Objective:To evaluate whether additional radical surgery is necessary following non-curative endoscopic resection of early colorectal cancer.Method:Clinicopathological data in 104 patients following non-curative endoscopic resection of early colorectal coucer at the Department of General Surgery, Peking University First Hospital between Jan 2011 and Dec 2021.Results:Lymph node metastasis and/or residual cancer was found in 23 patients (22%), including 12 cases of lymph node metastasis, 7 cases of residual cancer and 4 patients with both residual cancer and lymph node metastasis. Univariate analysis indicated that vascular infiltration, positive vertical margin, and female gender were risk factors for lymph node metastasis. Risk factors for residual cancer were tumors ≥2 cm in size, negative lift sign, infiltration depth of ≥1 000 μm, and positive horizontal and vertical margins. Multivariate Logistic regression analysis revealed that vascular invasion, positive vertical margins, and being female were independent risk factors for lymph node metastasis, while positive vertical margins was independent risk factor for residual cancer. Salvage surgery lasted for a median of 184 (156-233) minutes, with an estimated blood loss of 50 (20-100) ml and an average postoperative hospital stay of 9 (8-11) days. Seven cases of Clavein-Dindo Ⅱ or higher complications were observed, including pulmonary embolism in 1 case , anastomotic leakage in one, lymphatic fistula in one, bowel obstruction in 2 cases and urinary tract infection in 2 cases.Conclusion:Salvage surgery is mandatory for early endoscopic non-curative resection of colorectal cancer.

Objective To evaluate the influence of thermal damage on the cell proliferation,invasive metastasis and epithelial-mesenchymal transition of hepatocellular carcinoma (HCC) through experiments in vitro,and to explore the relationship between thermal ablation and the recurrence,metastasis of HCC.Methods The McA-RH7777 HCC cell thermal damage model was established by using external heating method.The effect of thermal damage on the proliferation of HCC cells was detected by Kit-8 assay (CCK-8),and the cell cycle changes were studied by flow cytometry.The effect of thermal damage on the invasion potential of HCC cells was assessed by using Transwell assay.Fluorescence quantitative polymerase chain reaction (RT-PCR) and Western blot were used to evaluate the influence of thermal damage on HCC cell invasion potential,and on the mRNA and protein expression levels of EMT-related molecular markers,including VEGF,MMP-9,Nm23,E-cadherinand vimentin.Results Heating treatment of McA-RH7777HCC cells was performed by putting the cells in 43.5℃ water basin for 30 min.Two to five days after heating treatment the cell proliferative ability was significantly higher than that of control group (P＜0.05).At 48-72hours after heating treatment the proportion of HCC cells in G1 phase was obviously reduced and the proportion of HCC cells in S+G2 phase was significantly increased,the differences were statistically significant (P＜0.05).Compared with the control group,the difference in HCC cell invasion potential determined at 24 h after heating treatment was not significant,while the HCC cell invasion potential determined at 72 h after heating treatment was strikingly increased (22.3±2.46 vs.14.2±l.82,P＜0.001).Real-time PCR and Western blotting results indicated that at 72 h after heating treatment the expression levels of VEGF,MMP-9 and vimentin were significantly increased,while the expression level of E-cadherin was remarkably decreased,the differences were statistically significant (P＜0.05).Conclusion Thermal damage with sub-lethal heating dose can induce McA-RH7777 HCC cell to develop epithelial-mesenchymal transition and to enhance its proliferation and invasive metastasis potential,and HCC cells show higher malignant potential.

We analyzed the best light intensity for callus induction and maintenance in Vitis vinifera and explored the mechanism of grape callus browning. Tender stem segments of grape cultivar "gold finger" were used to study the effects of different light intensities (0, 500, 1 000, 1 500, 2 000, 2 500, 3 000 and 4 000 Lx) on the induction rate, browning rate and associated enzyme activity and gene expression during Vitis vinifera callus formation. The callus induction rate under 0, 500, 1 000 and 1 500 Lx was more than 92%, significantly higher than in other treatments (P < 0.05). A lower browning rate and better callus growth were also observed during subculture under 1 000 and 1 500 Lx treatments. We found that chlorogenic acid, caffeic acid, p-hydroxybenzoic acid and coumaric acid contents were correlated with the browning rate of callus, among which chlorogenic acid content was positively correlated with the browning rate (P < 0.05). Peroxidase (POD) and polyphenol oxidase (PPO) activities were negatively correlated with the browning rate of callus (P < 0.01). The POD, PPO and phenylalanine ammonialyase (PAL) expression levels were positively correlated with the browning rate at P < 0.05 or P < 0.01. An appropriate light intensity for the tissue culture of Vitis vinifera was 1 000-1 500 Lx, higher or lower light intensities significantly impaired normal callus growth.
Caffeic Acids ; chemistry ; Catechol Oxidase ; chemistry ; Culture Media ; chemistry ; Gene Expression Regulation, Plant ; Light ; Peroxidase ; metabolism ; Phenylalanine Ammonia-Lyase ; metabolism ; Plant Stems ; enzymology ; radiation effects ; Tissue Culture Techniques ; Vitis ; enzymology ; radiation effects

Objective:To conduct transarterial embolization (TAE) in rat model of hepatic carcinoma and to investigate the effect of embolization on pulmonary metastasis and expression of E‐cadherin .Methods :Forty Buffalo rats were chosen and rat models of hepatic carcinoma with stable expression of green fluorescent protein (EGFP) were established .Rats were randomly divided into four groups with 10 rats in each group .The control group(Group A) were treated with 0 .2 mL of 0 .9% sodium chloride solution by gastroduodenal artery retrograde catheterization .The hepatic artery ligation group(Group B) were treated with suture ligation after separation of hepatic artery .The low dose embolization group(Group C) were treated with lipiodol ul‐trafluide(0 .2 mL/kg) by gastroduodenal artery retrograde catheterization .The high dose embolization group(Group D) were treated with lipiodol fluide(0 .4 mL/kg) by gastroduodenal artery retrograde catheterization .Body weights ,tumor volumes were evaluated after operation .At 21 d after operation ,the rats were killed and the samples of liver and lung were collected .The changes of tumor growth and the situations of pulmonary metastasis were evaluated .The changes in E‐cadherin mRNA and protein expression levels were detected by real‐time fluorescent quantitative PCR ,Western blotting and immunohistochemistry . Results:At 21 d after operation ,the hepatic tumor growth was obviously inhibited in Group D ,and the tumor growth in Group B or Group C was also inhibited while compared with that in Group A (P< 0 .01) .The number of pulmonary metastasis in Group D was lower than those in the other groups(P<0 .01) .The levels of E‐cadherin mRNA and protein in Group D were higher than those in the other groups and the differences were statistically significant (P<0 .01) .The rate of E‐cadherin‐posi‐tive cells in Group D were higher than those in the other groups according to immunohistochemistry ,and the differences were statistically significant(P<0 .01) .Conclusions :TAE ,in the treatment of hepatic carcinoma on the rat models ,can promote E‐cadherin expression ,and high dose lipiodol embolization can inhibit tumor grow th and reduce pulmonary metastasis .

Objective To assess the safety and efficacy of an olive oil-based lipid emulsion for parenteral nutrition in patients after esophagectomy.Methods In the randomized controlled trial,60 patients undergoing esophagectomy were divided into study group(n=30,received olive oil-based lipid emulsion)and control group [n=30,received medium-chain triglyceride/long-chain triglyceride(MCT/LCT)emulsion].The parenteral nutrition Was provided for 7-10 postoperative days.The nutritional formulas were equivalent in nitrogen,calorie,osmotic pressure,and fluid volume.Peripheral venous blood tests were performed before operation and on the first and eighth postoperative days.All the patients were evaluated by nutritional status(weight,body mass index,nutritional risk screening,etc.),safety profiles[full blood test,electrolytes,aspartate aminotransferase(AST),alanine amiotransferase(ALT),total bilirubin and direct bilirubin,blood urea nitrogen(BUN),creatinine,blood glucose,etc.],and efficacy indicators(hemoglobin,albumin,total protein,etc.).Results The albumin and total protein levels returned to the normal ranges in beth groups 8 days after operation,although both levels were significantly higher in study group(P=0.000).Also,the difference of total protein levels between the eighth and first postoperative days Was significantly higher in the study group(P=0.002).In addition,the AST and BUN readings returned to normal ranges 8 days after operation in the study group, which were significantly lower than those in control group (P = 0.025, P = 0.013).No serious adverse events were reported in both groups.Other nutritional parameters, renal and hepatic safety profiels, vital signs, and hematology showed no significant difference between two groups.Conclusions Olive oil-based lipid emulsion is a safe and efficient lipid emulsion for parenteral nutrition in patients undergoing esophagectomy.Compared with MCT/LCT, it has less effect on AST and BUN.

BACKGROUND: Artificial humeral head replacement is an effective method for the treatment of complex proximal humeral fractures, which has received good results in relieving pain. However, the final functional recovery is unpredictable. OBJECTIVE: To compare biomeshanical stability between anatomical and overlapping reconstruction of the greater tuberosity in cadaveric humeral head replacement models.METHODS: Eight pairs of fresh-frozen shoulder cadavers (16 shoulder joints) were match-paired into two groups. Standardized humeral head replacement procedure was performed in all specimens, and anatomical and overlapping reconstruction of thegreater tuberosity was adopted in each group respectively. For overlapping group, the greater tuberosity was reattached to the proximal humeral shaft in an overlapping style, which was achieved by an additional 5 mm bone osteotomized from the medial cortex of the humeral diaphysis. Custom mounting apparatus and fixation jigs were designed for designated shoulder motion.RESULTS AND CONCLUSION: When the shoulder was external rotated to neutral position, the mean displacement of greater tuberosity in the anatomical reconstruction group was smaller than that of the overlapping reconstruction group (P < 0.05). When the gleno-humeral joint was elevated to 30～ and 60～ forward flexion (accounting for 45° and 90° shoulder forward flexion), there was no significant difference of greater tuberosity displacement between the anatomical group and overlapping group. The findings demonstrated that, although overlapping reconstruction can increase the bone healing area between the greater tuberosity and the humeral diaphysis, there may be some loss in mechanical stability as the trade-off. Even though we strictly follow the standardized postoperative rehabilitation protocol after humeral head replacement, prominent displacement between the greater tuberosity relative to the humeral diaphysis was detected. Accordingly, postponing of the postoperative rehabilitation program after humeral head replacement for a decent period may improve tuberosity healing.

Objective To explore a better treatment of fresh Monteggia fracture and factors which lead to unsatisfactory results. Methods A retrospective study was done on 60 of the 114 patients with Monteggia fractures who had been treated from 1994 to 2004 in our hospital. According to Bado classification, 26 patients were type Ⅰ, 14 type Ⅱ, 19 type Ⅲ, and 1 type Ⅳ. All the cases received operation. Fixation included plates and screws, plates with tension band, with or without plaster to immobilize the limb after operation. For the fracture of the radial head, the radial head was totally or partially removed and fixated with screw or k-wire. Results 60 patients were followed up for an average of 2 years(1 to 6 years). The average score according to the system of Broberg and Morrey was 95 points (53 to 100 points). The result was excellent for 48 patients, good for 6, fair for 4 and poor for 2. Complications included heterotopic ossification, ulnohumeral osteoarthrosis, cross-union, nonunion, radial nerve injury and dysfunction of elbow joint and forearm. Conclusions Yong adults, especial males, tend to suffer this kind of low-energy injury. Anatomic reduction and rigid fixation is the key to satisfactory results. Heterotopic ossification, ulnohumeral osteoarthrosis are the major factors leading to unsatisfactory results.

Monteggia fracture dislocation refers to the fracture of the ulna with associated dislocation of the radial head. This rare injury only accounts for less than 5%of all the forearm fractures. By literature review of the history of Monteggia fracture dislocation, the authors further clarify the definition, classification, injury mechanism and treatment protocol of this special type of fracture. The key to a good result of the treatment for a Monteggia fracture dislocation is timely diagnosis and management so that anatomic reduction and stable fixation of the ulna can be achieved. In addition, enough attention must be paid to the associated injuries at the level of the elbow, including fractures of the coronoid process and the radial head as well as posterolateral rotatory instability of the ulnohumeral articulation. The factors strongly affecting prognosis include comminuted fractures of the ulna combined with fractures of the radial head and coronoid process.

Objective To introduce a procedure, proximally based conjoined t en don transfer, which is to be used for coracoclavicular ligment reconstruction in the treatment of acromioclavicular separation. Methods From 2001 to 2003, 26 pa tients with acromioclavicular dislocation of Rockwood Grades Ⅲ-Ⅴwere treated with transfer of the lateral half of the conjoined tendon to the distal clavicle in a proximally based fashion with additional coracoclavicular fixation. Radiol ogy was used to evaluate the acromioclavicular correspondence. ASES (American Sh oulder &Elbow Surgeon) score, SST (Simple Shoulder Test) form and Constant-Mur ley score were adopted to evaluate the shoulder functions. Results Follow-ups o f 22.6 months on average revealed that the height of distal clavicle reached ana tomic reduction in all the cases during operation. At the latest follow-up, the mean ASES score was 94.2, the mean VAS(Visual Analog Scale) score for pain was 1.2,the mean forward flexion was 150?,and the mean external rotation was 35? . The mean Constant-Murley score was 92.8. The number of positive answers to th e SST was 11. The overall satisfaction rate was 88.5%(23/26) and all patients r eplied with “Yes”when questioned with “Do you want to accept the same operati on if the same condition happens to your contralateral shoulder?”Conclusions Th is surgical procedure proves reliable without sacrificing the coracoacromial lig ament during coracoclavicular reconstruction. When the patients are complicated with fresh or old rotator cuff injury, or the coracoclavicular ligament is thin, or long ligament is needed in the reconstruction, the proximally based conjoine d tendon can be served as a good source of autograft ligament.

OBJECTIVETo study the diagnosis and treatment of rupture of patella ligament and Femoral quadriceps tendon.

METHODSTwenty-three patients with rupture of the patella ligament and femoral quadriceps tendon were treated from March 1990 to August 2000. They were retrospectively evaluated with regard to patient's age, cause of injuries, characteristics of injuries, symptoms and signs, supplemental checkup, patella position, operative method and time interval from injury to treatment, immobilization, motion of knee, functional recovery etc.

RESULTSThey were followed up for 6 years (4 months-11 years) on average. Thirteen of 15 acute injuries after treatment showed excellent results and good results in 2. In 5 old injuries of the extensor mechanism after treatment 2 got excellent results (3 lost to follow-up).

CONCLUSIONExcellent or good results could obtain in patients with acute injuries after operation. The results of old injuries are not as good as acute injures, but better results could also achieve after repair.

Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Knee Injuries ; diagnosis ; surgery ; Male ; Middle Aged ; Patellar Ligament ; injuries ; surgery ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Rupture ; diagnosis ; surgery ; Tendon Injuries ; diagnosis ; surgery