Abstract:Background and Aims: Laparoscopic colectomy has been widely used in the radical operation for colon cancer, and selecting an appropriate surgical approach is essential for the surgical efficacy. Due to the complex of the vascular structures around the right colonic area, the degree of surgical difficulty of right hemicolectomy is relatively high, so the surgical approach should be selected cautiously. This study was conducted to compare the clinical efficacy of using caudal-to-cranial approach and medial approach the ideal surgical approach in laparoscopic colectomy, so as to determine an ideal surgical approach for this procedure.  
Methods: A total of 136 patients with right colon cancer admitted from May 2016 to May 2019 were enrolled. The patients were randomly assigned to two groups, with 68 cases in each group. Patients in one group underwent laparoscopic right hemicolectomy via caudal-to-cranial approach (caudal-to-cranial approach group), and those in the other group underwent laparoscopic right hemicolectomy via medial approach (medial approach group). The main clinical variables and postoperative survival rates between the two groups of patients were compared. 
Results: There were no differences in baseline data between the two groups of patients (all P>0.05). In caudal-to-cranial approach group, the average operative time (123.52 min vs. 168.64 min), average intraoperative blood loss (12.46 mL vs. 24.28 mL) and conversion rate (2.94% vs. 11.76%) were significantly superior to those in medial approach group (all P<0.05). There were no significant differences in time to gas passage, defecation and food intake as well as the drainage volume, drainage time, and length of hospital stay between the two groups (all P>0.05). The incidence rates of incision infection, pulmonary inflammation, anastomotic leakage and intestinal obstruction as well as the overall incidence of postoperative complications (23.53% vs.35.29%) in caudal-to-cranial approach group were significantly lower than those in medial approach group (all P<0.05). There was no significant difference in the number of lymph node dissection and postoperative TNM stage between the two groups (both P>0.05). The 2-year survival rate of caudal-to-cranial approach group was significantly higher than that of medial approach group (82.35% vs. 52.94%, P<0.05). 
Conclusion: Using caudal-to-cranial approach for laparoscopic right hemicolectomy has the advantages of being safe minimally invasive, simple and easily operable, which can ensure the adequate vision of the surgical field and the accurate anatomical positioning. Its short- and long-term efficacy are superior to those of using medial approach for laparoscopic right hemicolectomy.

Abstract:Background and Aims: With the deepening of the understanding of key anatomical markers, surgical level and the concept of complete mesocolectomy, laparoscopic right hemicolectomy is becoming increasingly mature, and the scope of lymph node dissection and digestive tract reconstruction are gradually standardized. The selection of appropriate surgical approach is also of great significance for standardizing the scope of lymph node dissection, finding the correct anatomical plane and reducing intraoperative complications. This study was performed to evaluate the feasibility and safety of laparoscopic right radical hemicolectomy for colon cancer using combined craniolateral and caudolateral approach, so as to further improve the efficacy and success rates of this operation. 
Methods: The clinical data of 120 patients undergoing laparoscopic right radical hemicolectomy for right colon cancer in the Chenzhou First People’s Hospital from November 2014 to November 2018 were retrospectively analyzed. Of the patients, 68 cases underwent operation via combined craniolateral and caudolateral approach (observation group), and 52 cases underwent operation via the traditional medial approach (control group). The main clinical variables between the two groups of patients were compared.
Results: There were no significant differences in the baseline data between the two groups of patients (all P>0.05). In observation group versus control group, the average operative time was significantly shortened (110.9 min vs. 150.9 min, P<0.05) and the average intraoperative blood loss was significantly reduced (25.5 mL vs. 50.8 mL, P<0.05), but no significant differences were  noted in the total number of lymph node dissection, quality of surgical specimens, time to the first postoperative gas passage, length of postoperative hospital stay and incidence of complications (all P>0.05). Further subgroup analysis showed that either in patients with obesity or patients with tumor of hepatic flexure of the colon, observation group was superiority to control group not only in operative time and intraoperative blood loss, but also in the time to first postoperative gas passage (all P<0.05).
Conclusion: Laparoscopic radical resection of right colon cancer through combined craniolateral and caudolateral approach is safe and feasible. With the widespread use of laparoscopic equipment and continuous improvement of instruments, the popularization of laparoscopic technology and the accumulation of surgical experience, it can be further promoted to be used in clinical practice.

Abstract:Background and Aims: In recent years, the problem of colorectal cancer liver metastases (CRLM) has raised great concerned in the academic community, and a growing body of relevant research literature has emerged. This study was conducted to investigate the distribution patterns of literature and research hotspots on CRLM worldwide over the past nearly 20 years, so as to provide insights into the future research directions in this field. 
Methods: All relevant documents in the field of CRLM from 2000 to 2019 were searched from the Web of Science core collection database. The search fields that included the number annually published articles, country, journal and keywords were extracted by using bibliometric tool Bibexcel software, chart drawing and knowledge mapping were conducted by Excel and Pajek, respectively, the co-occurrence and cluster analyses of individual authors, institutions, national cooperative networks and high-frequency keywords were performed by VOSviewer software.
Results: A total of 7 965 articles related to CRLM were retrieved, and each year number of published papers after 2007 exceeded 400, which were mainly from the United States, Japan and China, containing 1 728, 1 108 and 1 078, respectively. From the perspective of fund distribution, the majority of high-yielding articles were from studies financed by funds of national level. Journals mainly concentrated on high-quality oncology journals such as JOURNAL OF CLINICAL ONCOLOGY and ANNALS OF ONCOLOGY. Twelve authors from the United States and 5 authors from France had an H index of 20 or above. In cluster analysis, 53 high-frequency keywords were clustered into 5 categories, which were successively surgery and chemotherapy, prognostic factors, auxiliary diagnosis, chemotherapy drugs and metastatic cancer. 
Conclusion: Over the past nearly 20 years, international CRLM research activities and cooperation increased continuously, but there are still large disparities among countries. Overall, the bibliometrics study identified three hotspots of CRLM: surgery and prognosis, chemotherapy, and adjuvant diagnosis. Therefore, further research on these topics may be helpful for promoting the clinical transformation of the treatment strategy, and making the management of CRLM and personalized prevention and treatment more accurate and effective in the future.

Abstract:Background and Aims: There is a close relationship between lymph node metastasis and the prognosis of the gastric cancer patients, and the presence or absence, as well as the degree of lymph node metastasis are crucial for treatment decision making of the patients. However, there are still many challenges in preoperative evaluation of the lymph node metastasis. The purpose of this study is to investigate the relevant risk factors for lymph node metastasis in gastric cancer patients, so as to provide certain way criteria for predicting lymph node metastasis before operation. 
Methods: The clinical and follow-up data of 380 patients with gastric cancer treated during January 2014 to April 2015 were reviewed. The relationship between lymph node metastasis and the relevant clinicopathologic factors of the patients were analyzed, in which, the risk factors for lymph node metastasis of gastric cancer were determined. Further, the efficiencies of the risk factors for predicting lymph node metastasis in gastric cancer were assessed by ROC curve, and the impacts of the risk factors on the prognosis of the patients were analyzed by Kaplan-Meier method.
Results: Of the 380 patients, lymph node metastasis occurred in 241 cases (63.42%). The results of univariate analysis showed that BMI, depth of tumor invasion, degree of differentiation, Lauren’s classification, tumor diameter and tumor marker CA125 were significantly associated with the metastasis of lymph node in gastric cancer (all P<0.05); the results of multivariate analysis revealed that BMI (OR=4.175, P=0.041) and the depth of tumor invasion (OR=16.444, P<0.000 1) were independent risks for lymph node metastasis; the results of correlation analysis demonstrated that there was a significant positive correlation between the positive rate of lymph node metastasis and BMI value (r=1.95, P=0.007). BMI (using 24 kg/m2 as a cut-off value) and depth of tumor invasion (using T4 stage as a threshold) had a same sensitivity of 63.16% and a specificity of 76.84% and 53.68% respectively for predicting the presence or absence of lymph node metastasis in gastric cancer; the specificity of their combined use was increased to 88.36%, and the area under the ROC curve reached 75.76%. The results survival analysis showed that the 3-year overall survival rate in patients with high BMI value was significantly lower than that in patients with low BMI value (51.09% vs. 53.13%, P<0.05). 
Conclusion: BMI and depth of tumor invasion are independent risk factors for lymph node metastasis in gastric cancer. Patients with high BMI value may face an increased risk of lymph node metastasis in gastric cancer. The combined consideration of BMI and depth of tumor invasion may have certain practical value in predicting lymph node metastasis before operation.

Abstract:Background and Aims: Long non-coding RNA (lncRNA) MLK7-AS1 is a newly identified lncRNA that is closely related to the occurrence and development of various tumors. However, the expression and function of lncRNA MLK7-AS1 in colon cancer have not been reported yet. Therefore, this study was conducted to investigate the expression of lncRNA MLK7-AS1 in colon cancer and its effects on the biological behaviors of the colon cancer cells. 
Methods: The lncRNA MLK7-AS1 expressions in the surgical specimens of 21 paired colon cancer tissue and corresponding adjacent normal tissue, as well as in different colon cancer cell lines (SW480, HCT116, SW620, DLD1, HT29 and LOVO) and normal colon epithelial cell line (NCM460) were detected by qRT-PCR. In colon cancer cells after transfection with lncRNA MLK7-AS1 overexpression plasmid, the changes in cell viability, colony forming capacity, cell cycle and the expressions of cell cycle-associated proteins were determined by MTS assay, plate cloning assay, flow cytometry and Western blot assays as well as qRT-PCR, respectively.
Results: The expression levels of lncRNA MLK7-AS1 in colon cancer tissue was significantly higher than that in normal adjacent tissue, and in all studied colon cancer cell lines were significantly higher than that in the normal colonic epithelial cells (all P<0.05). In both SW480 and HCT116 cells that had relatively low lncRNA MLK7-AS1 expressions after transfection with lncRNA MLK7-AS1 overexpression plasmid, the cell viabilities and colony forming capacities were significantly enhanced (both P<0.05); the proportion of cells in G1 phase were significantly decreased and the proportion of cells in S phase were significantly increased (all P<0.05); the expression levels of cyclin D1 and CDK6 were significantly up-regulated (all P<0.05).
Conclusion: LncRNA MLK7-AS1 is highly expressed in colon cancer, which can promote the proliferation and colony formation of colon cancer cells, and the mechanism is probably related to its regulating the cell cycle-associated proteins cyclinD1 and CDK6 expressions.

Abstract:Background and Aims: The FOXP transcription factor family has been shown to play an important role in multiple cancer types. However, the function of its member FOXP4 in colorectal cancer has not reported yet. This study was conducted to investigate the FOXP4 expression in colorectal cancer and its relationship with clinicopathologic characteristics and prognosis of the patients, as well as its potential mechanism of action. 
Methods: The FOXP4 expressions in the specimens of tumor tissue and tumor adjacent tissue from 50 colorectal cancer patients were determined by immunohistochemical staining and RT-PCR, respectively. Based on the GEIPA database, the FOXP4 expression in colorectal cancer tissues and its relationship with the survival rates of the patients were analyzed. The colorectal cell lines with stable FOXP4 overexpression or knockdown were created, and then, the changes in proliferative and migration abilities of them were examined by CCK8 and Transwell assay. The possible target promoter for FOXP4 was predicted by using AnimalTFDB 3.0 database, the combining ability of FOXP4 to its target promoter and the regulatory effect of FOXP4 on the corresponding target gene were verified by ChIP assay, luciferase reporter assay, RT-PCR and Western blot analysis, respectively. Finally, the function of the target gen was validated.
Results: The results of both analyses of the clinical specimens and GEIPA database showed that the FOXP4 expression in colorectal cancer tissue was significantly elevated, and its expression level was significantly associated with the tumor size, degree of tumor differentiation and TNM stage of the patients, and those with high FOXP4 expression had a significant low overall survival rate (all P<0.05). The results of the CCK8 and Transwell assay showed that the proliferative and migration abilities in colorectal cancer cells with FOXP4 overexpression were significantly increased, while in those with low FOXP4 expression were significantly decreased (all P<0.05). The analysis of AnimalTFDB 3.0 database showed that β-catenin promoter was the target promoter for FOXP4; ChIP assay revealed that FOXP4 recognized the β-catenin promoter region; luciferase reporter assay found that FOXP4 only recognized the wild-type β-catenin sequence; RT-PCR and Western blot analysis demonstrated that FOXP4 overexpression up-regulated both gene and protein expression levels of β-catenin. In colorectal cancer cells after treatment with β-catenin inhibitor, the enhancing effects of FOXP4 overexpression on proliferative and migration abilities were abolished (all P<0.05).
Conclusion: The FOXP4 expression is increased in colorectal cancer, which is closely related to the malignant clinicopathologic features and unfavorable prognosis of the patients. FOXP4 overexpression can promote the proliferation and migration of colorectal cancer cells probably by regulating the transcription of β-catenin. So, this study suggests that FOXP4 play a critical role in the occurrence and development colorectal cancer, and may be served as a potential therapeutic target for colorectal cancer.

Abstract:Background and Aims: The epithelial mesenchymal transition (EMT) is an important mechanism for cancer progression and metastasis, and the recent studies have shown that paired related homeobox 1 (PRRX1) is a critical transcription factor of promoting EMT. The previous studies of the authors demonstrated that the PRRX1 expression is increased in gastric cancer, which is closely related to the poor prognosis of patients. This study was conducted to further investigate the relations of PRRX1 promoting proliferation and metastasis of gastric cancer cells with the EMT and associates signaling pathway, so as to provide approaches for prevention and treatment of the recurrence and metastasis of gastric cancer. 
Methods: The PRRX1 expressions in normal human gastric mucosal GES-1 cells, and gastric cancer SGC 7901 and MNK45 cells were detected by Western blot analysis. The MNK45 cells were infected with PRRX1 overexpression lentivirus (PRRX1 overexpression group) or empty lentivirus (negative control group), with the untreated MNK45 cells as blank control, and then, the migration ability of the cells was detected by Transwell assay, and the expressions of PRRX1, TGF-β1, Smad2 and EMT markers, as well as the changes in these protein expressions after intervention of the TGF-β/Smad2 pathway inhibitor SB-431542 were determined by Western blot analysis. Eight nude mice were randomized into two groups, and then subcutaneously transplanted with PRRX1 overexpression lentivirus infected MNK45 cells (PRRX1 overexpression group) or empty lentivirus infected MNK45 cells (negative control group), and then, the growth properties of the tumor xenografts in the two groups of mice were observed.
Results: The PRRX1 expression in either gastric cancer SGC7901 or MNK45 cells was significantly higher than that in normal gastric mucosal GES-1 cells, and in SGC7901 cells was higher than that in MNK45 cells (all P<0.05). Compared with blank control group, the migration ability was significantly enhanced, the protein expressions of PRRX1, TGF-β1, Smad2 and the mesenchymal marker vimentin were significantly increased, while the expression of epithelial marker E-cadherin was significantly decreased in PRRX1 overexpression group (all P<0.05); no significant changes in expressions of above proteins were noted in negative control group (all P>0.05). In MNK45 cells of the PRRX1 overexpression group after SB-431542 treatment, the expressions of PRRX1 and TGF-β1 were unaffected (both P>0.05), but the increasing in Smad2 and vimentin expressions and the decreasing in E-cadherin expression were significantly suppressed (all P<0.05). Both volume growth rate and weight of tumor xenograft in nude mice of PRRX1 overexpression group were greater than those of negative control group (all P<0.05).
Conclusion: Overexpression of PRRX1 can promote the growth and metastasis of gastric cells, and the mechanism may be probably associated with its inducing the activation of TGF-β/Smad2 pathway and thereby promoting the EMT process. The interventions on PRRX1 overexpression and TGF-β/Smad2 pathway may be new approaches for prevention and treatment of the recurrence and metastasis of gastric cancer.

Abstract:Background and Aims: The family of coiled-coil domain-containing (CCDC) protein is of great biological significance, and its member CCDC34 is found to be overexpressed in various cancers and involved in tumor angiogenesis. However, its expression and function in gastrointestinal stromal tumors (GIST) have not been reported yet. This study was conducted to examine the CCDC34 expression and its relationship with angiogenesis in GIST. 
Methods: The CCDC34 expressions and the microvascular density (MVD) counts (labeled with CD34) in 84 specimens of GIST tissues and 30 specimens of normal gastrointestinal mucosal tissue were detected by immunohistochemical staining. The relationship between CCDC34 expression and clinicopathologic features of GIST patients as well as the MVD count were analyzed. Human GIST cells were transfected with CCDC34 overexpression vectors or CCDC34 interference vectors to establish CCDC34 overexpression and CCDC34 interference GIST882 cells through lentiviral transfection technique. Sixty nude mice were equally randomized into 3 groups, and were subcutaneously injected with untreated GIST882 cells (model group), CCDC34 overexpression GIST882 cells (overexpression group) and CCDC34 interference GIST882 cells (interference group) to create the tumor xenograft models. All nude mice were sacrificed 3 week later, the MVD counts and the protein expressions of PI3K, p-Akt, and VEGF-C in the tumor xenografts were determined by immunohistochemical staining and Western blot analysis, respectively. 
Results: The positive expression rate of CCDC34 in GIST tissue was significantly higher than that in normal gastrointestinal mucosal tissue (90.16% vs. 27.5%, χ2=10.295, P=0.001). The CCDC34 expression was irrelevant to the sex age and tumor site (all P>0.05), but was significantly related to tumor risk grade, tumor size, tumor cell mitotic and local invasion, necrosis and metastasis (all P<0.05); CCDC34 protein expression was positively correlated with MVD count (r=0.695, P<0.001). Compared with the model group, the MVD count and protein expressions of PI3K, p-Akt and VEGF-C in the xenograft tissues from overexpression group were significantly increased, while significant opposite changes in above parameters were observed in the xenograft tissues from interference group (all P<0.05).
Conclusion: The CCDC34 expression is increased in GIST, and CCDC34 overexpression can promote angiogenesis, and thereby enable GIST progression. The mechanism may be associated with activation of the PI3K/Akt signaling pathway. So, this pathway may become a new target for the treatment of GIST.

Abstract:carcinoma (HCC). However, the hepatic ischemia-reperfusion injury (HIRI) is difficult to avoid after hepatectomy, which severely influence the efficacy and outcomes of the patients. Given the oxidative stress and inflammation playing critical roles in the mechanism for HIRI, this study was designated to examine the effects of using the anti-inflammatory liver protective drug magnesium isoglycyrrhizinate combined with the antioxidant reduced glutathione on HCC patients undergoing liver resection.  
Methods: Ninety HCC patients scheduled to undergo liver resection from March 2016 to March 2019 were enrolled and randomly allocated to control group and observation group, with 45 cases in each group. Patients in control group were given reduced glutathione by intravenous infusion after operation, and those in observation group received intravenous infusion of magnesium isoglycyrrhizinate plus reduced glutathione after operation. Both regimens were administered once per day for 7 d. with 45 cases in each group. The main clinical variables, the levels of indexes for oxidative stress and inflammatory cytokines on postoperative day (POD) 3 and 7, as well as the incidence of postoperative complications were compared between the two groups of patients. 
Results: There were no significant differences in preoperative data, surgery type and liver resection scope as well as the levels of indexes for oxidative stress and inflammatory cytokines between the two groups of patients before operation (all P>0.05). The operations were successfully completed in in all patients, and there were no significant differences in time of hepatic portal occlusion, operative time and intraoperative blood loss between the two groups (all P>0.05). In observation group versus control group, the liver function parameters on POD 3 and 7 were all superior to those in control group (all P<0.05); the levels of superoxide dismutase and reduced glutathione peroxidase were significantly increased, while the level of malondialdehyde was significantly decreased (all P<0.05); the levels of C-reaction protein, interleukin-6 and tumor necrosis factor-α were significantly reduced (all P<0.05). No rash, pruritus or allergy occurred in both groups. The incidence of liver failure within postoperative one month in observation group was significantly lower than that in control group (4.4% vs. 11.1%, P<0.05). 
Conclusion: Magnesium isoglycyrrhizinate combined with reduced glutathione can protect the liver function of HCC patients undergoing hepatectomy, which is superior to that using antioxidant alone. This effect may be achieved by the double action of anti-oxidative stress and anti-inflammation, which can effectively suppress the HIRI.

Abstract:Background and Aims: Henoch-Sch?nlein purpura (HSP) is a multi-system inflammatory disease of the small blood vessels, involving skin, joints, gastrointestinal tract, kidneys and other areas. The clinical manifestations of HSP are nonspecific, and the diagnosis is more difficult for those with gastrointestinal symptoms preceding the onset of purpura rash. This study was conducted to summarize and analyze the clinical characteristics and treatment experience of abdominal HSP for improving the early recognition of this condition. 
Methods: The clinical data of 45 HSP patients with abdominal pain as the predominant symptom admitted to Xiangya Hospital, Central South University from January 2012 to January 2018 were retrospectively analyzed. 
Results: Among the 45 patients with abdominal HSP, 34 cases were males and 11 cases were females, with a male to female ratio of 3.1:1; the average age of onset was (31.1±18.6) years, and the majority of them were adolescents under 18 years old; autumn and winter were the most common seasons of onset. Twenty-four patients (53.3%) had the abdominal pain as the first symptom, which was most frequently occurred in the middle and upper abdominal regions, and mainly presented as intermittent colicky pain, 14 patients (31.1%) had a purpura rash as the first manifestation, and 5 patients (11.1%) had a concomitant abdominal pain and rash, and the other associated symptoms included nausea, vomiting, hematochezia, abdominal distention, and pain in both knees. In the laboratory examination, 32 patients (71.1%) had an elevated white blood cell count comprised mainly of neutrophils, 13 patients (28.9%) had a positive urinary protein test, 13 patients (28.9%) had red blood cells in the urine, 35 patients (77.8%) showed decreased albumin level, 27 patients (60.0%) showed increased C-reactive protein (CRP) level, 33 patients (73.3%) were positive for fecal occult blood test, and 4 patients (16.0%) had an increased immunoglobulin A (IgA) level. Thirty-two patients underwent food intolerance tests, 19 cases (59.4%) sensitized to food allergens, which mainly were heterologous proteins. Thirty-three patients (73.3%) underwent gastroscopic examination, and the lesions mainly involved the duodenal bulb and descending duodenum; 
26 cases had a colonoscopic examination, and the lesions mainly involved the terminal ileum; 3 cases were subjected to enteroscopic examination, and the lesions mainly involved the middle and lower ileum. Endoscopic findings were mainly congestion and edema of the gastrointestinal mucosa and lamellar erosion, and some lesions were accompanied by ulcerations. Seven patients (15.6%) underwent abdominal CT examination, all which showed intestinal wall thickening, and some were accompanied by retroperitoneal and mesenteric lymph node enlargement. Twelve cases (26.7%) underwent biopsy, and the results suggested nonspecific inflammation of the mucosa, with infiltration of eosinophils and plasma cells in some cases. All patients received comprehensive treatment after diagnosis, and the gastrointestinal symptoms and rash were significantly relieved 40 cases (88.9%) after glucocorticoid treatment. Recurrence occurred in 6 cases (13.3%), with a time to recurrence ranged from 1 month to 24 months. 
Conclusion: In abdominal HSP, the purpura rash usually appears later than gastrointestinal symptoms, which lacks specific symptoms and signs, and is likely misdiagnosed. Early gastrointestinal endoscopic examination should be performed in clinical practice, so as to improve the diagnosis and understanding of this condition.

Abstract:The recent success of anti-programmed death 1 (PD1) drugs in treatment of metastatic colorectal cancer patients with mismatch repair deficiency generated overwhelming enthusiasm for immunotherapy in this condition. However, patients with mismatch repair deficient colorectal cancer account for a small proportion of the colorectal cancer population. Current research focuses on advancing immunotherapy to earlier stages of the disease including adjuvant and first-line metastatic settings, and on inducing sensitivity to immune checkpoint inhibitor therapy through a combinatorial approach. However, which patients can benefit from the immunotherapy is an issue needing to be addressed because of the autoimmune toxicity of these drugs. As a detection biomarker, the programmed death ligand 1 (PD-L1) that is one of the ligands for PD-1 can be detected by immunohistochemistry. However, there are some confounding factors in the immunohistochemical detection, such as the application of different detection antibodies, different immunohistochemical threshold values, different collection and preparation methods of tumor tissues, different processing protocols, primary and secondary biopsy specimens, tumor-derived or induced PD-L1 expression, and staining of tumor and immune cells. The current results indicate that patients with tumor overexpression of PD-L1 by immunohistochemistry have better clinical effect when receiving anti-PDL1 treatment, while some tumors with low expression also have remission for this treatment, which lead to the complexities in PD-L1 analysis. Elucidation of the mechanism of host immune system and tumor microenvironment can better explain whether or not the drugs targeting PD-L1 are beneficial for the patients.

Abstract:As a global public health issue, cancer is one of the major diseases that endanger human health in the world today. According to the latest cancer statistics released by the National Cancer Center in 2019, there were 3.929 million new patients with malignant tumor in China in 2015, with a death rate of 2.338 million, an incidence rate of 2.8583/100 000 and a mortality rate of 1.705/100 000. The occurrence and development of tumor is a multi-factor, multi-gene, multi-stage progressive cumulative evolution process, involving tumor transformation, survival, proliferation, invasion, angiogenesis and metastasis. This process is accompanied by genetic and epigenetic changes: oncogenes, tumor suppressor genes, mismatch repair genes, cell adhesion molecules are changed at DNA, RNA and protein levels. Although tumor diagnosis and treatment techniques have made continuous progress in recent years, most patients are already in advanced stage and the overall prognosis is poor. So, it is significant to explore the pathogenesis of cancer and find more effective prevention and treatment methods. Existing researches show that epigenetic changes are of great significance in tumor occurrence, development, invasion and metastasis. It’s known that epigenetic modifications mainly include histone modification, DNA methylation, nucleosome remodeling, non-coding RNA, etc. In eukaryotes, histone modification includes acetylation, methylation, phosphorylation, ribosylation and ubiquitination, etc. Like other histone modifications, histone methylation is a dynamic and reversible process. Lysine-specific demethylase 1 (LSD1) can specifically catalyze the demethylation and dimethyl reactions of lysine at position 4 (H3K4) and lysine at position 9 (H3K9) of histone H3, and interact with histone deacetylase to act as a transcription repressor. This enzyme is crucial to the growth and development of mammals and participates in a variety of biological processes, including cell differentiation, formation of heterochromatin, reasonable maintenance of DNA methylation status in cells and induction of formation of pluripotent stem cells, etc. At present, it is confirmed that LSD1 is highly expressed in various malignant tumor tissues and plays an important role in the occurrence, development and drug resistance of tumors. Wnt signaling pathway is a highly conserved signaling pathway in evolution, which plays an important role in cell proliferation, differentiation, migration and apoptosis. Gene mutation of key molecules of Wnt signaling pathway plays an important role in the occurrence and development of tumors. Although LSD1 and Wnt signaling pathways are both related to tumor occurrence and development, whether there is a link between them has not been clarified. In recent years, more and more studies have shown that LSD1 can affect the occurrence and development of tumors by regulating the activity of classical Wnt signaling pathway. In this review, the authors summarize the new research findings in the LSD1-mediated Wnt/β-catenin signaling pathway in cancers.

Abstract:Acute appendicitis during pregnancy is one of the most common non-obstetric acute abdominal conditions, and it can occur at all stages of pregnancy, most frequently within the first 6 months of pregnancy. Due to the special physiological situation of pregnancy and the changes in the position of the appendix, the clinical manifestations of acute appendicitis during pregnancy are atypical, and highly variable at different stages of pregnancy. In the early pregnancy, the clinical manifestations are similar to those in the non-pregnancy period, with the typical sign of the localized tenderness over McBurney's point; in the middle and late pregnancy, the appendix becomes displaced upwards laterally and backwards, and the symptoms and signs are nonspecific, which likely leads to misdiagnosis and missed diagnosis, and thereby cause appendiceal perforation or gangrene, fetal abortion, premature delivery, or even endanger the life of mother and baby due to delayed treatment. In addition, laboratory findings are nonspecific, and auxiliary examinations such as imaging are required for diagnosis. Both ultrasound and MRI are safe and effective imaging diagnostic modalities, in which, ultrasound has the characteristics of convenience, rapidness and safety, and is the first choice of imaging examination at the initial diagnosis. Surgery is the primary treatment method, and should be ideally performed within 24 h of the onset of symptoms, so as to reduce the maternal and infant mortality and incidence of the associated complications. According to the surgical approaches, the surgical procedures include traditional open surgery and laparoscopic surgery. However, the selection of surgical procedures at present should be based on the general factors that include the existing expertise, surgeon’s experience, medical facilities, disease status, and patients’ intention. Laparoscopic surgery has been proven to be safe and effective, and open surgery is still the dominant choice.