Humans ; Gastrointestinal Microbiome ; Constipation/therapy* ; Probiotics/therapeutic use* ; Patients

Objective:We aimed to develop a novel visualized model based on nomogram to predict postoperative overall survival.Methods:This was a multicenter, retrospective, observational cohort study, including participants with histologically confirmed gastric and colorectal cancer who underwent radical surgery from 11 medical centers in China from August 1, 2015 to June 30, 2018. Baseline characteristics, histopathological data and nutritional status, as assessed using Nutrition Risk Screening 2002 (NRS 2002) score and the scored Patient-Generated Subjective Global Assessment, were collected. The least absolute shrinkage and selection operator regression and Cox regression were used to identify variables to be included in the predictive model. Internal and external validations were performed.Results:There were 681 and 127 patients in the training and validation cohorts, respectively. A total of 188 deaths were observed over a median follow-up period of 59 (range: 58 to 60) months. Two independent predictors of NRS 2002 and Tumor-Node-Metastasis (TNM) stage were identified and incorporated into the prediction nomogram model together with the factor of age. The model's concordance index for 1-, 3- and 5-year overall survival was 0.696, 0.724, and 0.738 in the training cohort and 0.801, 0.812, and 0.793 in the validation cohort, respectively.Conclusions:In this study, a new nomogram prediction model based on NRS 2002 score was developed and validated for predicting the overall postoperative survival of patients with gastric colorectal cancer. This model has good differentiation, calibration and clinical practicability in predicting the long-term survival rate of patients with gastrointestinal cancer after radical surgery.

Radiation-induced intestinal injury is a radiation injury of the colon and rectum after radiotherapy for pelvic malignant tumors. This condition affects multiple organs in the pelvis, making treatment challenging. In clinical practice, the most effective protocol is often determined through discussion by a multi-disciplinary team (MDT). However, due to the severity and complexity of radiation enteritis, many patients still experience poor diagnosis and treatment outcomes. Holistic integrative management (HIM) is a rapidly developing concept that has greatly enhanced clinical medicine in recent years. It improves the level of diagnosis, treatment, prevention, and rehabilitation from multiple dimensions of prevention, screening, diagnosis, treatment, and rehabilitation. In the context of radiation-induced intestinal injury, HIM also calls for the implementation of an individualized management system that focuses on the patient as a whole within the healthcare team. From the perspective of HIM, this article introduces some of the latest progress of radiation-induced intestinal injury in recent years.

Radiation-induced intestinal injury is a radiation injury of the colon and rectum after radiotherapy for pelvic malignant tumors. This condition affects multiple organs in the pelvis, making treatment challenging. In clinical practice, the most effective protocol is often determined through discussion by a multi-disciplinary team (MDT). However, due to the severity and complexity of radiation enteritis, many patients still experience poor diagnosis and treatment outcomes. Holistic integrative management (HIM) is a rapidly developing concept that has greatly enhanced clinical medicine in recent years. It improves the level of diagnosis, treatment, prevention, and rehabilitation from multiple dimensions of prevention, screening, diagnosis, treatment, and rehabilitation. In the context of radiation-induced intestinal injury, HIM also calls for the implementation of an individualized management system that focuses on the patient as a whole within the healthcare team. From the perspective of HIM, this article introduces some of the latest progress of radiation-induced intestinal injury in recent years.

Objective:To explore the clinical effects of uncut Roux-en-Y anastomosis versus Roux-en-Y anastomosis in laparoscopic distal gastrectomy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 194 patients who underwent laparoscopic distal gastrectomy in the First Affiliated Hospital of Air Force Military Medical University from January 2017 to May 2019 were collected. There were 130 males and 64 females, aged (57±10)years, with a range from 27 to 78 years. Of 194 patients, 62 undergoing uncut Roux-en-Y anastomosis digestive tract reconstruction in laparoscopic distal gastrectomy and 132 undergoing Roux-en-Y anastomosis digestive tract reconstruction in laparoscopic distal gastrectomy were allocated into uncut group and traditional group, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2) intraoperative and postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was conducted at the postoperative 3 months and 6 months to detect Roux stasis syndrome (RSS), tumor recurrence, readmission, and survival of patients. The propensity score matching was conducted by 1∶1 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test Fisher exact probability. Comparison of ordinal data between groups was analyzed using the nonparametric rank sum test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 104 of 194 patients had successful matching, including 52 in the uncut group and 52 in the traditional group respectively. Before propensity score matching, cases with age ≤60 years or >60 years, cases in stage Ⅰ, Ⅱ, Ⅲ of American Society of Anesthesiologists were 43, 19, 27, 28, 7 for the uncut group, respectively, versus 63, 69, 24, 92, 16 for the traditional group, showing significant differences between the two groups ( χ2=1.279, Z=2.818, P<0.05). After propensity score matching, the above indicators were 33, 19, 20, 25, 7 for the uncut group, versus 34, 18, 15, 33, 4 for the traditional group, showing no significant difference between the two groups ( χ2=0.000, Z=0.500, P>0.05). (2) Intraoperative and postoperative situations: 104 patients underwent laparoscopic distal gastrectomy successfully and received R 0 resection, without intraoperative complications or conversion to open surgery. After propensity score matching, the time of digestive tract reconstruction was (41±10)minutes for the uncut group, versus (52±15)minutes for the traditional group, showing a significant difference between the two groups ( t=4.511, P<0.05). (3) Follow-up: 104 patients were followed up at the postoperative 3 months and 6 months. The incidence of RSS at the postoperative 3 months was 0 for the uncut group, versus 30.8%(16/52) for the traditional group, showing a significant difference between the two groups ( P<0.05). The incidence of RSS at the postoperative 6 months was 0 for the uncut group, versus 9.6%(5/52) for the traditional group, showing no significant difference between the two groups ( P>0.05). There was no tumor recurrence, readmission, death within postoperative 30 days, or cancer-related death in the 104 patients. Conclusion:Uncut Roux-en-Y anastomosis is safe and feasible in the laparoscopic distal gastrectomy, which can effectively shorten the time of digestive tract reconstruction and reduce the occurrence of RSS after 3 months surgery.

OBJECTIVETo investigate the prognostic value of lymphatic vascular invasion (LVI) for stage I( gastric cancer patients after radical gastrectomy.

METHODSClinicopathological and intact follow-up data of 469 stage I( gastric cancer patients who underwent radical gastrectomy with R0 resection and were pathologically proven as gastric adenocarcinoma without other malignancy at the Department of Digestive Surgery, The First Affiliated Hospital, The Fourth Military Medical University between February 2009 and December 2012 were retrospectively collected. Chi square test was used to examine the relationship between LVI and clinicopathological data; Log-rank test was used for survival analysis; Cox proportional hazards model was used for univariate and multivariate analysis to explore the prognostic influence of LVI on stage I( gastric cancer patients.

RESULTSA total of 469 patients were enrolled, including 360 male (76.8%) and 109 female patients (23.2%). Median age was 58(25-82) years. There were 114 T1a cases (24.3%), 195 T1b cases (41.6%), and 160 T2 cases (34.1%). There were 439 (93.6%) cases without lymph node metastasis and 30 cases with lymph node metastasis. Presence of LVI was found in 52 patients (11.1%). LVI was closely associated with tumor grade, depth of invasion and status of lymph node metastasis (all P<0.05), rather than gender, age, tumor location and tumor diameter (all P>0.05). LVI detection rate was higher in poorly differentiated and undifferentiated group (14.3%, 32/223) than that in moderately and well differentiated group (8.1%, 20/246) (χ=4.590, P=0.032). LVI detection rate was higher in T2 (14.4%, 23/160) and T1b (13.3%, 26/195) group than that in T1a group (2.6%,3/114)(χ=11.020, P=0.004). LVI detection rate was higher in patients with lymph node metastasis (30.0%, 9/30) compared to those without lymph node metastasis (9.8%, 43/439) (χ=11.629, P=0.001). Median follow-up time was 63(3-74) months. There were totally 46 deaths (9.8%). The 5-year overall survival rate was 90.2%. The 5-year overall survival rate was 82.7% in patients with LVI and 91.1% without LVI, which was significantly different (P=0.039). Univariate analysis showed that age (P=0.012), AJCC T stage (8th edition) (P=0.011), and LVI (P=0.043) were closely associated with the prognosis of gastric cancer patients, while gender, tumor location, tumor diameter, tumor grade, lymph node metastasis or postoperative chemotherapy were not associated to the prognosis (all P>0.05). Multivariate analysis revealed that only age(HR=2.038, 95%CI:1.126 to 3.686, P=0.019) and advanced T stage (T1b: HR=1.427, 95%CI:0.554 to 3.678; T2: HR=2.926, 95%CI:1.199 to 7.140; P=0.017) were independent prognostic factors of stage I( gastric cancer patients (both P<0.05).

CONCLUSIONSLVI is not an independent prognostic factor of stage I( gastric cancer patients. In clinical practice, we should consider adjuvant chemotherapy prudently for stage I( gastric cancer patients with LVI.

Objective:To investigate the influence of clinical outcomes and the risk factors of poor prognosis for preoperative nutritional risk in gastric cancer patients.Methods:A prospective study was performed in 140 patients with gastric cancer and the nutritional risk screening 2002 (NRS 2002) was done.The influence of preoperative nutritional risk on postoperative complications,hospital stay,ICU stay,hospital expenses,60 days readmission and mortality was analyzed,and the risk factors of perioperative complication were identified by univariate and multivariate analysis.Results:The significant difference (NRS 2002 ≥ 3 group vs.NRS 2002 ＜ 3 group) was observed in the rates of overall postoperative complications,pulmonary infection,overall hospital stay and postoperative hospital stay (P ＜ 0.05).The rates of anastomotic fistula,pleural effusion,60 days readmission,60 days mortality and hospitalization expenses in NRS 2002 ≥ 3 group were higher than that of NRS 2002 ＜ 3 group,but there were no differences between the two groups (P ＞ 0.05).By univariate and multivariate analysis,preoperative high cholesterol levels and preoperative nutritional risk are the risk factors of poor prognosis and postoperative complications.Conclusion:Preoperative high cholesterol levels and preoperative nutritional risk are independent risk factors of postoperative complications.

Objective To investigate the efficacy of laparoscopic assisted and open surgery for right colectomy.Methods 230 patients underwent right colectomy were selected,and they were randomly divided into laparoscopic group and laparotomy group according to the digital table,each group in 115cases.The laparoscopic group was treated with laparoscopic assisted operation.The laparotomy group was treated with open surgery.The complications after operation,the quality of life and follow up were compared between the two groups.Results The operation time,number of lymph node dissection and total cost of the laparoscopic group were (120.75 ± 28.20) min,(15.89 ± 3.83),(4.5 1 ±0.72) million,respectively,which of the l aparotomy group were (110.44 ± 23.58) min,(11.14 ± 4.01),(3.71 ±0.69) million,respectively,the differences were statistically significant (t =3.008,9.186,8.603,all P ＜ 0.01).The intraoperative blood loss and incision length of the laparoscopic group were (91.23 ± 14.85) mL and (5.85 ± 2.32) cm,respectively,which were significantly lower than those of the laparotomy group [(121.63 ± 12.32) mL,(15.05 ±7.72)cm,t =16.895,12.238,all P ＜ 0.01].The bowel exhaust time,fluid time,postoperative drainage time,postoperative analgesia time,postoperative catheterization time and hospitalization time of the laparoscopic group were (3.47 ± 1.55)d,(4.80 ±2.12)d,(6.31 ±3.21)d,(5.01 ± 1.75)h,(3.25 ± 1.07)d,(15.37 ±4.41)d,respectively,which were significantly shorter than those of the laparotomy group [(4.62 ± 1.68) d,(7.43 ± 2.58) d,(7.67 ±2.80)d,(9.51 ±3.54)h,(6.20 ±2.33) d,(22.62 ±5.39)d,t =16.895,12.238,5.395,8.446,3.424,12.220,12.338,11.163,all P ＜ 0.01].The incidence rate of complication in the laparoscopic group was 1.74％,which was significantly lower than 14.78％ in the laparotomy group(x2 =12.908,P ＜0.01).The scores of quality of life in the laparoscopic group were significantly higher than those in the laparotomy group(all P ＜ 0.01).The two groups were followed up for 9 months,the local recurrence,metastasis and other differences were not statistically significant (all P ＞ 0.05).Conclusion Laparoscopic assisted right colectomy has less wounded in patients,faster recovery after operation,lower incidence of complications,higher quality of life,but relatively expensive medical expenses.

Objective To observe after the NIBP (NIK and IKK beta binding protein) gene transfected into colon cancer cell lines HT29, the migration of cells and expression of p65, MMP2, MMP9 mRNA and proteins. Methods The experimental group: divided into without transfection HT29 cell (HT29 group) and transfection no-load HT29 cell (HT29-NC group) and transfection NIBP HT29 cell (HT29-NIBP steady group). Using the Transwell test to detect cell migration ability. Q-PCR method to detect the mRNA expressions of NIBP , p65, MMP2, MMP9. Western Blot method to detect the expressions of NIBP, p65, phosphorylation p65 (p-p65) proteins. The method of ELISA was used to detect the secretion of matrix metalloproteinase (MMP)-2, MMP-9. Results The high expression of NIBP may enhance the migration ability of colon cancer cell lines HT29 , increasing the expression of p-p65, MMP2, MMP9 mRNA and proteins (P < 0.05). Conclusion NIBP potently enhances colon cancer HT29 cell migration and invasion. Activation of NF-κB signaling pathways resulted in up-regulation of MMP-2 and MMP-9 maybe one of its molecular mechanisms.

Laparoscopic vagal-sparing esophagogastrectomy for the treatment of early esophageal cancer has the advantages of minimal invasion,functional sparing and better quality of life,and it can radically resect the tumor.The clinical data of 3 patients in the Daping Hospital of Third Military Medical University and 9 patients in the Xijing Hospital of Digestive Diseases who received laparoscopic vagal-sparing esophagogastrectomy from September 2009 to August 2013 were retrospectively analyzed.All the 12 patients were followed up for 1-24 months.One patient was complicated with transit hoarseness and 1 with cervical anastomotic fistular,and they were cured by conservative treatment; 1 patient was complicated with cervical anastomotic stricture,and was cured by dilatation for 3 times; no dysphagia and recurrence was observed in the other 9 patients during the follow-up.Laparoscopic vagal-sparing esophagogastrectomy is a good option for early esophageal cancer and benign esophageal diseases.