ObjectiveTo observe the clinical efficacy of Tongfu Kuanzhong decoction （TFKZ） in the treatment of constipation-predominant irritable bowel syndrome （IBS-C） with spleen deficiency and Qi stagnation and its effects on anorectal manometry and colonic electrical activity parameters. MethodsSixty-four patients with IBS-C of the spleen deficiency and Qi stagnation type were included as research subjects and were randomized into the observation group （thirty-two cases） and control group （thirty-two cases）. The control group was orally administered mosapride citrate tablets， and the observation group was orally administered TFKZ. Both groups were treated for 4 weeks. The traditional Chinese medicine （TCM） syndrome scores， patient assessment of constipation symptoms （PAC-SYM） score， general anxiety disorder-7 （GAD-7） score， patient health questionnaire-9（PHQ-9）score， anorectal manometry， and colonic electrical activity parameters were observed before and after treatment in the two groups. ResultsThe total points of TCM syndromes were significantly lower in both groups after treatment （P<0.01） and lower in the observation group （P<0.05）. The fecal symptoms， rectal symptoms， abdominal symptoms， and total symptom scores of the patients in both groups were significantly decreased after treatment （P<0.01）， and the rectal symptoms， abdominal symptoms， and total symptom scores of the observation group were lower （P<0.05，P<0.01）. In both groups， the forced anal residual pressure and the initial rectal sensation threshold decreased after treatment （P<0.05，P<0.01）， and forced anal residual pressure in the control group was lower （P<0.01）. After treatment， the GAD-7 and PHQ-9 scores of patients in both groups decreased significantly （P<0.01）， and the GAD-7 score of the observation group was significantly lower （P<0.01）. After treatment， the average wave amplitude at different time points of each lead increased significantly in both groups， compared with that before treatment （P<0.01）. The average wave amplitude of each lead of the ascending colon， descending colon， sigmoid colon， and rectum in the observation group at 5 min before the meal and 10 min after the meal， as well as that of the ascending colon and rectum at 20 min and 30 min after the meal， was higher than that of the control group （P<0.05）. ConclusionTFKZ is effective in the treatment of IBS-C. Its mechanism may be related to the regulation of colonic function by down-regulating the forced anal residual pressure and the initial rectal sensation threshold and up-regulating the amplitude and frequency of intestinal electrical activity in each intestinal segment of the colon.

Objective:To evaluate the short-term efficacy of parallel overlapping anastomosis in 3D laparoscopic radical resection for transverse colon cancer.Methods:A retrospective analysis of clinical data was conducted on 73 patients who underwent 3D laparoscopic radical resection and parallel overlapping anastomosis for reconstruction of digestive tract transverse colon cancer at He'nan Provincial People's Clinical Medical School of Zhengzhou University between Apr 2019 and Jul 2023.Results:The average operation time was (165.3±28.9) min, the parallel overlapping anastomosis time was (15.6±2.6) min, the intraoperative blood loss was (47.7±19.4) ml, the first postoperative exhaust time was(2.2±0.9) d, the first time getting out of bed was (1.1±0.4) d, the number of lymph node dissection was (18.2±5.1), the first postoperative oral fluid diet time was (4.4±0.8) d, the postoperative hospital stay was (6.4±1.8) d. Anastomotic leakage occurred in one patient , who was discharged after enterostomy; Two patients with poor wound healing were cured after wound debridement and dressing change; Pulmonary infection in one patient was healed by anti-infection treatment. The postoperative complication rate was 6%, and no complications such as anastomotic bleeding, anastomotic stenosis, intestinal obstruction, abdominal infection occurred.Conclusion:Parallel overlapping anastomosis is a safe and reliable anastomotic procedure for the reconstruction of digestive tract in patients undergoing 3D laparoscopic radical resection of transverse colon cancer.

Objective:To evaluate the short-term efficacy of parallel overlapping anastomosis in 3D laparoscopic radical resection for transverse colon cancer.Methods:A retrospective analysis of clinical data was conducted on 73 patients who underwent 3D laparoscopic radical resection and parallel overlapping anastomosis for reconstruction of digestive tract transverse colon cancer at He'nan Provincial People's Clinical Medical School of Zhengzhou University between Apr 2019 and Jul 2023.Results:The average operation time was (165.3±28.9) min, the parallel overlapping anastomosis time was (15.6±2.6) min, the intraoperative blood loss was (47.7±19.4) ml, the first postoperative exhaust time was(2.2±0.9) d, the first time getting out of bed was (1.1±0.4) d, the number of lymph node dissection was (18.2±5.1), the first postoperative oral fluid diet time was (4.4±0.8) d, the postoperative hospital stay was (6.4±1.8) d. Anastomotic leakage occurred in one patient , who was discharged after enterostomy; Two patients with poor wound healing were cured after wound debridement and dressing change; Pulmonary infection in one patient was healed by anti-infection treatment. The postoperative complication rate was 6%, and no complications such as anastomotic bleeding, anastomotic stenosis, intestinal obstruction, abdominal infection occurred.Conclusion:Parallel overlapping anastomosis is a safe and reliable anastomotic procedure for the reconstruction of digestive tract in patients undergoing 3D laparoscopic radical resection of transverse colon cancer.

Objective:To evaluate the effect of ultrasound-guided adductor canal block with bupivacaine liposome on analgesia in elderly patients undergoing total knee arthroplasty.Methods:This was a prospective study. Sixty American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ patients, regardless of gender, aged 65-83 yr, weighing 50-80 kg, scheduled for elective unilateral total knee arthroplasty under subarachnoid anesthesia from April 2023 to January 2024 in Zhengzhou Orthopaedic Hospital, were divided into 2 groups ( n=30 each) using a random number table method: bupivacaine liposome group (LB group) and ropivacaine group (R group). Ultrasound-guided adductor canal block was performed at 30 min before subarachnoid anesthesia, bupivacaine liposome diluent 20 ml (133 mg) was injected in LB group, and 0.5% ropivacaine 20 ml was injected in R group. Patient-controlled intravenous analgesia was performed after operation, and tramadol was used for rescue analgesia when the visual analogue scale (VAS) score ≥3. VAS scores at rest and during activity were recorded at 8, 12, 24, 48 and 72 h after surgery. The time to the first pressing analgesia pump and rescue analgesia were recorded within 72 h after surgery. The quadriceps muscle strength was measured at 1 day before surgery and 12, 24, 48 and 72 h after surgery. The knee joint range of motion was assessed at 1 day before surgery and 24, 48 and 72 h after surgery. Patient′s satisfaction with analgesia was recorded at 72 h after surgery. The adverse reactions within 72 h after surgery were also recorded. Results:Compared with R group, VAS scores at rest and during activity were significantly decreased at 12, 24, 48 and 72 h after surgery, the time to the first pressing analgesia pump was prolonged, the rate of rescue analgesia after surgery was decreased, the score for the patient′s satisfaction with analgesia was increased, the knee joint range of motion was increased ( P<0.05), and no significant change was found in the quadriceps muscle strength and incidence of adverse reactions in LB group ( P>0.05). Conclusions:Ultrasound-guided adductor canal block with bupivacaine liposome provides better analgesia than ropivacaine in elderly patients undergoing total knee arthroplasty.

Objective:To retrospectively analyze the dual plasma molecular adsorption system (DPMAS) treatment technology and the laboratory data before and after treatment in patients with liver failure and refractory hyperbilirubinemia, so as to provide a clinical basis for the prediction and prevention of common related complications.Method:A retrospective study was conducted on 161 cases with liver failure and 68 cases with refractory hyperbilirubinemia who underwent DPMAS treatment in our department from October 2022 to July 2024. The general clinical data characteristics, DPMAS treatment status, DPMAS-related complications, and changes in important laboratory indicators before and after the initial DPMAS treatment in both patient groups were analyzed.Results:Among the 229 enrolled cases, 82.53% were male, and the median age was 50 years. The cause of liver failure was hepatitis B virus infection in 84.47%, while hepatitis B accounted for only 51.47% in the other group. There were significant differences in platelets, creatinine, coagulation function, and inflammatory factor-related indicators between the two groups at baseline. The total number of DPMAS treatments given was 471 times. The proportion of albumin used in the initial stage of treatment was significantly higher in patients with refractory hyperbilirubinemia than that in the liver failure group, while the proportion of plasma used in the liver failure group was significantly higher ( P<0.001). The most commonly used anticoagulation regimen was unfractionated heparin. A combined anticoagulation therapy regimen was used in 9.3% of the refractory hyperbilirubinemia group. The internal jugular vein was selected in nearly half of the treated cases. A peripheral vascular access pathway was the treatment option in 31.2%. The proportion of centrifugal separation was significantly higher than that of membrane separation (76.22% vs. 23.78%). The incidence rate of DPMAS-related complications was 16%. The most common complication was bleeding, including bleeding at the puncture site (accounting for 32% of the total complications) and bleeding at non-puncture sites (12%), followed by hypotension (22%), allergic reactions (13%) and infections (11%), respectively. The indexes of hemoglobin, platelets, total bilirubin, and C-reactive protein were significantly decreased within 24-48 hours after DPMAS treatment in both groups of patients. The prothrombin time and international normalized ratio were significantly increased in the liver failure group, while fibrinogen was significantly reduced. Conclusion:DPMAS clinical application is generally safe in patients with liver disease. The most common complications are bleeding, hypotension, allergic reactions, and infections, which need to be paid special attention and timely intervention to ensure the safety profile of treatment.

Objectives:To investigate the application value of laparoscopic double stapler firings and double stapling technique combined with rectal eversion and total extra-abdominal resection (LDER) in the anal preservation treatment of low rectal cancer.Methods:Inclusion criteria: (1) age was 18-70; (2) the distance of the lower tumor edge from the anal verge was 4-5 cm; (3) primary tumor with a diameter ≤3 cm; (4) preoperative staging of T1~2N1~2M0; (5) "difficult pelvis", defined as ischial tuberosity diameter<10 cm or body mass index>25 kg/m 2; (6) patients with strong intention for sphincter preservation; (7) no preoperative treatment (e.g., chemotherapy, radiotherapy, molecular targeted therapy, or immunotherapy); (8) no lateral lymph node enlargement; (9) no previous anorectal surgery; (10) patients with good basic condition who could tolerate surgery. Exclusion criteria: (1) previously suffered from malignant tumors of the digestive tract or currently suffering from malignant tumors out of the digestive tract; (2) patients with preoperative anal dysfunction (Wexner score ≥ 10), or fecal incontinence. The specific surgical steps are as follows: the distal end of the rectum was dissected to the level of the interspace between internal and external sphincters of anal canal. Five centimeters proximal to the tumor, the mesorectum was ligated, and a liner stapler was used to transect the rectum. The distal rectum with the tumor were then everted and extracted through the anus. The rectum was transected 0.5-1.0 cm distal to the tumor with a linear stapler. Full thickness suture was used to reinforce the stump of the rectum, which was then brought back into the pelvic cavity. Finally, an end-to-end anastomosis between the colon and the rectum was performed. A retrospective descriptive study was performed of the clinical and pathological data of 12 patients with T1-T2 stage low rectal cancer treated with LDER at Henan Provincial People's Hospital from January 2020 to December 2022. Results:All 12 patients successfully completed LDER with sphincter preservation, without conversion to open surgery or changes in surgical approach. The median surgical time was 272 (155-320) minutes, with a median bleeding volume of 100 (50-200) mL. No protective stoma was performed, and all patients received R0 resection. The average hospital stay was 9 (7-15) days. There were no postoperative anastomotic leakage or perioperative deaths. All 12 patients received postoperative follow-up, with a median follow-up of 12 months (6-36 months) and a Wexner score of 8 (5-14) at 6 months postoperatively. There was no tumor recurrence or metastasis during the follow-up period.Conclusions:LDER is safe and effective for the treatment of low rectal cancer.

Objectives:To investigate the application value of laparoscopic double stapler firings and double stapling technique combined with rectal eversion and total extra-abdominal resection (LDER) in the anal preservation treatment of low rectal cancer.Methods:Inclusion criteria: (1) age was 18-70; (2) the distance of the lower tumor edge from the anal verge was 4-5 cm; (3) primary tumor with a diameter ≤3 cm; (4) preoperative staging of T1~2N1~2M0; (5) "difficult pelvis", defined as ischial tuberosity diameter<10 cm or body mass index>25 kg/m 2; (6) patients with strong intention for sphincter preservation; (7) no preoperative treatment (e.g., chemotherapy, radiotherapy, molecular targeted therapy, or immunotherapy); (8) no lateral lymph node enlargement; (9) no previous anorectal surgery; (10) patients with good basic condition who could tolerate surgery. Exclusion criteria: (1) previously suffered from malignant tumors of the digestive tract or currently suffering from malignant tumors out of the digestive tract; (2) patients with preoperative anal dysfunction (Wexner score ≥ 10), or fecal incontinence. The specific surgical steps are as follows: the distal end of the rectum was dissected to the level of the interspace between internal and external sphincters of anal canal. Five centimeters proximal to the tumor, the mesorectum was ligated, and a liner stapler was used to transect the rectum. The distal rectum with the tumor were then everted and extracted through the anus. The rectum was transected 0.5-1.0 cm distal to the tumor with a linear stapler. Full thickness suture was used to reinforce the stump of the rectum, which was then brought back into the pelvic cavity. Finally, an end-to-end anastomosis between the colon and the rectum was performed. A retrospective descriptive study was performed of the clinical and pathological data of 12 patients with T1-T2 stage low rectal cancer treated with LDER at Henan Provincial People's Hospital from January 2020 to December 2022. Results:All 12 patients successfully completed LDER with sphincter preservation, without conversion to open surgery or changes in surgical approach. The median surgical time was 272 (155-320) minutes, with a median bleeding volume of 100 (50-200) mL. No protective stoma was performed, and all patients received R0 resection. The average hospital stay was 9 (7-15) days. There were no postoperative anastomotic leakage or perioperative deaths. All 12 patients received postoperative follow-up, with a median follow-up of 12 months (6-36 months) and a Wexner score of 8 (5-14) at 6 months postoperatively. There was no tumor recurrence or metastasis during the follow-up period.Conclusions:LDER is safe and effective for the treatment of low rectal cancer.

Objective:To retrospectively analyze the dual plasma molecular adsorption system (DPMAS) treatment technology and the laboratory data before and after treatment in patients with liver failure and refractory hyperbilirubinemia, so as to provide a clinical basis for the prediction and prevention of common related complications.Method:A retrospective study was conducted on 161 cases with liver failure and 68 cases with refractory hyperbilirubinemia who underwent DPMAS treatment in our department from October 2022 to July 2024. The general clinical data characteristics, DPMAS treatment status, DPMAS-related complications, and changes in important laboratory indicators before and after the initial DPMAS treatment in both patient groups were analyzed.Results:Among the 229 enrolled cases, 82.53% were male, and the median age was 50 years. The cause of liver failure was hepatitis B virus infection in 84.47%, while hepatitis B accounted for only 51.47% in the other group. There were significant differences in platelets, creatinine, coagulation function, and inflammatory factor-related indicators between the two groups at baseline. The total number of DPMAS treatments given was 471 times. The proportion of albumin used in the initial stage of treatment was significantly higher in patients with refractory hyperbilirubinemia than that in the liver failure group, while the proportion of plasma used in the liver failure group was significantly higher ( P<0.001). The most commonly used anticoagulation regimen was unfractionated heparin. A combined anticoagulation therapy regimen was used in 9.3% of the refractory hyperbilirubinemia group. The internal jugular vein was selected in nearly half of the treated cases. A peripheral vascular access pathway was the treatment option in 31.2%. The proportion of centrifugal separation was significantly higher than that of membrane separation (76.22% vs. 23.78%). The incidence rate of DPMAS-related complications was 16%. The most common complication was bleeding, including bleeding at the puncture site (accounting for 32% of the total complications) and bleeding at non-puncture sites (12%), followed by hypotension (22%), allergic reactions (13%) and infections (11%), respectively. The indexes of hemoglobin, platelets, total bilirubin, and C-reactive protein were significantly decreased within 24-48 hours after DPMAS treatment in both groups of patients. The prothrombin time and international normalized ratio were significantly increased in the liver failure group, while fibrinogen was significantly reduced. Conclusion:DPMAS clinical application is generally safe in patients with liver disease. The most common complications are bleeding, hypotension, allergic reactions, and infections, which need to be paid special attention and timely intervention to ensure the safety profile of treatment.

Objective:To investigate the influene of sarcopenia on quality of life in patients with adenocarcinoma of gastroesophageal junction (AEG).Methods:The retrospective cohort study was conducted. The clinicopathological data of 109 patients with AEG who were admitted to Henan Provincial People′s Hospital from January 2019 to December 2022 were collected. There were 63 males and 46 females, aged (63±11)years. All patients underwent 3D laparoscopic assisted radical total gastrectomy+D 2 lymph node dissection. The skeletal muscle content of patient was obtained within 3 days before surgery by using a multi-frequency bioelectrical impedance human body composition analyzer. Observation indicators: (1) clinical characteristics of patients with sarco-penia and non sarcopenia; (2) intraoperative and postoperative conditions in patients with sarco-penia and non sarcopenia; (3) analysis of serious postoperative complications in patients with AEG; (4) preoperative and postoperative quality of life score in patients with sarcopenia and non sarco-penia. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Mann-Whitney U non-parameter rank sum test. Repeated measurement data were analyzed using the repeated ANOVA, and their variances were tested using a spherical test. Univariate analysis was conducted using the Logistic regression model, and multivariate analysis was conducted using the Logistic stepwise regression model. Results:(1) Clinical characteristics of patients with sarcopenia and non sarcopenia. Of 109 patients with AEG, there were 42 cases with sarcopenia and 67 cases with non sarcopenia. The body mass index (BMI), forced expiratory volume in 1 second (FEV1), rate of FEV1/forced vital capacity were (20.3±2.3)kg/m 2, 92%±9%, 79%±11% in patients with sarcopenia, respectively, versus (24.4±2.7)kg/m 2, 97%±9%, 85%±11% in patients with non sarcopenia, showing significant differences in the above indicators between them ( t=8.07, 2.46, 2.77, P<0.05). (2) Intraoperative and postoperative conditions in patients with sarcopenia and non sarco-penia. The volume of intraoperative blood loss, time to postoperative first flatus, duration of post-operative hospital stay, cases with postoperative complications were 208(192, 231)mL, (3.4±0.9)days, (11.4±3.2)days, 26 in patients with sarcopenia, respectively, versus 195(150,215)mL, (2.8±0.7)days, (9.9±1.6)days, 14 in patients with non sarcopenia, showing significant differences in the above indi-cators between them ( Z=-2.14, t=3.25, 3.38, χ2=18.69, P<0.05). (3) Analysis of serious postoperative complications in patients with AEG. Results of multivariate analysis showed that sarcopenia and BMI reduction were independent risk factors influencing serious postoperative complications in patients with AEG ( odds ratio=2.04, 1.98, 95% confidence interval as 1.24-3.36, 1.09-3.60, P<0.05). (4) Pre-operative and postoperative quality of life score in patients with sarcopenia and non sarcopenia. Results of multivariate test in physical function, role function, social function, overall score of patients with sarcopenia and non sarcopenia before surgery, 2 weeks after surgery, 4 weeks after surgery, and 8 weeks after surgery showed that there were significant differences in the temporal effect, intergroup effect and interaction effect of the above indicators between patients with sarcopenia and non sarcopenia ( P<0.05). Results of individual effects showed that there were significant differences in the intergroup effect of the above indicators between patients with sarcopenia and non sarcopenia ( P<0.05). Conclusion:Preoperative sarcopenia increases the risk of severe postoperative complications and reduces the postoperative quality of life in patients with AEG.

Objective:To investigate the effects of serum exosomes of patients with gastric cancer on cisplatin resistance, clonal formation, migration, invasion and apoptosis of the AGS gastric cancer cells, and the corresponding molecular mechanisms.Methods:The experimental study was conducted. The exosomes of patients with gastric cancer was separated from their serum, and the expression of lncRNA HOTTIP was analyzed using the quantitative real time polymerase chain reaction (qRT-PCR). Normal gastric epithelial cell line GES1, gastric cancer cell line AGS and human embryonic kidney cell 293T were cultured in vitro. AGS cells were incubated with exosomes (Exo),with phos-phate buffered saline (PBS) treatment as control, and transfected with si-NC or si-HOTTIP-3, named as Exo group, PBS group, si-NC+Exo group, and si-HOTTIP-3+Exo group. The AGS cells were trans-fected with si-NC, si-HOTTIP-1, si-HOTTIP-2, si-HOTTIP-3, oe-HOTTIP, vector, oe-HOTTIP+miR-138-5p mimic, oe-HOTTIP+mimic NC, miR-138-5p inhibitor, inhibitor NC, miR-138-5p inhibitor+si-TJP1 and miR-138-5p inhibitor+si-NC. They were recorded as si-NC group, si-HOTTIP-1 group, si-HOTTIP-2 group, si-HOTTIP-3 group, oe-HOTTIP group, vector group, oe-HOTTIP+miR-138-5p mimic group, oe-HOTTIP+mimic NC group, miR-138-5p inhibitor group, inhibitor NC group, miR-138-5p inhibitor+si-TJP1 group and miR-138-5p inhibitor+si-NC group. The 293T cells transfected with mimic NC+HOTTIP wt, miR-138-5p mimic+HOTTIP wt, mimic NC+HOTTIP mut, miR-138-5p mimic+HOTTIP mut, mimic NC+TJP1 3'UTR wt, miR-138-5p mimic+TJP1 3'UTR wt, mimic NC+TJP1 3'UTR mut, miR-138-5p mimic+TJP1 3'UTR mut were recorded as the mimic NC+HOTTIP wt group, miR-138-5p mimic+HOTTIP wt group, mimic NC+HOTTIP mut group, miR-138-5p mimic+HOTTIP mut group, mimic NC+TJP1 3'UTR wt group, miR-138-5p mimic+TJP1 3'UTR wt group, mimic NC+TJP1 3'UTR mut group, miR-138-5p mimic+TJP1 3'UTR mut group. The cell counting kit-8 (CCK8) was used to analyze the cisplatin sensitivity of gastric cancer cells. The colony formation experiment was used to analyze the colony formation of gastric cancer cells. The Transwell experiment was used to analyzed cell migration and invasion of gastric cancer cells. The flow cytometry experiment was used to analyze cell apoptosis of gastric cancer cells. The Western bolt assay was used to analyze the expression of exosome marker proteins, including the CD63 and CD81, and the protein of TJP1, the drug-resistance related proteins, including the P-gp and MCL-1. The dual-luciferase assay was used to analyze the targeted relationships among lncRNA HOTTIP, miR-138-5p and TJP1. Observation indicators: (1) expression of lncRNA HOTTIP; (2) resistance of gastric cancer cells to cisplatin regulated by exosome-mediated lncRNA HOTTIP; (3) regulation of cisplatin resistance in gastric cancer cells mediated by miR-138-5p through lncRNA HOTTIP overexpression; (4) targeting of TJP1 gene 3′-untranslated region (UTR) by miR-138-5p; (5) regulation of cisplatin resistance in gastric cancer cells by TJP1 through miR-138-5p inhibition. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. The one-way ANOVA was used for comparison for multiple groups and the Tukey′s test was used for further pairwise compari-son. Count data were described as absolute numbers, and the chi-square test was used for comparison. Correlation analysis was conducted using the Pearson′s test. Results:(1) Expression of lncRNA HOTTIP. The expression of lncRNA HOTTIP in the serum exosome of patients with gastric cancer was higher than that in healthy volunteers, showing a significant difference ( P<0.05). Results of transmi-ssion electron microscopy examination showed that the serum exosomes were circular or oval in shape. Results of Western bolt assay showed the expression of marker proteins of CD63 and CD81 in serum exosomes. (2) Resistance of gastric cancer cells to cisplatin regulated by exosome-mediated lncRNA HOTTIP. Compared with the PBS group, the biochemical half maximal inhibitory concentra-tion (IC50), the number of clone formation, the number of invasive cell, the number of migratory cell, expression of P-gp protein, expression of MCL-1 protein in the Exo group increased, while the cell apoptosis rate decreased, showing significant differences between them ( P<0.05). Compared with the si-NC+Exo group, the IC50, the number of clone formation, the number of invasive cell, the number of migratory cell, expression of P-gp protein, expression of MCL-1 protein in the si-HOTTIP-3+Exo group decreased, while the cell apoptosis rate increased, showing significant differences between them ( P<0.05). (3) Regulation of cisplatin resistance in gastric cancer cells mediated by miR-138-5p through lncRNA HOTTIP overexpression. Compared with the vector group, the IC50, the number of clone formation, the number of invasive cell, the number of migratory cell, expression of P-gp protein, expression of MCL-1 protein in the oe-HOTTIP group increased, while the cell apoptosis rate decreased, showing significant differences between them ( P<0.05). Compared with the oe-HOTTIP+mimic NC group, the IC50, the number of clone formation, the number of invasive cell, the number of migratory cell, expression of P-gp protein, expression of MCL-1 protein in the oe-HOTTIP+miR-138-5p mimic group increased, while the cell apoptosis rate decreased, showing significant differences between them ( P<0.05). (4) Targeting of TJP1 gene 3′-UTR by miR-138-5p. Results of dual-luciferase assay showed that the luciferase activity in 293T cells treatment with mimics of control+vectors of wild type of TJP1 gene 3′-UTR and 293T cells treatment with mimics of miR-138-5p+vectors of wild type of TJP1 gene 3′-UTR was 1.00±0.09 and 0.21±0.03, respectively, showing a significant difference between them ( t=15.02, P<0.05). (5) Regulation of cisplatin resistance in gastric cancer cells by TJP1 through miR-138-5p inhibition. Compared with the inhibitor group, the IC50, the number of clone formation, the number of invasive cell, the number of migratory cell, expression of P-gp protein, expression of MCL-1 protein in the miR-138-5p inhibitor group increased, while the cell apoptosis rate decreased, showing significant differences between them ( P<0.05). Compared with the miR-138-5p inhibitor+si-NC group, the IC50, the number of clone formation, the number of invasive cell, the number of migratory cell, expression of P-gp protein, expression of MCL-1 protein in the miR-138-5p inhibitor+si-TJP1 group decreased, while the cell apoptosis rate increased, showing significant differences between them ( P<0.05). Conclusion:Serum exosomes-mediated lncRNA HOTTIP can promote cisplatin resistance, clonal formation, migration, invasion and apoptosis of gastric cancer cells and inhibit cell apoptosis of gastric cancer cells through regulating the expression of miR-138-5p/TJP1.