Objective To explore the relationship between Epstein-Barr virus (EBV) infection with serum human kissin-1 (KISS-1) and matrix metalloproteinase 2 (MMP2) levels and prognosis in patients with colon cancer. Methods A total of 86 colon cancer patients who were hospitalized in our hospital from April 2015 to April 2016 were selected as the colon cancer group; in the same period, 84 cases of physical examination person in our hospital were selected as the control group. Real-time fluorescent quantitative PCR (qRT-PCR) was used to test colon cancer patients for EBV DNA, and divided the patients into EBV DNA negative group and EBV DNA positive group according to the test results. Enzyme-linked immunosorbent (ELISA) method was used to detect serum KISS-1 and MMP2 levels. Pearson method was used to analyze the correlation between serum KISS-1 and MMP2 levels in patients with colon cancer infected with EBV. The survival curve was drawn by Kaplan-Meier method, and the relationship between EBV infection and prognosis of colon cancer patients was analyzed by log-rank test. Multivariate Cox regression analysis were used to analyze the factors affecting the prognosis of colon cancer patients. Results Compared with the control group, the positive rate of EBV DNA in the colon cancer group was higher (χ2=21.854, P<0.001). The EBV DNA positive rate of patients with lymph node metastasis, TNM stage Ⅲ–Ⅳ, tumor low differentiation and tumor infiltration T3–T4 was higher than those without lymph node metastasis, TNM stage Ⅰ–Ⅱ, tumor high/medium differentiation and tumor infiltration T1–T2 (P<0.05). Compared with the EBV DNA negative group, the serum KISS-1 level of the EBV DNA positive group decreased, and the MMP2 level increased (P<0.001). There was a negative correlation between serum KISS-1 and MMP2 levels in colon cancer patients with EBV infection (r=–0.510, P<0.001). The 5-year survival rates of colon cancer patients in the EBV DNA-negative group and the EBV DNA-positive group were 52.94% (27/51) and 14.29% (5/35), respectively, the difference between the two groups was statistically significant (χ2=13.274, P<0.001). EBV infection, MMP2 high expression, and lymph node metastasis were independent risk factors affecting the prognosis of colon cancer patients (P<0.05), and KISS-1 low expression was a protective factor affecting the prognosis of colon cancer patients (P<0.05). Conclusions EBV infection is closely related to the progression and prognosis of colon cancer. The down-regulation of KISS-1 and the up-regulation of MMP2 may be related to EBV infection.
Objective To explore clinical characteristics and therapeutic strategy of undifferentiated pleomorphic sarcoma of colon. Methods A retrospective study of 3 patients with undifferentiated peomorphic sarcoma of the colon was conducted. These cases were treated at the Peking Union Medical College Hospital from October 1983 to July 2016. In addition, the clinicopathologic data of 23 patients with undifferentiated pleomorphic sarcoma of colon reported in the literatures were analyzed. Results These 3 cases all received surgery in our hospital, including two patients who received postoperative radiotherapy. These three cases died of the local relapse or metastasis respectively at 5 months, 3 years, and 5 years after surgery. The 23 patients reported in the literatures were treated surgically except for 1 case, of which received chemotherapy after operation in the 2 cases, did not receive adjuvant therapy after operation in the 15 cases, were not reported clearly in the 6 cases. Sixteen cases had the results of follow-up, of which 9 cases had no recurrences or metastases and 7 cases died. Conclusions Undifferentiated pleomorphic sarcoma of colon has no specific clinical manifestation, it’s prognosis is very poor. Surgery is a main treatment for it at present. Thorough resection of tumor at an early stage is essential to patient’s recovery. Treatments such as chemotherapy and radiotherapy could be selected as postoperative adjuvant treatment, however, therapeutic schemes and effectiveness need further to be studied.
ObjectiveTo study feasibility of sheath technique with seromuscular sleeve of pedicled colon in preventing anastomotic leakage following laparoscopic anterior resection of rectal cancer.MethodsThe clinical data of patients who underwent laparoscopic anterior resection of rectal cancer in our hospital from January 2017 to March 2020 were retrospectively collected. According to different surgical methods, they were divided into two groups: pedicled seromuscular sleeve sheath group (referred to as sleeve sheath operation group) and traditional operation group. The intraoperative and postoperative statuses were compared between these two groups.ResultsIn this study, 87 patients with rectal cancer were included, 37 in the sleeve sheath operation group and 50 in the traditional operation group. There were no significant differences in the baseline data such as the gender, age, body mass index (BMI), complicating disease, distance from lower tumor margin to anal verge, histological classification, neoadjuvant radio- chemotherapy, and TNM stage between the two groups (P>0.05). There were no significant differences in the volumes of intraoperative blood loss, the number of lymph node dissection, the first postoperative anal exhaust time and the hospitalization expense between the two groups (P>0.05). Compared with the traditional operation group, the operative time of the sleeve sheath operation group was longer (P<0.05), the postoperative hospitalization time of the sleeve sheath operation group was shorter (P<0.05). The incidence of postoperative anastomotic leakage in the sleeve sheath operation group and the traditional group were 0.0% (0/37) and 12.0% (6/50), respectively, and the difference was statistically significant (P<0.05). There were no significant differences in the anastomotic stenosis, the lymphatic fistula and the incision infection between the two groups (P>0.05). All patients were followed-up for 6 to 36 months, with a median time of 21 months. No recurrence or death occurred.ConclusionThe sheath technique with seromuscular sleeve of pedicled colon can increase the anti tension ability of anastomotic stoma and reduce the incidence of anastomotic leakage, which is a safe and effective surgical method.
摘要:目的:探索槐耳清膏对体结肠癌SW480细胞增殖能力影响及其机制。方法:采用噻唑蓝(MTT)比色法检测槐耳清膏对SW480细胞增殖能力的作用,并探求最佳作用浓度;将体外培养细胞随机分为常氧组(NC组)、低氧组(HC组)和低氧槐耳组(HH组),逆转录聚合酶链反应（RTPCR）检测各组血管内皮生长因子(VEGF) mRNA表达水平,Western blot检测蛋白表达水平。结果:槐耳清膏对SW480细胞抑制率随药物浓度增加而上升,1 mg/mL时抑制率最大(66.7%),与氟尿嘧啶组(浓度为10 μg/mL)相比无统计学意义。HH组和HC组VEGF mRNA表达均显著高于NC组,分别为4.71±0.07,4.54±0.02和1.19±0.03(P＜0.05),但HH组与HC组比较差异无统计学意义。HC组VEGF蛋白表达显著高于NC组,分别为0.66±0.03和0.38±0.02(P＜0.05),HH组较HC组VEGF蛋白表达均显著下降,分别为0.37±0.03和0.66±0.03(P＜0.05)。结论:槐耳清膏可抑制SW480细胞增殖,1 mg/mL时抑制率最大。其机制为槐耳清膏下调细胞内VEGF蛋白表达,从而抑制肿瘤生长。Abstract: Objective: To investigate the effect of Huaier cream on proliferation of colon cancer cells SW480 and its mechanism. Methods: The proliferation was analyzed by MTT. SW480 cells were randomly divided into normoxic group (NC group), hypoxia group (HC group) and hypoxia group treated by Huaier (HH group). Levels of mRNA and protein expression of VEGF were detected by RTPCR and Western blot, respectively． Results: Huaier cream induced a dosedependent inhibition of SW480 cells. The maximum percentage of growth inhibition was 66.7% at a concentration of 1.0 mg/mL, but no significant difference was found compared to the positive control (5FU 10 μg/mL). VEGF mRNA levels were significantly higher in HC group and HH group than in NC group (4.71±0.07, 4.54±0.02 vs 1.19±0.03, all Plt;0.05), but not significantly different between HC group and HH group. VEGF protein expression was higher in HC group than NC group (0.66±0.03 vs 0.38±0.02, Plt;0.05). In HH group, VEGF protein was inhibited remarkably compared with HC group (0.37±0.03 vs 0.66±0.03, Plt;0.05). Conclusion: Huaier cream can significantly inhibit SW480 cells and the top inhibition concentration is 1.0 mg/mL. Huaier cream plays a role in inhibiting tumor through downregulating protein expression of VEGF.
ObjectiveTo explore the causes of colon-anal anastomotic stenosis in patients with low rectal cancer after prophylactic ileostomy under complete laparoscopy. MethodsA total of 194 patients with low rectal cancer who received complete laparoscopic radical resection of rectal cancer combined with preventive ileostomy in our hospital from January 2020 to December 2020 were selected as the study objects, and were divided into non-stenosis group (n=136) and stenosis group (n=58) according to postoperative colon-anal anastomosis stenosis. The clinical data of the two groups were compared. Univariate and multivariate logistic regression were used to analyze the factors affecting postoperative colon-anal anastomotic stenosis, and stepwise regression was used to evaluate the importance of each factor. The risk prediction model of postoperative colon-anal anastomotic stenosis was constructed and evaluated. ResultsIn the stenosis group, the proportion of males, tumor diameter ＞3 cm, NRS2002 score >3 points, manual anastomosis, left colic artery not preserved, anastomotic leakage, pelvic infection and patients undergoing neoadjuvant radiotherapy and neoadjuvant chemotherapy were higher than those in the non-stenosis group (P<0.05). The results of univariate logistic analysis showed that female and preserving the left colonic artery were the protective factors for postoperative colon-anal anastomotic stenosis (P<0.05), and the tumor diameter >3 cm, NRS2002 score >3 points, manual anastomosis, anastomotic leakage, pelvic infection, neoadjuvant radiotherapy and neoadjuvant chemotherapy were the risk factors for postoperative colon-anal anastomotic stenosis (P<0.05). Multivariate logistic regression analysis showed that gender, tumor diameter, NRS 2002 score, anastomotic mode, anastomotic leakage, and pelvic infection were independent influencing factors for postoperative colon-anal anastomotic stenosis (P<0.05). Stepwise regression analysis showed that the top three factors affecting postoperative colon-anal anastomotic stenosis were NRS 2002 score, gender and anastomotic leakage. Multivariate Cox risk proportional model analysis showed that the multivariate model composed of NRS 2002 score, gender and anastomotic leakage had a good consistency in the risk assessment of postoperative colon-anal anastomotic stenosis. Based on this, a risk prediction model for postoperative colon-anal anastomotic stenosis was constructed. The results of strong influence point analysis show that there are no data points in the modeling data that have a strong influence on the model parameter estimation (Cook distance <1). Receiver operating characteristic curve results showed that the model had good differentiation ability, the area under curve was 0.917, 95%CI was (0.891, 0.942). The calibration curve was approximately a diagonal line, showing that the model has good predictive power (Brier value was 0.097). The results of the clinical decision curve showed that better clinical benefits can be obtained by using the predictive model to identify the corresponding risk population and implement clinical intervention. ConclusionThe prediction model based on NRS 2002 score, gender and anastomotic fistula can effectively evaluate the risk of colon-anal anastomotic stenosis after preventive ileostomy in patients with low rectal cancer under complete laparoscopy.
Objective To investigate the relationship between preoperative hemoglobin, albumin, lymphocyte and platelet (HALP) score, and clinicopathologic features of colon cancer, and to analyze the predictive value of HALP score for postoperative liver metastasis. Methods The clinical data of 163 patients with colon cancer admitted to the 909th Hospital of Joint Logistic Support Force (Dongnan Hospital of Xiamen University) from January 2018 to December 2019 were retrospectively analyzed. According to the occurrence of postoperative liver metastasis, the patients were divided into metastatic group (n=35) and non-metastatic group (n=128). The correlation between preoperative HAPL score and clinicopathologic features of colon cancer was analyzed. The predictive value of HALP score for postoperative liver metastasis of colon cancer was analyzed by using receiver operating characteristic (ROC) curve. The risk factors of liver metastasis after colon cancer surgery were analyzed by using univariate and multivariate logistic analysis. Kaplan-Meier risk curve was drawn, and log-rank test was used to analyze the predictive value of different HALP score for postoperative liver metastasis. Results HALP score were decreased in patients with maximum tumor diameter ≥5 cm, preoperative carcinoembryonic antigen (CEA) ≥5 μg/L, serous membrane and extrasserous infiltration, lymph node metastasis and vascular invasion, and the difference was statistically significant (P<0.05). Multivariate logistic regression analysis showed that HALP score [OR=1.467, 95%CI (1.253, 1.718), P<0.001], maximum tumor diameter [OR=3.476, 95%CI (1.475, 5.358), P=0.013], preoperative CEA level [OR= 6.197, 95%CI (2.436, 6.248), P=0.005], and lymph node metastasis [OR=2.593, 95%CI (1.667, 6.759) , P=0.003] were risk factors for postoperative liver metastasis of colon cancer. ROC curve analysis showed that the area under the curve of HALP score for predicting liver metastasis after colon cancer surgery was 0.908 (0.841, 0.974), the maximum value of the Youden index was 0.738, the optimal cut-off value of the HALP score was 35.5, the sensitivity was 0.852, the specificity was 0.886. Kaplan-Meier risk curve showed that the risk of early postoperative liver metastasis in the low HALP score group was higher than that in the high HALP score group (χ2=8.126, P=0.004). Conclusion Low HALP score in patients with colon cancer is associated with adverse prognosisi related pathological features, and is an influential factor for postoperative liver metastasis of colon cancer, and has predictive value for patients with postoperative liver metastasis of colon cancer.
Objective To analysis the risk factors for lower airway bacteria colonization and ventilator-associated pneumonia ( VAP) in mechanically ventilated patients. Methods A prospective observational cohort study was conducted in intensive care unit. 78 adult inpatients who underwent mechanical ventilation( MV) through oral endotracheal intubation between June 2007 and May 2010 were recruited. Samples were obtained from tracheobronchial tree immediately after admission to ICU and endotracheal intubation( ETI) , and afterward twice weekly. The patients were divided naturally into three groups according to airway bacterial colonization. Their baseline characteristics, APACHEⅡ score, intubation status and therapeutic interventions, etc. were recorded and analyzed. Results In the total 78 ventilated patients, the incidence of lower airway colonization and VAP was 83. 3% and 23. 1% , respectively. The plasma albumin( ALB) ≤29. 6 g/L( P lt; 0. 05) , intubation attempts gt; 1( P lt; 0. 01) were risk factors for lower airway colonization. In the patients with lower airway colonization, preventive antibiotic treatment, applying glucocorticoid and prealbumin( PA) ≤ 69. 7 mg/L were risk factors for VAP ( P lt; 0. 05) . Conclusions The risk factors for lower airway colonization in ventilated patients were ALB≤29. 6 g/L and intubation attempts gt; 1. And for lower airway colonized patients, PA ≤ 69. 7 mg/L, preventive antibiotic treatment and applying glucocorticoid were risk factors for VAP.
Objective To explore the influencing factors for pulmonary infection after radical resection of colon cancer. Methods A cohort study included 56 patients who underwent radical resection of colon cancer in People’s Hospital of Daye City from Oct. 2014 to Oct. 2016 were followed-up prospectively, to observe the occurrence of pulmonary infection, and collectting the related factors for pulmonary infection in addition. Results The clinical data of 53 patients were finalized and the clinical data of these patients were complete. Among them, 13 patients suffered from pulmonary infection after radical resection of colon cancer, and 40 patients had no obvious exacerbation and no complicated pulmonary infection. Results of logistic regression showed that, value of forced expiratory volume in1 second/forced vital capacity (OR=1.174, P=0.033), operative time (OR=1.638, P=0.012), levels of postoperative copeptin (OR=1.328, P=0.032), and procalcitonin (OR=1.465, P=0.042) were risk factors for pulmonary infection after radical resection of colon cancer. Receiver operating characteristic curve (ROC) showed that, operative time was 6.207-hour, postoperative copeptin level was 10.420 pmol/L, and the postoperative procalcitonin level was 3.676 ng/mL, which had the best predictive effect on predicting pulmonary infection after radical resection of colon cancer. Conclusions Value of forced expiratory volume in 1 second/forced vital capacity, operative time, levels of copeptin and procalcitonin after operation are the independent influencing factors for pulmonary infection after radical resection of colon cancer, and it has best prognostic outcome when the operative time is 6.207-hour, postoperative copeptin level is 10.420 pmol/L, and the postoperative procalcitonin level is 3.676 ng/mL.
The technique of laparoscopic radical right hemicolectomy is becoming mature, but there are still controversies on some key steps, including the extent of lymph node dissection, the scope of bowel resection, the choice of surgical access and anastomosis. The new function-preserving surgery and natural-orifice transluminal endoscopic surgery (NOTES) have further enhanced the minimally invasive nature of surgery. The author’s have reviewed the latest domestic and international literature, combined with the experience of the author’s center, and elaborated on the current focus issues of laparoscopic radical surgery for right-sided colon cancer.
ObjectiveTo investigate the influence of surgical treatment on early postoperative anal function in left colon cancer patients with acute complete obstruction. MethodsThe clinical data of left colon cancer patients with acute complete obstruction were retrospectively chosen from January 2017 to June 2020 in Yibin Second People’s Hospital. The patients were grouped according to the treatment plan including emergency operation group (54 cases), stent+operation group (46 cases) and stent+neoadjuvant chemotherapy (NAC)+operation group (44 cases). The anal function was evaluated at 4 weeks, 1 month and 6 months after operation, and quality of life was evaluated at 12 months after operation. Unconditional logistic regression model was used to explore the factors influencing early postoperative anal function injury. Results The proportion of open surgery in the emergency operation group was statistically higher than the stent+operation group and stent+NAC+operation group (P<0.05). The low anterior rectum resection syndrome (LARS) score at 4 weeks after operation of the emergency operation group was statistically higher than those of the stent+operation group and stent+NAC+operation group (P<0.05). However there was no statistical difference in LARS score at 1 month and 6 months after operation among the three groups (P>0.05). The score of social function in the emergency operation group at 12 months after operation was statistically lower than those of the stent+operation group and stent+NAC+operation group (P<0.05). Multivariate logistic regression analysis showed that body mass index (BMI) ≥24 kg/m2, emergency operation, and Eastern Collaborative Oncology Group (ECOG) score were the risk factors for early postoperative anal dysfunction in the left colon cancer patients with acute complete obstruction (P<0.05). ConclusionsLeft colon cancer patients complicated with acute complete obstruction who only received emergency surgery, BMI≥24 kg/m2, or one score of ECOG are more likely to have functional impairment, and the quality of life of those patients underwent emergency surgery alone is decreased. In addition, the stent placement at the obstruction site should be helpful to avoid the above problems.