OBJECTIVES: To investigate the expression of cartilage acidic protein 1 (CRTAC1) in gastric cancer (GC) and its effect on biological behaviors and immune cell infiltration of GC. METHODS: Transcriptomic, GO and KEGG analyses were conducted to investigate the association of CRTAC1 expression with prognosis of GC patients and its involvement in cell function and signaling pathways. ESTIMATE algorithm was used to analyze the effect of CRTAC1 expression on the tumor microenvironment and the tumor mutation load. In two GC cell clines (HGC-27 and MKN-74), CCK8, EdU and clone formation assays, flow cytometry, and Hoechst staining were used to examine the effects of CRTAC1 knockdown on cell proliferation, cell cycle changes and apoptosis. Wound healing assay, Transwell assay, and Western blotting were performed to analyze the effect of CRTAC1 knockdown on GC cell migration and the underlying mechanism. RESULTS: Bioinformatics analysis showed significantly higher expression of CRTAC1 in GC tissues than in adjacent tissues (P<0.05). Age and tumor stage were both prognostic risk factors in GC patients with high CRTAC1 expression (P<0.001). Analysis using ESTIMATE algorithm showed that CRTAC1 expression increased immune cell infiltration and decreased tumor mutational load in GC (P<0.001). In HGC-27 and MKN-74 cells, CRTAC1 knockdown significantly inhibited cell proliferation and migration and promoted cell apoptosis. Western blotting demonstrated that CRTAC1 knockdown significantly increased E-cadherin expression and reduced the expression levels of vimentin, p-PI3K, AKT2, p-AKT and p-mTOR in GC cells. CONCLUSIONS High expression of CRTAC1 in GC tissues affects immunotherapeutic efficacy and prognosis of the patients, possibly by promoting epithelial-mesenchymal transition via modulating tumor mutational load, tumor microenvironment, and the PI3K/AKT signaling pathway.
Stomach Neoplasms/metabolism* ; Humans ; Cell Proliferation ; Proto-Oncogene Proteins c-akt/metabolism* ; Phosphatidylinositol 3-Kinases/metabolism* ; Signal Transduction ; Cell Movement ; Cell Line, Tumor ; Prognosis ; Apoptosis ; Tumor Microenvironment ; Female ; Male ; Epithelial-Mesenchymal Transition/genetics*

Objective To summarize the application of seven-stitch definitive suture in total laparoscopic total gastrectomy with esophagojejunostomy.Methods From March 2021 to July 2022,14 patients with early and advanced upper gastric cancer were treated with total laparoscopic total gastrectomy,esophagojejunal anastomosis to reconstruct digestive tract,and manual anastomosis was optimized by seven-stitch definitive suture method for anastomosis.The operative time,intraoperative blood loss,intraoperative anastomosis reconstruction cost,postoperative complications,postoperative pathology and prognosis were analyzedResults The average operation time of the 14 patients was 300 minutes,the average intraoperative blood loss was 110 ml,and the average cost of consumables for resection and reconstruction was 16 767 yuan.Of the 14 patients,3 had perioperative complications.Conclusion Compared with instrument anastomosis,seven-stitch definitive suture avoids the risk of excessive tissue anastomosis tension and tissue compression caused by individual differences,does not increase the incidence of postoperative complications,reduces the medical cost of patients,and safely and effectively optimizes the process of endoscopic manual anastomosis.

Objective To summarize the application of seven-stitch definitive suture in total laparoscopic total gastrectomy with esophagojejunostomy.Methods From March 2021 to July 2022,14 patients with early and advanced upper gastric cancer were treated with total laparoscopic total gastrectomy,esophagojejunal anastomosis to reconstruct digestive tract,and manual anastomosis was optimized by seven-stitch definitive suture method for anastomosis.The operative time,intraoperative blood loss,intraoperative anastomosis reconstruction cost,postoperative complications,postoperative pathology and prognosis were analyzedResults The average operation time of the 14 patients was 300 minutes,the average intraoperative blood loss was 110 ml,and the average cost of consumables for resection and reconstruction was 16 767 yuan.Of the 14 patients,3 had perioperative complications.Conclusion Compared with instrument anastomosis,seven-stitch definitive suture avoids the risk of excessive tissue anastomosis tension and tissue compression caused by individual differences,does not increase the incidence of postoperative complications,reduces the medical cost of patients,and safely and effectively optimizes the process of endoscopic manual anastomosis.

Laparoscopic pancreaticoduodenectomy (LPD) is technically safe and feasible with advantage of minimally invasive feature, and has become a routine procedure in some minimally invasive pancreatic centers. However, LPD is complicated to be operated and will take a long time to operate proficiently. How to successfully promote LPD application has become a key issue in the new era. This article focuses on the key issues in how to promote LPD application safely in primary hospitals, whether LPD can be used for malignant tumors, and how to cultivate new generation LPD experts.