Objective:To investigate the predictive value of serum procalcitonin (PCT) for the localization of acute digestive tract perforation.Methods:This retrospective study included 88 patients from the Department of Gastrointestinal Surgery of the First Affiliated Hospital of Southwest Medical University who were diagnosed as acute digestive tract perforation between January 2015 and January 2018. According to the intraoperative diagnosis and postoperative pathological reports, the enrolled patients were divided into the upper digestive tract perforation group (45 cases) and the lower digestive tract perforation group (43 cases) (above or below Treitz ligament). Preoperative serum PCT, white blood cell, neutrophil rate, C-reactive protein (CRP), albumin (ALB), C-reactive protein to albumin (CRP/ALB) ratio were measured and compared between the two groups. Univariate analysis and multivariate logistic regression analysis were used to analyze the independent risk factors of the lower digestive tract perforation group, and the receiver operating characteristic curve was used to analyze the predictive value of the above mentioned markers in the localization of acute digestive tract perforation.Results:Univariate analysis showed that patients in the lower digestive tract perforation group exhibited significantly higher levels of serum PCT, CRP, ALB, and CRP/ALB ratio than patients in the upper digestive tract perforation group ( P<0.05). Multivariate logistic regression analysis showed that serum PCT, CRP and CRP/ALB ratio were independent risk factors for the diagnosis of lower digestive tract perforation [PCT: odds ratio ( OR)=1.241, 95% confidence interval (95% CI): 1.098~1.403, P = 0.001; CRP: OR= 0.95, 95% CI: 0.912~0.99, P = 0.014; and CRP/ALB ratio: OR= 35.104, 95% CI: 3.889-316.885, P = 0.002]. The area under curve of serum PCT, CRP, CRP/ALB ratio to distinguish upper or lower digestive tract perforation were 0.932 (95% CI: 0.879~0.985), 0.77 (95% CI: 0.667~0.872), and 0.898 (95% CI: 0.827~0.969), respectively. The optimal cutoff value of PCT in differential diagnosis of upper or lower digestive tract perforation was 16.595 ng/mL, with a sensitivity of 86.0% and a specificity of 91.1%. The optimal cutoff value of CRP was 55.4 mg/mL, with a sensitivity of 76.7% and a specificity of 80.0%. The optimal cutoff value of CRP/ALB ratio was 1.45 and its sensitivity and specificity were 83.7%, 88.9%, respectively. Conclusions:Serum PCT, CRP, and CRP/ALB ratio are helpful to predict the localization of acute digestive tract perforation and can improve the diagnostic accuracy. The diagnostic efficiency of PCT is better than CRP and CRP/ALB ratio, exerting excellent clinical value.

Objective:To evaluate the prognostic value of C-reactive protein (CRP) to albumin ratio (CAR) before and after adjuvant chemotherapy for colorectal cancer.Methods:From February 2013 to March 2014, the clinical data of 248 patients underwent radical resection of colorectal cancer combined with postoperative adjuvant chemotherapy in Department of Gastroenterology Surgery of the Affiliated Hospital of Southwest Medical University were retrospectively analyzed.The patients were followed up every 3 months within 2 years, once every six months after three years, and the deadline for follow-up was March 2019.Receiver operating characteristic (ROC) and Cox risk assessment were analyzed before, after and after chemotherapy.The optimal cut-off points of CAR before and after adjuvant chemotherapy were obtained by ROC curve. According to the optimal cut-off point, the patients were divided into high CAR group before chemotherapy and low CAR group before chemotherapy, high CAR group after chemotherapy and low CAR group after chemotherapy. The relationship between CAR and clinicopathological features and survival was compared before and after chemotherapy.Results:There was a positive correlation between CAR before adjuvant chemotherapy(0.23±0.05) and after chemotherapy (0.31±0.07) (r 0.382, P<0.001). Combined analysis of car before and after adjuvant chemotherapy the ROC curve area of CAR was 0.808, the sensitivity and specificity were 79.3% and 78.5%, respectively, which was higher than those of CAR before chemotherapy alone (the area under the curve was 0.776, the sensitivity and specificity were 78.1% and 66.2%, respectively, z=1.675, P<0.001) and CAR after chemotherapy (the area under the curve was 0.699, the sensitivity and specificity were 76.5% and 53.8%, Z=3.361, P<0.001). Cox risk assessment model single factor analysis and multivariate analysis showed that high CAR before chemotherapy ( HR=2.853, 95% CI 2.021-4.029, P<0.001) and and after chemotherapy ( HR=2.165, 95% CI 1.890-2.565, P<0.001) were independent risk factors for colorectal cancer prognosis. Conclusion:The combined detection of CAR before and after adjuvant chemotherapy is valuable in evaluating the prognosis of colorectal cancer.

Tumor cells along with a small proportion of cancer stem cells exist in a stromal microenvironment consisting of vasculature, cancer-associated fibroblasts, immune cells and extracellular components. Recent epidemiological and clinical studies strongly support that vitamin D supplementation is associated with reduced cancer risk and favorable prognosis. Experimental results suggest that vitamin D not only suppresses cancer cells, but also regulates tumor microenvironment to facilitate tumor repression. In this review, we have outlined the current knowledge on epidemiological studies and clinical trials of vitamin D. Notably, we summarized and discussed the anticancer action of vitamin D in cancer cells, cancer stem cells and stroma cells in tumor microenvironment, providing a better understanding of the role of vitamin D in cancer. We presently re-propose vitamin D to be a novel and economical anticancer agent.

Objective:To explore the value of preoperative neutrophil-lymphocyte ratio (NLR),preoperative platelet-lymphocyte ratio (PLR),changes between pre and postoperative neutrophil-lymphocyte ratio(postoperative NLR/preoperative NLR) and changes between pre and postoperative platelet-lymphocyte ratio(postoperative PLR/preoperative PLR) in predicting the occurrence of anastomotic leakage after surgery in patients of rectal cancer.Methods: 187 rectal cancer patients in the Gastrointestinal Surgery Department in the First Affiliated Hospital of Southwestern Medical University during March,2015-March,2016 were included in our study.Preoperative NLR,preoperative PLR,changes between pre and postoperative NLR and changes between pre and postoperative PLR were observed.At the same time we included age,gender,pathological staging,stage of lymph node metastasis,tumor differentiation,distance between tumor and anus in our study.χ2 test or Fisher′s exact value was used in the univariate analysis,while Logistic Regression Analysis was used in the multivariate analysis.Results: The univariate analysis showed that preoperative NLR (Fisher′s exact value=7.242),preoperative PLR (χ2=6.787),changes between pre and postoperative NLR (χ2=15.656),PLR (χ2=9.298),age (χ2=4.813) and distance between tumor and anus(χ2=5.951) were related to anastomotic leakage(P<0.05).Other risk factors such as,gender(χ2=0.001),pathological staging (Fisher′s exact value =2.107),stage of lymph node metastasis(Fisher′s exact value =1.298),tumor differentiation (Fisher′s exact value =2.206),and were not associated with anastomotic leakage (P>0.05).Multivariate analysis showed that the preoperative NLR(OR=1.647,P=0.000),change between pre and postoperative NLR (OR=1.880,P=0.000)and distance between tumor and anus(OR=4.364,P=0.048) were associated with anastomotic leakage.Conclusion: preoperative NLR,change between pre and postoperative NLR and distance between tumor and anus are independent risk factors for anastomotic leakage after rectal anterior resection.

Objective To investigate the expression of GrB and Bid gene in gastric carcinoma and development of gastric carcinoma,exploring their effect on the mechanism of immune tolerance of tumor.Methods S-P method was used to detect the expression status of GrB and Bid gene in gastric carcinoma and margin tissue.Results The positive expression rate of GrB of gastric carcinoma tissues was 47.62％,the positive rate in the margin tissue was 40.48％,there was no significant difference(P ＞ 0.05) ; The positive expression rate of Bid of gastric carcinoma tissues (26.19％) was significantly lower than that of margin tissue(76.19％) (P ＜ 0.05) ; The expression of GrB had significantly correlation with TNM stage and lymph node metastasis of the tumor (P ＜ 0.05),the expression of Bid in gastric cancer had significantly correlation with differentiation,invasive depth,TNM stage and lymph node metastasis of the tumor (P ＜ 0.05) ; the expression of GrB was negatively correlated with that of Bid in gastric cancaer(rs =-0.311,P ＜ 0.05).Conclusion The expression of GrB and Bid may be involved in development of gastric carcinoma,down-regulated or scarce expression of Bid may be cause cancer cells escaping from endogenous or exogenous GrB-mediated cell apoptosis,and acquire immune tolerance,potential,to escape the immune response.

Objective: To investigate clinical effect of improved flushing method applied in anastomotic leakage (AL) atfer low anterior resection for rectal cancer. Methods: We performed a retrospective study to analyze the therapeutic effect for 39 AL from 438 patients who received Dixon surgery in the Affliated Hospital of Luzhou Medical College. Among them, 23 patients received the traditional lfushing method (the traditional group) and 16 received the improved lfushing method (the improved group). Results: hTe rate of AL was 8.9% (39/438). All patients were cured with non-operative treatment. hTe cleanliness degree of the surrounding skin of drainage tube in the improved group was higher than that in the traditional group. hTe duration of average hospitalization and extubation of drainage tube was shorter in the improved group than that in the traditional group (P<0.05). Conclusion: Compared with the traditional methods, the improved one is better for the ALpatients. Both the patients themselves or their family members can chose it. hTe improved lfushing method is worth to be spread in clinic.

Objective To investigate the expression of B-cell lymphoma/leukemia-2 gene (Bcl-2) in the gastric carcinoma,and the relationship between Bcl-2 and clinical biological behaviour and prognosis.Methods To use SP immunohistochemistry to detect respectively the expression level of Bcl-2 in the gastric carcinoma and incisal margin epithelial tissue of 42 gastric carcinoma patients.Results The positive expression rates of Bcl-2 in the gastric carcinoma and incisal margin epithelial tissue were 69.05％ and 21.43％.It had statistical significance (P ＜0.05) ; the expression of Bcl-2 in gastric carcinoma had not significantly correlation repectively with patient' s age,gender and invasive depth (P ＞ 0.05),but had significantly correlation with differentiation,TNM stage and lymph node metastasis of the tumor (P ＜ 0.05).Conclusion The expression level of Bcl-2 in gastric carcinoma may be one of biology indexes of the inwsion,migration,advancement and prognosis of the gastric carcinoma.

Granzyme B is an important effect factor of cytotoxic T lymphocytes in the immune killer function,can quickly induce cell apoptosis of the target cell.It is complicated for the reasons and the ways of the occurrence of the cell apoptosis,many genes are involved in gene regulation of cell apoptosis,and the B-cell lymphoma/leukemia-2 gene family members play a crucial role in the process of cell apoptosis.This paper mainly reviews the correlation of GrB and Bcl-2,Bid with cell apoptosis.

Serine proteinase inhibitor9(P1-9),a charac-teristic member of serpins,has been identified as the only inhibitor of granzyme B(GrB).Accumulated evidence suggested that PI-9 inhibits GrB-induced apoptosis by blocking DNA fragmentation of target cell.Physiologically,PI-9 could protect cytotoxic lymphocytes from committing autolysis or fratricide,and play an important role in facilitating immunologic tolerance of immune-privileged sites.In addition,evidences in recent years suggest that PI-9 Was also involved in vailous pathologic processes,such as inflammation,trans plantation and immune tolerance of tumor.

0.05). Integrin ? 5? 1 was significantly over expressed in lymph node metastatic cancer compared with that in corresponding PGC ( t =2.45, P 0.05) and it showed no correlation with integrin ? 5? 1 expression( r = 0.156, P =0.37).Conclusion Over expression of integrin ? 5? 1 is present in GC and associates with the progression of tumor, implying that it may be viewed as the indicator of invasion and metastasis and the candidate target of gene therapy of gastric cancer. However, integrin ? 5? 1 may not play an important role in the vascularization of GC.