Abstract:Abstract:Objective:To observe the distribution of sentinel nodes(SN) in gastric cancer, and investigate their clinical significance. Methods:The extent and features of intraoperatively stained sentinel nodes in 288 cases of gastric cancer were analyzed retrospectively. Methylene blue was injected intraoperatively into the subseral muscle and submucosa of the normal gastric wall adjacent to the neoplasms,then lymphadenography was performed,and the nodes were resected for histopathological examination. Results:The pathological diagnosis of the 288 cases with gastric cancer was T1 in 102 cases,T2 106 cases and T3 60 cases. Stained nodes were detectable in 270 cases(success rate: 93.8%). One hundred and two cases were found to have lymph node metastasis; 66 cases had metastasis in both SNs and non-SNs; 18 cases in SNs alone; and 18 cases in non-SNs alone. Conclusions:Sentinel lymph nodes can accurately predict the lymph node metastatic status of gastric cancer patients during operation. Intraoperative sentinal lymph node mapping can avoid routine lymph node dissection in patients with gastric cancer with negative lymph node metastasis.

Abstract:Abstract:Objective:To analyze the quality of life(QOL) of gastric cancer patients who underwent different types of gastrectomy and digestive tract reconstruction procedures. Methods:Among the patients who underwent gastrectomy in our department over a period of 4 years, 61 cases that survived for more than 2 years were analyzed for QOL using 14 parameters. The 61 cases included 13 cases of proximal subtotal gastrectomy and esophagogastrostomy, 18 cases of total gastrectomy and jejunal P pouch reconstruction, and 30 cases of total gastrectomy and double Braun type of jejunal reconstruction. Pouch emptying function in 12 patients with different types of reconstruction was determined in by Isotope 99mTC scintigraphy.Results:At 6 months after operation, the parameters showed no significant differences between the 3 groups. At 12 months after operation, the QOL of patients with double Braun-type reconstruction was superior to that of patients with P jejunal pouch and patients with esophagogastrostomy in intake time(P<0.05), intake frequency(P<0.05) and body weight gain(P<0.05). At 24 months after operation, the double Braun-type reconstruction group was superior to the other two reconstruction groups in body weight gain(P<0.05); and retention time of food after the double Braun reconstruction was longer than that after the other two types of reconstruction(P=0.001,P=0.002,respectively).Conclusions:Patients undergoing total gastrectomy and double Braun reconstruction have a better postoperative QOL in the short term as compared to that of jejunal P pouch reconstruction and esophagogastrostomy. The double Braun reconstruction provides excellent food storage function.

Abstract:Abstract:Objective:To investigate the expression of vascular endothelial growth factor-C(VEGF-C) and matrix metalloproteinase-7(MMP-7) in gastric carcinoma and their correlation with tumor invasion and metastasis. Methods:Streptavidin peroxidase immunohistochemistry technique(SP)was used to detect the expression of VEGF-C and MMP-7 in 60 gastric carcinoma specimens, 60 specimens of gastric mucosa adjacent to carcinoma, and 30 regional lymph node specimens. Results:The positive expression rate of VEGF-C,MMP-7 in gastric carcinoma was markedly higher than that in normal gastric mucosa and gastric mucosa adjacent to carcinoma . The positive expression rates of VEGF-C and MMP-7 in metastatic regional lymph nodes were significantly higher than that in non-metastatic regional lymph nodes(P<0.01).The positive expression of VEGF-C and MMP-7 in gastric carcinoma specmens in patients with lymphatic metastasis was significantly higher than that in without lymphatic metastasis(P<0.05).The positive expression level of VEGF-C and MMP-7 was significantly correlated with lymph node metastasis,lymphatic vessel invasion, tumor infiltration depth and UICC TNM staging(P<0.05). Conclusions:The increased expression of VEGF-C and MMP-7 in gastric carcinoma closely correlates with tumor invasion and metastasis.

Abstract:Abstract:Objective:To study the activation effects to cytotoxic T lymphocytes by gastric cancer cell-dendritic cell(DC) fusion vaccines and to provide theoretical data for biological therapy of gastric cancer based on anti-tumor fusion vaccines. Methods:(1)Peripheral blood mononuclear cells from gastric cancer patients were separated and co-cultured with granulocyte macrophage colony stimulating factors, interleukin-4 and tumor necrosis factor-α to generate mature dendritic cells. (2)The dendritic cells and SGC7901 cells were fusioned by use of polyethylene glycol, and the pure fusion cells were screened out and cultured with HAT and HT selective culture systems. (3)The ability of fusion cells to activate the cytotoxic T lymphocytes was investigated by using MLA method. Results:(1)Mature dendritic cells were gained from gastric cancer patients′ peripheral blood mononuclear cells by co-culturing with granulocyte-macrophage colony stimulating factors, interleukin-4 and tumor necrosis factor-α. (2)Dendritic cells and SGC7901 cells could be fusioned by PEG and could get pure fusion cells by culture with HAT/HT selective culture systems. (3)The fusion vaccines could strongly activate cytotoxic T lymphocytes, and there were significent differences between the fusion vaccine group and the control group. (P<0.01). Conclusions:Gastric cancer cell-dendritic cell fusion vaccine has stronger ability to stimulate the proliferation of T lymphocytes than that of parent dendritic cells, and may be a basis for induction of stronger anti-tunmor biological effects.

Abstract:Abstract:Objective:To study the significance of polo like kinase1(plk1) mRNA and protein expression in gastric cancer tissues and the relationship between the plk1mRNA and protein expression level in gastric cancer tissues and the clinicopathological parameters. Methods:Plk1mRNA and protein level were respectively measured by real-time PCR and Western blot in fresh tumor tissues and the normal gistric mucosa from 60 patients with gastric cancer. Results:plk1mRNA and protein expression level in gastric cancer tissues was significantly higher than that in normal gastric tissues(P<0.05, P<0.01). plk1mRNA expression level in gastric cancer tissues was closely related to degree of tumor differentiation and depth of invasion(P<0.05), and plk1 protein level was closely related to tumor differentiation (P<0.05). Conclusions:The overexpression of plk1 may promote carcinogenesis and the development of gastric cancer, and plk1 can be a novel marker for determing certain biological behaviours of gastric cancer.

Abstract:Abstract:Objective:To study the effects of L-NAME on invasion and metastasis of human colorectal carcinoma cell line（LS-174T） and explore its possible mechanism. Methods:The LS-174T cells were co-incubated with L-NAME at various concertrations. Griess techniqe was used to examine the effect of L-NAME on excretion of nitric oxide(NO) of the cells. The effects of L-NAME on invasion and migration of LS-174T were evaluated using Transwell chambers attached with polycarbonate filters and reconstituted basement membrane. Expression of MMP2 mRNA and TIMP2mRNA in LS-174T cells was measured by RT-PCR. Results:(1)L-NAME decreased the excretion of NO of the cells in a dose-dependent manner. (2)The ability of the L-NAME treated LS-174T cells to invade the reconstituted basement membrane increased significantly with the concentration and time, at the concentration of 0.2 mmol/L,0.4 mmol/L, 0.8mmol/L and 1.0mmol/L, respectively,after 72 hour, the inhibition rates were 10.29%,19.62%,34.08% and 42.23%,respetively. （ P<0.05, P<0.01, P<0.01, P<0.01,respectively）. (3)L-NAME can also inhibit LS-174T cells migration ,and the inhibition rates were 20.76%,24.95%,39.43% and 46.85% in L-NAME at 0.2 mmol/L,0.4 mmol/L,0.8mmol/L and 1.0mmol/L, respectively（ P<0.01）. (4)NO concontration was positive related to expression of MMP2mRNA, and negative related to expression of TIMP2mRNA.Conclusions:L-NAME has anti-invasive and anti-metastatic effects on LS-174T cells, and the anti-invasive and anti-metastatic action of L-NAME might be associated with expression of MMP2mRNA,TIMP2mRNA in tumor cells.

Abstract:Abstract:Objective:To evaluate the effect and mechanism of non-steroidal anti-flammatory drags(NSAIDs) on the colon cancer cell growth by using S-nitrosoglutathione(GSNO) which can produce nitric oxide. Methods:Apoptosis of 3 colon cell lines were evaluated by cell growth curve and flow cytometry, the PGE2 levels in cell culture supernatants were determined by competitive enzyme immunoassay method, and the protein expression of COX-1 and COX-2 were analyzed by Western blot. Results:The production level of PGE2 was increased with CSNO treated concentration and time. Using 500μmol/L CSNO treatment for 48h, the expression level of COX-1 and COX-2 protein increased. NASIDs can block the production of PGE2 but had no effect on the inhibition of cell growth induced by GSNO.Conclusions:GSNO can increase PGE2 production and induce COX-1 and COX-2 protein expression in a dose-and time-dependent manner. Higher concentrations of GSNO also can inhibite cell growth and induced apoptosis in all 3 cell lines. NSAIDs can block production of PEG2 but NSAIDs are no effect on cell growth.

Abstract:Abstract:Objective:To study the function of hepatocyte growth factor/scatter factor(HGF/SF) in the proliferation of colorectal cancer cells. Methods:The expression of c-met,the receptor of HGF, was detected in Caco-2 and Colo320 cell lines by Western blot. The activation of p42/p44MAPK and p38MAPK induced by HGF in these two cell lines was observed. Observation of the effect of the inhibitor of p42/p44MAPK(PD98059), p38MAPK(SB203580) on the inhibition of HGF-induced proliferation of Caco-2 and Colo320 cells were made by Using ［3H］-TdR, MTT assay. Results:（1）Both cell lines expressed the c-met.（2）HGF activated p42/p44MAPK and p38MAPK, and 20ng/ml HGF treated cells showed maximum activity in both to be within 10min.（p42/p44MAPK,2.28±0.01;p38MAPK, 2.25±0.01）. （3）HGF was found to significantly increase ［3H］ thymidine incorporation(P<0.01) , when cells were pretreated with inhibitors of p42/p44MAPK (PD98059) in different doses(1μmol/L，5μmol/L，10μmol/L) ,HGF-induced thymidine uptake was suppressed in a dose-dependent manner(P<0.01). （4）MTT assay found HGF enhanced the proliferation of Caco-2 ,however, PD98059 inhibited this proliferation.Conclusions:The results demonstrate that HGF activates MAPK in both colorectal carcinoma cell lines, and p42/p44MAPK take part in the mitosis of the Caco-2 cells, while HGF promotes the proliferation of Caco-2 cells. The function of HGF/SF and p42/p44MAPK in colorectal cancer cells may have cellular selection.

Abstract:Abstract:Objective:To measure circulating vascular endothelial growth factor-C (VEGF-C) levels in patients with colorectal carcinoma, and assess the clinical significance in diagnosis of lymph node metastasis. Methods:Sixty-six patients with colorectal carcinoma and 30 healthy control patients were included in this study. Circulating VEGF-C and VEGF levels were assessed by enzyme-linked immunosorbent assay.Results:Serum VEGF-C and VEGF concentration was higher in patients with colorectal carcinoma than in healthy control patients(P<0.01). Patients with lymph node metastasis revealed higher serum VEGF-C and VEGF concentrations than those without hymph node metastasis(P<0.01). The level of VEGF-C and VEGF in lymphatic vessel invasion and venous invasion was higher in the group with invasion than in the group without invasion(P<0.01). Serum VEGF-C levels reached a sensitivity of 81.0% and a specificity of 76.0% with a cutoff value of 1438.0 pg/mL, whereas VEGF levels reached 72.0% sensitivity and 74.0% specificity at 240.2 pg/mL. With combined determination of VEGF-C and VEGF levels, the positive predictive value was 84.6%, the negative predictive value was 94.6%, and accuracy was 93.7%. Conclusions:Circulating VEGF-C levels may provide additional information for distinguishing between the absence or presence of lymph node metastasis in patients with colorectal carcinoma.VEGF-C can become a new target spot in the treatment of lymphatic metastasis in patients with colorectal cancer.

Abstract:Abstract:Objective:To investigate the significance of the mutation of c-kit gene in the development, clinical pathology and prognosis of gastrointestinal stromal tumors(GISTs).Methods:The technique of PCR-SSCP was used to detect c-kit gene mutation in 106 cases of GIST, and 57 of the cases were followed-up. Results:The c-kit gene mutation rate in the whole group was 45.3%(48/106), and 3.4%(2/41) in benign GIST, and 70.8%(46/65) in malignant GIST. The 1-,3 and 5-year survival rates and median survival time of the mutation positive group were all markedlly lower than those of the mutation negative group. A comparison of the parameters that can differentiate the benign GISTs from malignant ones such as size,histological necrosis,aggressive grade,nucleus mitotic count and nuclear discrepancy, showed significant difference between the of postive and negative gene mutation(P<0.005), and the occurrence rates of tumor invasion into neighboring structures, metastasis and recurrence in mutation positive group were all obviously higher than those in mutation negative group.Conclusions:Mutation of c-kit can play an important role in the occurrence and development of GIST, and it may be an important marker to predict the clinical prognosis of GIST patients.

Abstract:Abstract:Objective:To establish a simple and stable model of orthotopic small intestinal transplantation (OIT) in rats. Methods:The harvested en bloc segmental intestine consisted of donor abdominal aorta with superior mesenteric artery and portal vein. After in situ infusion with lactated Ringer′s solution , the graft was stored in 4℃ lactated Ringer′s solution. The segmental intestine transplantation was performed by end-to-side anastomosis of donor abdominal aorta to recipient abdominal aorta . The donor portal vein was anastomosed to the recipient left renal vein by "cuff anastomosis". The graft was anastomosed orthotopically by continuous sutures. Results:Sixteen intestine transplantations were, performed the average time for the arterial and venous anastomosis was 25±5 min and 4±1 min,respectively. Among the 16 recipient rats, 13 survived more than 5 days. The average survival time was 10.35±2.84 days; the longest survival time was 21 days. Conclusions:Graft harvesting, the technique of vascular and intestinal anastomosis and the maintenance of adequate blood volume are the key points for success of the operation. This successfully established model can serve as an excellent animal model for basic research of small intestinal trasplantation.

Abstract:Abstract:Objective:To investigate the rational method of treatment of rectal carcinoid and its outcome. Methods:The clinical data of 36 cases of rectal carcinoid were retrospectively analysed. Results:During a follow-up of 82.6+/-63.4 months, there were no cases with recurrence among the 20 patients with tumor size<1cm, 3 cases with recurrence in the 9 patients with tumor size between 1 to 2 cm, and there were 3 cases who died from liver metastasis among the 7 patients with tumor size>2cm .Conclusions:Tumor diametar can be used to estimate the degree of malignancy of rectal carcinoid. TNM staging is simpler and practical for deciding the method of surgical treatment.

Abstract:Abstract:Objective:To discuss the causes, the methods of intraoperative prevention and treatment of local recurrence in patients after operation for rectal carcinoma. Methods:Fifty-two re-operated patients with local recurrence of rectal carcinoma were analyzed retrospectively. Results:In these 52 patients , there were 14 patients with perianus and pelvic cavity recurrence, 31 patients with stoma recurrence, 4patients with vaginal wall recurrence , 2 patients with prostate gland recurrence and 1 patient with implantation in the incision of abdominal wall . Among them, 36 patients underwent radical operation, 13 patients had palliative resection and 3 patients were treated by enterostomy. The median survival time for the groups who underwent radical operation and palliative resection was 33.5(12~80) months and 12(3~23) months respectively. Conclusions:Patients with local recurrence of rectal cancer should still be given aggressive operative treatment. Radical resection of the lesions and formal radical lymphadenectomy can prolong patient survival time and improve quality of life.

Abstract:Abstract:Objective:To investigate the early diagnosis and treatment of duodenal papilla carcinoma. Methods:The clinical data of 71 patients with duodenal papilla carcinoma were analyzed retrospectively. Results:Painless jaundice (57 cases), discomfort of upper abdomen (10 cases) and hemorrhage of upper digestive tract (4 cases) were the initial main clinical symptoms. The correct diagnostic rate for preoperative examinations were: ERCP in 100%, duodenoendoscopy in 96.8%, MRCP in 83.3%, BUS in 85.9% and CT in 72.3% of cases. Forty-six cases underwent pancreatoduodenectomy, 22 cases received local resection, and the remaining 3 cases were treated by palliative surgery. The 3-year survival rate of Whipple operation and local resection was 43.9% and 44.4% respectively, and the 5-year survival rate was 31.7% and 33.3% respectively. Conclusions:Duodenoendoscopy, ERCP and MRCP are the major effective diagnostic methods for duodenal papilla carcinoma. Early diagnosis and early selection of rational radical operation are essential for successul treatment of this condition.

Abstract:Abstract:Objective:To study the clinical manifestations, diagnosis ,treatment and prognosis of gastrointestinal stromal tumors(GISTs). Methods:Clinical and pathological data of 31 cases of GISTs admitted from 1995 to 2005 were retrospectively studied. Results:Using Fletcher′s classification ,tumors were divided in very low risk(3/31,9.68%), low risk (5/31,16.13%), intermediate risk (15/31,48.39%), and high risk (8/31,25.81%).The positive expression rate of CD117,CD34,desmin,SMA and S-100 protein was 94%, 87%, 39%,35% 26%,respectively. There was no significant difference in the expression of CD117,CD34,desnin, SMA and S-100 protein among all the different risk groups (χ2=0.35,0.12,0.03,0.05,0.01,P>0.05).The infiltration of tumor to the muscularis mucosa or serosa layers was significantly correlated with the risk of GISTs(χ2=4.87,P<0.05).Conclusions:Fletcher′s classification is scientific and rational for assessment of the stage of GISTs. Recurrence rate of intermediate risk and high risk cases was 26.0% which was much higher than that of very low risk and low risk case(P<0.001). Complete surgical excision of the GISTs is the best choice for cure. The infiltration of tumor to the muscularis mucosa or serosa layers is an important indicator of the risk of GISTs. Mitotic rate is an independent factor that may predict the prognosis of GISTs.