression or octreotide in 3-12 days. Compared with the Octreotide group, the first passage of flatus was earlier [(4.7 +/- 1.9) d vs (6.7 +/- 1.6) d] and abdominal circumference recovered faster [(90.4 +/- 2.0)% vs (95.1 +/- 1.3)%] in the naso-intestinal tube group (P < 0.05). But the volume of cumulative and daily gastrointestinal decompression were more in naso-intestinal tube group than those in Octreotide group [(4037 +/- 1155) ml vs (3316 +/- 1038) ml; (890 +/- 181) ml vs (492 +/- 83) ml; P < 0.05].

CONCLUSIONSPatients with EPII could be safely and effectively managed by naso-intestinal tube decompression or octreotide. It is possible for those patients to avoid second laparotomy. Naso-intestinal tube decompression and octreotide are associated with faster recovery and less fluid loss respectively.

Abdomen ; surgery ; Adult ; Aged ; Aged, 80 and over ; Decompression ; methods ; Female ; Humans ; Intestinal Obstruction ; etiology ; therapy ; Intubation, Gastrointestinal ; Male ; Middle Aged ; Octreotide ; therapeutic use ; Postoperative Complications ; therapy ; Prospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVEThe goals of this work was to analyse the cost of Shenqi Fuzheng injection-an extraction of a Chinese traditional herbs on reducing adverse effects in lung cancer patients during chemotherapy.

METHODSIn a randomized cross-over trial, each patient completed two identical cisplatin-based chemotherapy cycles, one with Shenqi Fuzheng injection, another without Shenqi Fuzheng injection. Adverse effects and change scores of quality of life (QOL) during chemotherapy were compared in tow cycles. The direct cost dealing with adverse effect and cost-effectiveness analysis were taken.

RESULTSOne hundred and thirty were enrolled with 123 of whom were evaluable. The patient characteristics were well balanced between the two groups. The chemotherapy cycles with Shenqi Fuzheng injection spent 220.5 more Chinese yuan, but the adverse effect of leukopenia, thrombocytopenia and vomiting were slight different and the change of score of several QOL domains showed significant better as compared to those in another cycle.

CONCLUSIONShenqi Fuzheng injection could reduce the severity of toxicity related to chemotherapy and improve the QOL of patients and had some benefits in terms of cost-effectiveness.

Aged ; Antineoplastic Agents ; adverse effects ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Cross-Over Studies ; Drugs, Chinese Herbal ; economics ; therapeutic use ; Female ; Humans ; Injections ; Lung Neoplasms ; drug therapy ; Male ; Middle Aged

BACKGROUNDLaparoscopic liver resection (LLR) has been considered to be safe and feasible. However, few studies focused on the comparison between the anatomic and nonanatomic LLR. Therefore, the purpose of this study was to compare the perioperative factors and outcomes of the anatomic and nonanatomic LLR, especially the area of liver parenchymal transection and blood loss per unit area.

METHODSIn this study, surgical and oncological data of patients underwent pure LLR procedures for malignant liver tumor were prospectively collected. Blood loss per unit area of liver parenchymal transection was measured and considered as an important parameter. All procedures were conducted by a single surgeon.

RESULTSDuring nearly 5 years, 84 patients with malignant liver tumor received a pure LLR procedure were included. Among them, 34 patients received anatomic LLR and 50 received nonanatomic LLR, respectively. Patients of the two groups were similar in terms of demographic features and tumor characteristics, despite the tumor size was significantly larger in the anatomic LLR group than that in the nonanatomic LLR group (4.77 ± 2.57 vs. 2.87 ± 2.10 cm, P = 0.001). Patients who underwent anatomic resection had longer operation time (364.09 ± 131.22 vs. 252.00 ± 135.21 min, P < 0.001) but less blood loss per unit area (7.85 ± 7.17 vs. 14.17 ± 10.43 ml/cm 2 , P = 0.018). Nonanatomic LLR was associated with more blood loss when the area of parenchymal transection was equal to the anatomic LLR. No mortality occurred during the hospital stay and 30 days after the operation. Moreover, there was no difference in the incidence of postoperative complications. The disease-free and overall survival rates showed no significant differences between the anatomic LLR and nonanatomic LLR groups.

CONCLUSIONSBoth anatomic and nonanatomic pure LLR are safe and feasible. Measuring the area of parenchymal transection is a simple and effective method to estimate the outcomes of the liver resection surgery. Blood loss per unit area is an important parameter which is comparable between the anatomic LLR and nonanatomic LLR groups.

Aged ; Blood Loss, Surgical ; Female ; Humans ; Laparoscopy ; methods ; Length of Stay ; Liver ; pathology ; surgery ; Liver Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; Prospective Studies

BACKGROUNDThe coagulation function in patients with pancreatic carcinoma is abnormal and the reason is not very clear. In this study, we retrospectively analyzed the coagulation function in patients with pancreatic carcinoma.

METHODSFrom June 2004 to December 2007, 132 patients received diagnosis and treatment in our hospital. The coagulative parameters including the prothrombin time, activated partial thromboplastin time, and fibrinogen levels were collected and studied retrospectively.

RESULTSThe average fibrinogen levels in patients with pancreatic carcinoma, (476.21 +/- 142.05) mg/dl, were significantly higher than in patients with cholangiolithiasis, (403.28 +/- 126.41) mg/dl (P < 0.05). In patients with pancreatic carcinoma, the levels of fibrinogen in the group with jaundice were significantly higher than in patients without jaundice (P < 0.05). In patients who received Pancreaticoduodenectomy, Whipple's operation, the level of fibrinogen in the group with local invasiveness was significantly higher than in the group without invasiveness. The group with lymphatic metastasis had higher levels than the group without lymphatic metastasis (P < 0.05). There was no significant difference of intraoperative blood loss between patients with vitamin K, (748.27 +/- 448.51) ml, and those without vitamin K, (767.31 +/- 547.89) ml (P > 0.05).

CONCLUSIONSThe level of fibrinogen in patients with pancreatic carcinoma was elevated. The elevated fibrinogen level may be associated with invasiveness and lymphatic metastasis. Using vitamin K in perioperation management did not reduce intraoperative blood loss.

Adult ; Aged ; Aged, 80 and over ; Blood Coagulation ; physiology ; Cholelithiasis ; drug therapy ; metabolism ; surgery ; Female ; Fibrinogen ; metabolism ; Humans ; Jaundice ; metabolism ; physiopathology ; Lymphatic Metastasis ; physiopathology ; Male ; Middle Aged ; Pancreatic Neoplasms ; drug therapy ; metabolism ; physiopathology ; surgery ; Pancreaticoduodenectomy ; Retrospective Studies ; Vitamin K ; therapeutic use ; Young Adult

Objective:To explore the surgical strategies for the treatment of T1 b gallbladder cancer patients diagnosed intraoperatively or postoperatively.Methods:A retrospective analysis of 42 patients with T1 b gallbladder cancers was performed.There were 14 patients diagnosed intraoperatively and 28 patients diagnosed postoperatively.The reevaluations of T stages were conducted in the 28 T1 b gallbladder cancer patients diagnosed postoperatively by the professional pathologist.After T stage reevaluation,25 confirmed T1 b patients with complete follow-up data were divided into simple cholecystectomy group and radical resection group,and the clinicopathologic characteristics between the two groups were analyzed.Results:Only 2 of the 14 T1 b gallbladder cancer patients diagnosed by the intraoperative frozen specimen proved to be T1b on postoperative paraffin pathology,and for the remaining 13 patients,T2 was in 11 patients,and T3 in one patient.The rate of misdiagnosis was 85.7％ by the intraoperative frozen specimens,postoperative T stages were equal or higher than intraoperative T stages.Two of the 28 postoperatively diagnosed T1b patients were proved to be T2 after reevaluation,the rate of misdiagnosis was 7.1％,the reevaluated T stages were equal to or higher than the previous stages.Twenty-five confirmed T1 b gallbladder cancer patients had complete follow-up data,11 of whom underwent simple cholecystectomy and the remaining 14 radical resections.No patient had vessel or perineural invasion on pathology in the 25 confirmed T1b patients.Metastasis was absent in all the 30 lymph nodes examined,which achieved from 14 patients with radical resection.The survival rate after simple cholecystectomy was comparable to that after radical resection (P =0.361).Only one patient with radical resection had abdominal cavity implantation relapse,who received gallbladder compression during operation and 2 years later died from metastasis.Conclusion:Intraoperatively diagnosed T1 b gallbladder cancer should receive radical resection.Reevaluation of the T stage is necessary and the initial step for postoperative diagnosed T1b gallbladder cancer patients.The pros and cons of radical surgery for definitive T1b patients should be carefully evaluated,and systemic chemotherapy is recommended for those with bile spillover.

OBJECTIVETo investigate the pathological feature of primary hepatic carcinoma and the clinical significance.

METHODSFrom August 2000 to December 2007, there were 89 patients with cirrhosis and carcinoma of liver who accepted whole liver resection. The whole liver was cut into 10 mm slices to examine the tumor size, number, distribution, capsule, satellite nodes, portal vein tumor thrombi (PVTT). The invaded adjacent tissue and lymph nodes were recorded, the distance from satellite to major tumor was measured, then histological examinations were carried out, and the final diagnosis was made by pathologists.

RESULTSThe total of 89 cases included hepatocellular carcinoma in 86 cases and cholangiocarcinoma in 3 cases; 53 cases with multiple tumors and 36 cases with solitary tumor; complete capsule only in 14 cases, no obvious margin in 11 cases, 13 cases had a major tumor in the right lobe and a small tumor in the left lobe; 8 of 25 cases with gross invaded tissue were confirmed by histological examination, 7 of 16 cases with swollen lymph nodes were infiltrated by cancer cells. There were 47 cases with PVTT (47.2%) and 39 cases with satellite nodes (43.8%). PVTT and satellite nodes increased with the increase of sizes and the numbers of the tumors. The distance from satellite node to major tumor mostly were 0.5 - 3.0 cm.

CONCLUSIONSThe whole explanted liver can completely reflect the characteristics of growth and infiltration of hepatic carcinoma. Attention must be paid to the small cancer lesions in another lobe, distal satellite nodes from major tumor, and tumor thrombi in a small branch of portal vein, which can not be found by imaging, and might influence the curative effectiveness after liver resection or transplantation.

Adult ; Carcinoma, Hepatocellular ; pathology ; surgery ; Female ; Hepatectomy ; Humans ; Liver ; pathology ; Liver Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Young Adult

Background: The enteric reconstruction procedure of pancreatic stump after pancreaticoduodenectomy remains to be the critical factor influencing the mortality and morbidity. No widely accepted surgical procedure for the pancreaticojejunostomy has been erected yet. We have developed a new technique of pancreaticojejunostomy named "shark mouth pancreaticojejunostomy." The aim of this study is to assess the efficacy of "shark mouth pancreaticojejunostomy." Methods: This is a prospective single-arm observational study to evaluate the clinical efficacy of "shark mouth pancreaticojejunostomy." Patients with diseases, in whom a pancreaticoduodenectomy is indicated, would be recruited from Peking University Third Hospital. The hypothesis to be tested is that a "shark mouth pancreaticojejunostomy" will reduce fistula rate from around 20% to less than 10%. A sample size of 120 patients will be needed. The primary endpoint is the incidence rate of postoperative pancreatic fistula (POPF). The secondary endpoints of the study are anastomosis time, postoperative hospital stay, and morbidities besides the POPF such as the hemorrhage. Enrolled patients will undergo pancreaticoduodenectomy and be followed up for 3 months. The relevant data will be monitored and recorded. Conclusions: The current trial will explore the therapeutic value of the newly raised pancreaticojejunostomy procedure as the "shark mouth pancreaticojejunostomy." Its theoretical base and pragmatic feature will promise high external validity. Trial registration Clinical Trials.gov: NCT03366038; https://www.clinicaltrials.gov.