ObjectiveTo explore the influence of enhanced recovery after surgery (ERAS) on intestinal flora in patients with colorectal cancer.MethodsBy convenient sampling method, 60 patients with colorectal cancer were selected from August 2018 to December 2019 in the Department of Gastrointestinal Surgery of West China Hospital of Sichuan University and randomly divided into ERAS group and traditional treatment group (traditional group). Among them, the perioperative clinical management was carried out according to the ERAS management and traditional treatment process in the the ERAS group and in the traditional group, respectively. The fresh fecal samples were collected within 24 h after admission and the first natural defecation after operation. The bacterial 16 Sr DNA V3–V4 region was sequenced by Illumina MiSeq sequencer, and the results were analyzed by bioinformatics.ResultsA total of 60 patients with colorectal cancer were included, 30 cases in the traditional group and 27 cases in the ERAS group (3 people temporarily withdrew from the study). There were no significant differences in the basic informations between the two groups (P>0.05). ① Before or after operation, there were no significant differences in Shannon index and Simpson index between the two groups. The difference between preoperative and postoperative comparison in the same group was also not statistically significant (P>0.05). ② Beta diversity analysis showed that there was no significant difference in community composition between the traditional group and the ERAS group before operation, and there was a clear boundary between the traditional group and the ERAS group after operation. ③ At the phylum level, compared with the preoperative abundance, the postoperative abundance Firmicutes decreased by 26.5% and 5.5% in the traditional and ERAS group, respectively; Bacteroidetes increased by 21.6% and 4.7% in the traditional and ERAS group, respectively; Proteobacteria increased by 7.2% and 2.2% in the traditional and ERAS group, respectively. At the genus level, compared with the preoperative abundance, the postoperative abundance of Bacteroides in the traditional group increased by 17.6% and in the ERAS group decreased by 1.6%; Bifidobacterium decreased by 1.8% and 1.3% in the traditional group and in the ERAS group, respectively.ConclusionsERAS does not affect species diversity of intestinal flora. Although ERAS has some damage to structure of intestinal flora, it is weaker than traditional process, so it is more conducive to reconstruction and restoration of intestinal microecological environment.
Objective To study the construction feasibility of a biodegradable artificial esophagus by the squamous epithelial cells and the myoblast cells seeded on the small intestinal submucosa(SIS) and to investigate the growth patternand angiogenesis of the co-cultured human embryonic squamous epithelial cells and the skeletal myoblasts in vivo. Methods The squamous epithelial cells and the myoblast cells were obtained from the 20-week aborted fetus. Both of their cellswere marked by 5-BrdU in vitro.The isolated cells were then seeded on the SIS and co-cultured in vitro for 24 hours, and then the compound of the cells and the SIS was transplanted into the subcutaneous tissue of the athymismus mice. The observation on the morphology and the cytokeratin AE3 and α-actin specified immunohistochemistry of the squamous epithelial cells and the myoblastcells was performed at each of the following time points: 3 days, 1 week, 2 weeks, and 3 weeks after transplantation. Results The morphological observation indicated that the cultured cells could penetrate into the small intestinal submucosa and form several-layered cell structures, and that the compound of the cells and the SIS could have angiogenesis within 2-3 weeks. The 5-BrdU specified immunohistochemical observation suggested that the cells growing in the small intestinal submucosa scaffold might be the cells transplanted.The cytokeratin AE3 specified and α-actin specified immunohistochemical studies demonstrated that the transplanted cells could differentiate in vivo. Conclusion It is possible to fabricate the framework of a biodegradable artificial esophagus with the epithelial cells and the myoblast cells seeded on the small intestinal submucosa.
Objective To summarize the imaging manifestation and identification of ectopic pancreas (EP), so as to improve clinicians and radiologists’ knowledge of EP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate and avoiding unnecessary surgery. Methods Combined with clinical experience and relevant literatures in recent years, the histopathology, common imaging manifestations and main differential diagnosis of ectopic pancreas were summarized. Results EP is a rare congenital developmental anomaly of pancreas, the most common location is the upper digestive system. At present, the commonly used imaging technology is computed tomography. The imaging findings of ectopic pancreas were similar to those of normal pancreas, and its density and enhancement characteristics were related to its histopathological composition. The specific signs of ectopic pancreas include “central umbilical sign” “ductal structure” and “flat/adherent sign”. Heterotopic pancreas should be differentiated from submucosal tumor of gastrointestinal tract. Conclusions The imaging findings of EP have certain characteristics. For some cases with atypical imaging findings, imaging diagnosis is difficult.
Objective To investigate the changes of gastrointestinal hormone and body composition in patients with gastric cancer after gastrectomy. Methods Thirty-eight patients with gastric cancer were divided into three groups: distal gastrectomy group, proximal gastrectomy group and total gastrectomy group and 9 volunteers as control group. The nutrition status and gastrointestinal function were evaluated by four times. The time of postoperative first anal exsufflation and defacation, hospital stay and complications were recorded, and the pre-meal and the post-meal level of gastrointestinal hormones 1 month after operation were detected. Results Compared with control group, the basic levels of somatostatin (SS), cholecystokinin (CCK) and motilin (MTL) of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group significantly increased (Plt;0.01). The post-meal level of gastrointestinal hormones significantly increased as compared with the pre-meal level in each group (Plt;0.01). The CCK in proximal gastrectomy group was lower than that of distal gastrectomy group and total gastrectomy group (Plt;0.01). The postoperative body weight and body composition in each group decreased. One month after operation, patients of total gastrectomy group got the lowest body weight (Plt;0.01). The decreasing level of fat free mass (FFM) was listed by total gastrectomy group, proximal gastrectomy group and distal gastrectomy group. The edema index had significant difference in distal gastrectomy group, proximal gastrectomy group and total gastrectomy group (Plt;0.01), and total gastrectomy group was the most obvious. The postoperative passing flatus and defecation time and average hospital stay in total gastrectomy group were significantly prolonged (Plt;0.05). The gastrointestinal symptoms score among three groups was significantly different (Plt;0.05). Conclusion There are different changes of gastrointestinal hormone and body composition in patients with gastric cancer after different gastrectomy, the basic levels of SS, CCK and MTL of distal gastrectomy group, proximal gastrectomy group and total gastrectomy group are higher than those of control group. The CCK of proximal gastrectomy group is lower than that of distal gastrectomy group and total gastrectomy group. Patients received total gastrectomy lose much body weight and FFM and get higher edema index.
Objective To detective KRAS and BRAF mutations in gastrointestinal stromal tumors (GISTs) and explore its significance in resistance of imatinib treatment. Methods Three hundred and eighty-one c-kit/PDGFRA mutation samples, 119 c-kit/PDGFRA wild type samples, and 19 pairs of samples before and after imatinib resistance from 519 patients with GIST were enrolled in this study. Polymerase chain reaction was used to detect KRAS exon 2 and BRAF exon 15 mutations. The survival data were evaluated in patients with KRAS or BRAF mutation. Results KRAS mutation was found in 2 cases (1.7%) of c-kit /PDGFRA wild type GISTs, the type of KRAS mutation was G12D and G12C, respectively. BRAFV600E mutation was found in 2 cases (1.7%) of wild type GISTs. No KRAS and BRAF mutations were found in the patients with the c-kit/PDGFRA mutation GISTs and pairs of GISTs before and after imatinib resistance. Two patients with KRAS mutation showed shorter progression free survivals for imatinib treatment. Two patients with BRAF mutation had longer recurrence free survivals. Conclusions Low frequency of KRAS or BRAF mutation only happens in wild type GISTs. KRAS mutation might be related to imatinib primary resistance, but not to secondary resistance.
ObjectiveTo sum up the diagnosis and treatment of adult ileal duplication with clinical cases from Peking Union Medical College Hospital (PUMCH). MethodsSix cases of adult ileal duplication admitted in our hospital from February 1996 to December 2010 were analyzed. Different assistant investigations were supposed to different patients due to the chief complaints including gastroscope, colonoscopy, abdominal CT scan, arteriography, 99Tcm radionuclide imaging, and double-balloon intestinal endoscope. None was made a definite diagnosis before operation with only one uncertain case. All cases received operation and pathological examination. Results All cases admitted were male. The chief complaints included intestinal bleeding, abdominalgia, intestinal obstruction, and abdominal mass. Five out of six patients received gastroscope, colonoscopy, and abdominal CT scan while three received mesenteric arteriography, but none was found any suggestion for ileal duplication. Even 99Tcm radionuclide imaging pointed out only two with abnormal abdominal bleeding. Three received doubleballoon intestinal endoscope, paying attention that only one discovered with ileal duplication. In a concluding, none was made a definite diagnosis before operation with only one uncertain case. All the cases received operation. The duplications of ileum in the length of 6-25 cm were found at the site of 11-100 cm proximal to ileocecum during the operation. Pathological report confirmed the clinical diagnosis of all cases with adult ileal duplications． Two cases were found with ectopic gastric mucosa, another two with diverticulum, and one with ectopic pancreas， in addition the remaining with inflammatory fibrous pseudotumor. Prognosis were good for all after operation. ConclusionsIleal duplications are rarely seen in adults, gender prefer male． Without specific clinical symptoms and inspections, definite diagnosis before operation is hard to make. But maybe doubleballoon intestinal endoscope and 99Tcm radionuclide imaging can give out positive result. Surgeons should be aware of this condition when performing abdominal exploration. Once discovered, resection is necessary.
Objective To review the relationship between histone modifications and gastrointestinal cancer. Methods Literatures on histone modifications and the relationship between histone modifications and gastrointestinal cancer were collected and reviewed. Results Histone modifications played an important role in the establishment of gene silencing during tumorgenesis. DNA methylation and histone modifications might interact with each other and form a complex network to establish and maintain gene silencing. Restoring gene function silenced by epigenetic changes in cancer had the potential of ‘normalizing’ cancer cells, which was named epigenetic therapy. Epigenetic therapy was very promising in prevention and treatment of gastrointestinal cancer, but many unsolved issues remain which need to be addressed in future studies. Conclusion Histone modifications are associated with the pathogenesis of gastrointestinal cancer. Restoring gene function silenced by epigenetic changes may have a great role in the prevention and treatment of gastrointestinal cancer.
摘要:目的:探讨老年人梗阻性大肠癌的围手术期处理。方法:回顾性分析2003年至2008年间71例60岁以上老年人梗阻性大肠癌的围手术期处理情况。 结果:术前发现并存病者43例,术中出现并发症19例,术后发生并发症37例得,除5例死亡外,均得到有效控制,死亡原因与并存疾病有关。结论:加强围手术期处理,积极治疗并存疾病,老年人梗阻性大肠癌的治疗同样能取得满意的效果。Abstract: Objective:To study the perioperative measures for the aged patients with Obstructive Colorectal Cancer. Methods: Seventyone cases above 60 years with Obstructive Colorectal Cancer were analysed retrospectively on their individual accompanied diseases and perioperative treatments, from 2003 to 2008.Results: Fortythree cases of them had suffered from other diseases. Midoperative complications occurred in 19 cases. Postoperative complications occurred in 37 cases. Except 5 cases of death, complications occurring in others cases were well controlled. The death causes mainly were correlated with accompanied chronic diseases. Conclusion: Strengthen care, active management of other chronic diseases are important significantly for senile patients with colorectal carcinoma to get satisfied outcome.
ObjectiveTo review the association of gut microbiota and postoperative gastrointestinal dysfunction (GID) in patients after abdominal surgery and to provide a new idea for the pathogenesis, prevention, and treatment of postoperative GID in patients after abdominal surgery.MethodThe related and latest literatures were reviewed by searching the literatures on “intestinal flora” “gut microbiota” “intestinal microbial population” “brain-gut axis” “gastrointestinal function” “gastric paralysis” “intestinal paralysis” and “ileus” from January 1, 2000 to April 2, 2021 in Chinese and English databases.ResultsGut microbiota diversity was closely related to postoperative GID symptoms in patients after abdominal surgery. Gut microbiota regulated gastrointestinal motility and mucosal barrier function by metabolizing food to produce metabolites such as 5-hydroxytryptamine, melatonin, short-chain fatty acid, succinic acid, lactic acid, and so on.ConclusionsThe imbalance of gut microbiota is closely related to postoperative GID in patients after abdominal surgery. However, the relevant bacterial metabolites that have been found are limited at present, and the relevant mechanism needs to be further investigated.
The 2024 American Society of Clinical Oncology Gastrointestinal Cancers Symposium (ASCO-GI) was held in San Francisco, the USA from January 18th to 20th, 2024 (local time). The multiple studies presented in this symposium will have a significant impact on the clinical practice of esophageal cancer. This article will focus on the surgical methods of esophageal cancer, perioperative immunotherapy, drug therapy for advanced esophageal cancer, rescue treatment after immunotherapy resistance, and other relevant aspects. It aims to summarize and interpret the significant advancements in the field of esophageal cancer presented in this symposium.