The surgical management of gastroesophageal reflux disease has evolved significantly with the increased understanding of the physiology of the reflux barrier. Initially, emphasis was on reduction of hiatal hernias and crural closure. With persistence of reflux symptoms, along with the development of esophageal manometry and the discovery of a high-pressure zone, focus evolved to surgical augmentation of the lower esophageal sphincter, including reconstruction of the angle of His, ensuring sufficient intra-abdominal esophageal length, fundoplication, and magnetic sphincter augmentation. More recently, the role of crural closure in antireflux and hiatal hernia repair has again received renewed attention due to the persistence of postoperative complications and recurrences. Rather than simply preventing transthoracic herniation of the fundoplication as was originally thought, crural closure has been documented to have a critical role in re-establishing intra-abdominal esophageal length and maintaining the pressure of LES. The application of mesh provides more options for strengthening crural closure. In this review, this article will discuss the evolution of surgical techniques for gastroesophageal reflux disease over the past century, aiming to better guide the surgical treatment and clinical research of gastroesophageal reflux disease.

Gastric cancer is one of the most common malignancies worldwide. The capacity for invasion and metastasis, as well as high heterogeneity, are the main reasons that gastric cancer patients lose the opportunity for surgery and have a poor prognosis. Despite the rapid advancement of molecular targeted therapies, such as HER2 and immune checkpoint inhibitors, survival of gastric cancer patients is still unsatisfactory because the understanding of the mechanism of gastric cancer progression is still incomplete. Recently, genomic research has critically deepened our knowledge of which gene products are dysregulated in invasive gastric cancer. Furthermore, the study of the interaction of gastric cancer cells with the tumor microenvironment has emerged as a principal subject in driving invasion and metastasis. These results are expected to provide a profound knowledge of how biological molecules are implicated in gastric cancer development. This review will summarize the advances in our current understanding of the molecular mechanism of gastric cancer invasion. Compared to conventional therapy using protease or molecular inhibitors alone, multi-therapy targeting invasion plasticity may seem to be an assuring direction for the progression of novel strategies.

Objective To analyze the pathogenesis,type,diagnosis and surgical methods of adult intussusception.Methods The clinical presentation,diagnosis and therapeutic management of 23 patients admitted with the diagnosis of intussusception in Kunshan First People's Hospital Affiliated to Jiangsu University from January 2014 to March 2017 were reviewed retrospectively.Results For all patients,Symptom included paroxysmal bellyache (22/23),abdominal mass (7/23),nausea and vomit (2/23).Twenty one patients received operation,and all discharged from hospital.Malignant neoplasm,benign tumor,diverticulum,inflammation and fecal stone were main cause for intussusception.Conclusion Most of adult intussusceptions are secondary lesions,with complex pathologic condition and non-specific symptoms.CT scanning has been proved to be the most useful diagnostic radiologic method.Surgery is the main treatment of adult intussusception.As for patients recevied conservative treatment and intraoperative exploration with no obvious lesions,endoscopy is necessary postoperative.

Objective To explore the clinical diagnosis and treatment of primary appendiceal adenocarcinoma.Methods The clinical data of 8 patients with primary appendiceal adenocarcinoma were retrospectively analyzed.Results The cases of primary appendiceal adenocarcinoma accounted for all appendectomy specimens of 0.13％ (8/6 069).Among them,only 1 case was diagnosed correctly before operation,preoperative conventional abdominal CT examination was valuable for the diagnosis.One stage right hemicolectomy was performed in 2 cases,two stage right hemicolectomy was carried out in 5 cases.Postoperatively systemic chemotherapy was performed in 2 cases.Conclusions Lack of particular presentation,primary appendiceal adenocarcinoma is uncommon and difficult to be diagnosed exactly,preoperative misdiagnosed rate is very high.Right hemicolectomy is the most commonly recommended surgical option,systemic chemotherapy should be offered according to the stage.

Objective To explore the effect of ionizing radiation and cisplatin on the expression of Transducer of erbB2,1 ( TOB1 ) in human lung adenocareinoma SPCA-1 and LTEP-α-2 cell lines.Methods SPCA-1 and/or LTEP-α-2 cells were respectively irradiated with 2,4,6,8,and 10 Gy X-rays generated by a linear accelerator (with the source skin distance of 100 cm and dose rate of 200 cGy/min).The cell molecular samples were subtracted at 6,12,18,and 24 h after 6 Gy irradiation.For X-rays and cisplatin combination treatment,cells were divided into radiation group (6 Gy X-rays),cisplatin group (20 mol/L cisplatin),and combination group (6 Gy X-rays + 20 mol/L cisplatin).SPCA-1 and LTEP-α-2 cells without any treatment were used as control group.The relative levels of TOB1 mRNA and protein expression were detected by rigorously controlled semi-quantitative RT-PCR and Western blot analysis with quantitation of the mRNA/protein bands by densitometry.Results The expression level of TOB1 was significantly increased in both mRNA and protein level after radiation exposure (t =8.25-24.48,P ＜0.05).For time-dependent induction of TOB1,the expression was significantly increased 6 h after X-rays exposure (t =14.23-15.82,P ＜ 0.05 ).More significant increase of TOB1 expression was identified after the combination treatment of X-rays and cisplatin,compared to that of the radiation and/or cisplatin treatment alone (t =11.21-13.67,P ＜0.05).Conclusions lonizing radiation and cisplatin could upregulate the expression of TOB1 in lung cancer cells in both mRNA and protein levels.TOB1 may be a molecular target for ionizing radiation and cisplatin treatment in lung cancer and it may have potential implication in evaluating the curative efficiency of chemo-and radio-therapy.

Objective To investigate the effect of EGCG on the radiosensitivity of human nasopharyngeal carcinoma CNE-1 cells.Methods CNE-1 cells were divided into four groups:control,EGCG treatment,UVC or X-ray exposure,and EGCG combined with UVC or X-rays.After treatment with different concentrations of EGCG for 24,48 and 72 h and UVC or X-rays,cell growth was determined with MTT assay,cell survival was measured with clonogenic assay,cell cycle was deteeted with flow cytometry,cell apoptosis was detected by the annexin V-FITC cell apoptosis kit,and protein expression was assayed by Westem blot.Results EGCG inhibited cell growth in a dose-and time-dependent manner(r =0.817and 0.364).Compared with UVC or X-ray irradiation alone,the radiosensitivity of CNE-1 cells was enhanced by 2 h pre-treatment of 50 μmol/L EGCG,which disrupted S phase arrest caused by UVC( t =18.68,P ＜ 0.05 ) and increased the population of S and G2/M arrest caused by X-rays ( t =7.11 and 6.99,P ＜0.05 ).UVC could cause a significant increase of sub-G1 population( t =6.67,P ＜ 0.05 ) and Annexin V-FITC assay indicated apoptosis was further elevated by EGCG ( t =10.28,P ＜ 0.05 ).However,no significant induction of apoptosis was observed in the cells either irradiated with X-rays alone or combinationly treated with EGCG and X-rays.The combination treatment of EGCG and UVC significantly increased the expression of Bax and Caspase-3 proteins,but failed to affect Bcl-2 protein expression.Conclusions EGCG enhances the growth inhibition of CNE-1 cells caused by UVC or X-rays,which is relevant to apoptosis induction or cell cycle arrest.

B-cell translocation gene/transducer of erbB2 (BTG/TOB) protein family is a new antiproliferative protein family.Recent studies have found that BTG/TOB family is absent obviously in many tumor tissue specimens,such as lung cancer,breast cancer and thyroid cancer,and contributes to the genesis and progression of various malignancies.