[Clinicopathological characteristics and prognosis of patients with small bowel tumors: A single center analysis of 220 cases]

Objective: To analyze the clinicopathological characteristics and prognosis of patients with small bowel tumors. Methods: This was a retrospective, observational study. We collected clinicopathological data of patients with primary jejunal or ileal tumors who had undergone small bowel resection in the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University between January 2012 and September 2017. The inclusion criteria included: (1) older than 18 years; (2) had undergone small bowel resection; (3) primary location at jejunum or ileum; (4) postoperative pathological examination confirmed malignancy or malignant potential; and (5) complete clinicopathological and follow-up data. Patients with a history of previous or other concomitant malignancies and those who had undergone exploratory laparotomy with biopsy but no resection were excluded. The clinicopathological characteristics and prognoses of included patients were analyzed. Results: The study cohort comprised 220 patients with small bowel tumors, 136 of which were classified as gastrointestinal stromal tumors (GISTs), 47 as adenocarcinomas, and 35 as lymphomas. The median follow-up for all patient was 81.0 months (75.9-86.1). GISTs frequently manifested as gastrointestinal bleeding (61.0%, 83/136) and abdominal pain (38.2%, 52/136). In the patients with GISTs, the rates of lymph node and distant metastasis were 0.7% (1/136) and 11.8% (16/136), respectively. The median follow-up time was 81.0 (75.9-86.1) months. The 3-year overall survival (OS) rate was 96.3%. Multivariate Cox regression-analysis results showed that distant metastasis was the only factor associated with OS of patients with GISTs (HR=23.639, 95% CI: 4.564-122.430, P<0.001). The main clinical manifestations of small bowel adenocarcinoma were abdominal pain (85.1%, 40/47), constipation/diarrhea (61.7%, 29/47), and weight loss (61.7%, 29/47). Rates of lymph node and distant metastasis in patients with small bowel adenocarcinoma were 53.2% (25/47) and 23.4% (11/47), respectively. The 3-year OS rate of patients with small bowel adenocarcinoma was 44.7%. Multivariate Cox regression-analysis results showed that distant metastasis (HR=4.018, 95%CI: 2.108-10.331, P<0.001) and adjuvant chemotherapy (HR=0.291, 95% CI: 0.140-0.609, P=0.001) were independently associated with OS of patients with small bowel adenocarcinoma. Small bowel lymphoma frequently manifested as abdominal pain (68.6%, 24/35) and constipation/diarrhea (31.4%, 11/35); 77.1% (27/35) of small bowel lymphomas were of B-cell origin. The 3-year OS rate of patients with small bowel lymphomas was 60.0%. T/NK cell lymphomas (HR= 6.598, 95% CI: 2.172-20.041, P<0.001) and adjuvant chemotherapy (HR=0.119, 95% CI: 0.015-0.925, P=0.042) were independently associated with OS of patients with small bowel lymphoma. Small bowel GISTs have a better prognosis than small intestinal adenocarcinomas (P<0.001) or lymphomas (P<0.001), and small bowel lymphomas have a better prognosis than small bowel adenocarcinomas (P=0.035). Conclusions: The clinical manifestations of small intestinal tumor are non-specific. Small bowel GISTs are relatively indolent and have a good prognosis, whereas adenocarcinomas and lymphomas (especially T/NK-cell lymphomas) are highly malignant and have a poor prognosis. Adjuvant chemotherapy would likely improve the prognosis of patients with small bowel adenocarcinomas or lymphomas.

[The impact of the dosage of intraoperative opioids on postoperative survival outcomes in patients with pancreatic cancer]

Objective: To investigate the impact of the dosage of intraoperative opioids on postoperative survival of pancreatic cancer patients who underwent pancreatectomy. Methods: The clinical data of 95 patients with pancreatic cancer who underwent pancreatectomy at Harbin Medical University Cancer Hospital from September 2013 to August 2018 were retrospectively collected. Dosage of intraoperative opioid medications was converted to fentanyl equivalent dose. Patients were divided into high-dose group (fentanyl consumption ≥2.21 mg, n=46) and low-dose group (fentanyl consumption<2.21 mg, n=49) according to the median intra-operative fentanyl equivalents. The relapse-free survival (RFS) and overall survival (OS) between the two groups were compared. Cox proportional hazards regression model was used to analyze the impact of important covariates on RFS and OS. Results: RFS of patients in low-dose group at 1, 3 and 5 years was 75.5%, 26.5% and 15.2% respectively. OS of patients in low-dose group at 1, 3 and 5 years was 77.6%, 32.5% and 24.4% respectively. RFS of patients in high-dose group at 1, 3 and 5 years was 76.1%, 23.9% and 12.0% respectively. OS of patients in high-dose group at 1, 3 and 5 years was 76.1%, 37.0% and 15.0%. There was no significant difference in RFS and OS between the two groups (all P>0.05). Multivariate Cox analysis showed that dosage of intraoperative fentanyl was not associated with RFS (HR=1.205, 95%CI: 0.737-1.970, P=0.456) or OS (HR=1.062, 95%CI: 0.634-1.778, P=0.818). Conclusion: Dosage of intraoperative opioid has no effect on RFS and OS in pancreatic cancer patients undergoing pancreatectomy.

[Safety and effectiveness of esophagojejunostomy through extracorporeal versus intracorporeal methods after laparoscopic total gastrectomy]

Objective: To compare the safety and effectiveness of esophagojejunostomy (EJS) through extracorporeal and intracorporeal methods after laparoscopic total gastrectomy (LTG). Methods: A retrospective cohort study was carried out. Clinicopathological data of 261 gastric cancer patients who underwent LTG, D2 lymphadenectomy, and Roux-en-Y EJS with complete postoperative 6-month follow-up data at the General Surgery Department of Nanfang Hospital from October 2018 to June 2021 were collected. Among these 261 patients, 139 underwent EJS with a circular stapler via mini-laparotomy (extracorporeal group), while 122 underwent intracorporeal EJS (intracorporeal group), including 43 with OrVil(TM) anastomosis (OrVil(TM) subgroup) and 79 with Overlap anastomosis (Overlap subgroup). Compared with the extracorporeal group, the intracorporeal group had higher body mass index, smaller tumor size, earlier T stage and M stage (all P<0.05). Compared with the Overlap subgroup, the Orvil(TM) subgroup had higher proportions of upper gastrointestinal obstruction and esophagus involvement, and more advanced T stage (all P<0.05). No other significant differences in the baseline data were found (all P>0.05). The primary outcome was complications at postoperative 6-month. The secondary outcomes were operative status, intraoperative complication and postoperative recovery. Continuous variables with a skewed distribution are expressed as the median (interquartile range), and were compared using Mann-Whitney U test. Categorical variables are expressed as the number and percentage and were compared with the Pearson chi-square, continuity correction or Fisher's exact test. Results: Compared with the extracorporeal group, the intracorporeal group had smaller incision [5.0 (1.0) cm vs. 8.0 (1.0) cm, Z=-10.931, P=0.001], lower rate of combined organ resection [0.8% (1/122) vs. 7.9% (11/139), χ(2)=7.454, P=0.006] and higher rate of R0 resection [94.3% (115/122) vs. 84.9 (118/139), χ(2)=5.957, P=0.015]. The morbidity of intraoperative complication in the extracorporeal group and intracorporeal group was 2.9% (4/139) and 4.1% (5/122), respectively (χ(2)=0.040, P=0.842). In terms of postoperative recovery, the extracorporeal group had shorter time to liquid diet [(5.1±2.4) days vs. (5.9±3.6) days, t=-2.268, P=0.024] and soft diet [(7.3±3.7) days vs. (8.8±6.5) days, t=-2.227, P=0.027], and shorter postoperative hospital stay [(10.5±5.1) days vs. (12.2±7.7) days, t=-2.108, P=0.036]. The morbidity of postoperative complication within 6 months in the extracorporeal group and intracorporeal group was 25.9% (36/139) and 31.1%, (38/122) respectively (P=0.348). Furthermore, there was also no significant difference in the morbidity of postoperative EJS complications [extracorporeal group vs. intracorporeal group: 5.0% (7/139) vs. 82.% (10/122), P=0.302]. The severity of postoperative complications between the two groups was not statistically significant (P=0.289). In the intracorporeal group, the Orvil(TM) subgroup had more estimated blood loss [100.0 (100.0) ml vs.50.0 (50.0) ml, Z=-2.992, P=0.003] and larger incision [6.0 (1.0) cm vs. 5.0 (1.0) cm, Z=-3.428, P=0.001] than the Overlap subgroup, seemed to have higher morbidity of intraoperative complication [7.0% (3/43) vs. 2.5% (2/79),P=0.480] and postoperative complications [37.2% (16/43) vs. 27.8% (22/79), P=0.286], and more severe classification of complication (P=0.289). Conclusions: The intracorporeal EJS after LTG has similar safety to extracorporeal EJS. As for intracorporeal EJS, the Overlap method is safer and has more potential advantages than Orvil(TM) method, and is worthy of further exploration and optimization.

[Clinical significance of No.11p posterior lymph nodes dissection in gastric cancer surgery]

Objective: To analyze the association of No.11p posterior lymph node metastasis with clinicopathological features and its prognostic significance in gastric cancer. Methods: A single-center retrospective cohort study was conducted. Clinicopathological data of patients with primary gastric cancers undergoing No.11p posterior lymph node dissection from January 2016 to December 2020 were retrieved from the Database of Gastric Cancer, West China Hospital, Sichuan University. Case inclusion criteria: (1) gastric cancer proved by pathology; (2) radical resection with intraoperative No.11p posterior lymph node dissection; (3) operations performed by the same surgical team; (4) no previous history of other malignant tumors and no concurrent malignant tumors. Those with stump gastric cancer, history of gastrectomy, neoadjuvant chemotherapy, incomplete clinicopathological data and lost to follow-up were excluded. During the operation, the upper edge of the pancreas was retracted forward to expose the area between the upper edge of the pancreas and the splenic vessels. The proximal segment of the splenic artery was skeletonized to remove lymphatic tissue anterior and superior to the splenic artery for No.11p lymph node dissection. For patients with lymphadenopathy in the area between the splenic artery and the splenic vein, dissection was performed. The enlarged lymph nodes were labeled with titanium clips and named as No.11p posterior lymph node. Pathological examination was performed separately after the specimen was isolated. Statistical analysis was performed using R software. Results: A total of 127 gastric cancer patients, who underwent No.11p posterior lymph nodes dissection were included in this study, of which 120 patients without No.11p posterior lymph nodes metastasis (No.11p posterior lymph nodes negative) and 7 patients with No.11p posterior lymph nodes metastasis (No.11p posterior lymph nodes positive). A total of 8 metastatic No.11p posterior lymph nodes were detected in 7 patients, metastasis rate and with a ratio of 5.5% (7/127) and 6.8% (8/127), respectively. In the subgroup analysis of T3-4 stage patients, the metastasis rate and ratio of No.11p posterior lymph nodes were 9.0% (7/78) and 10.7% (8/75), respectively. Compared to negative cases, patients with No.11p posterior lymph nodes metastasis had larger tumor (P=0.002), higher proportion of Borrmann type Ⅲ and Ⅳ tumors (P=0.005), more metastatic lymph nodes (P<0.001), more advanced T stage (P=0.043), N stage (P=0.004) and TNM stage (P=0.015). In survival analysis, patients with No.11p posterior lymph node metastasis had a significantly worse prognosis than those without metastasis after adjusting for TNM stage (hazard ratio=3.009, 95% confidence interval: 1.824-4.964, P<0.001). Conclusions: The No.11p posterior lymph node metastasis in gastric cancer is associated with worse prognosis. For patients of T3-4 stage gastric cancer, No.11p posterior lymph node dissection should be emphasized during radical operation.

Association of chronic obstructive pulmonary disease with mild cognitive impairment and dementia risk: A systematic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a common public health issue that has been linked to cognitive dysfunction.

AIM

To investigate the relationship between COPD and a risk of mild cognitive impairment (MCI) and dementia.

METHODS

A comprehensive literature search of the PubMed, Embase, Google Scholar, and Cochrane Library electronic databases was conducted. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs) were calculated using a random or fixed effects model. Studies that met the inclusion criteria were assessed for quality using the Newcastle Ottawa Scale.

RESULTS

Twenty-seven studies met all the inclusion criteria. Meta-analysis yielded a strong association between COPD and increased risk of MCI incidence (OR = 2.11, 95%CI: 1.32-3.38). It also revealed a borderline trend for an increased dementia risk in COPD patients (OR = 1.16, 95%CI: 0.98-1.37). Pooled hazard ratios (HR) using adjusted confounders also showed a higher incidence of MCI (HR = 1.22, 95%CI: -1.18 to -1.27) and dementia (HR = 1.32, 95%CI: -1.22 to -1.43) in COPD patients. A significant lower mini-mental state examination score in COPD patients was noted (MD = -1.68, 95%CI: -2.66 to -0.71).

CONCLUSION

Our findings revealed an elevated risk for the occurrence of MCI and dementia in COPD patients. Proper clinical management and attention are required to prevent and control MCI and dementia incidence in COPD patients.

[Application and clinical significance of TCGA molecular classification in endometrial cancer]

Objective: To explore the application and clinical significance of the cancer genome atlas (TCGA) molecular classification in endometrial cancer (EC). Methods: Sixty-six EC patients collected from December 2018 to March 2021 from Peking University People's Hospital were categorized into four subgroups based on TCGA molecular classification tested by next generation sequencing. The correlation among four molecular subgroups and the clinical-pathological features including prognosis were analyzed. Results: (1) Clinical and pathological features: median age at diagnosis was 56 years (range: 24-78 years). The cases were distributed as follows: 3 (5%) cases DNA polymerase epsilon (POLE) ultra-mutated, 11 (17%) cases high microsatellite instability (MSI-H) including 2 Lynch syndrome, 42 (64%) cases low copy-number (CN-L) and 10 (15%) cases high copy-number (CN-H). There were significant differences among four subtypes in the combination of other tumors, tumor family history, surgical method, International Federation of Gynecology and Obstetrics (FIGO, 2009) stage, depth of muscle invasion and lymph vascular space invasion (all P<0.05). The proportions of patients in CN-H subgroup with advanced FIGO stage (stage Ⅲ-Ⅳ), deep muscle invasion and positive lymph-vascular space invasion were significantly increased. There were no significant differences in age, menopausal status, body mass index, metabolic syndrome-related complications, preoperative serum CA₁₂₅ and human epididymis protein 4 levels, tumor size, pathological grade (only endometrioid cancer), and lymph node metastasis among the 4 TCGA molecular types (all P>0.05). (2) Immuno-related molecular analysis: among 66 EC patients, 27 patients underwent immunohistochemical analysis of programmed cell death 1 ligand 1 (PD-L1) protein, and 28 patients underwent tumor mutation burden (TMB) detection. POLE and MSI-H subgroups contained TMB than those in CN-L and CN-H (P<0.05).(3) Prognosis: the median follow-up time was 10 months (range: 0-28 months). The progression-free survival rate of TCGA molecular types were 100% (POLE ultra-mutated), 100% (MSI-H), 98% (CN-L), and 80% (CN-H) respectively and had significant differences (P=0.034). The overall survival were 100% (POLE ultra-mutated), 100% (MSI-H), 98% (CN-L), and 90% (CN-H) respectively, but there were not statistically significant difference (P=0.361). POLE ultra-mutated and MSI-H subgroups had the best survival, while CN-H had the worst. Conclusion: TCGA molecular classification has feasibility and clinical value in clinical application of EC, which is helpful to identify the prognosis of patients.

[The treatment strategy and outcome of pregnancy complicated with Stanford type A aortic dissection]

To summarize the clinical characteristics and surgical treatment experience of pregnant women with acute Stanford type A aortic dissection.We collected the clinical data of 12 cases with acute aortic dissection during pregnancy and puerperal period from June 2010 to July 2020 in Beijing Anzhen Hospital and analyzed retrospectively, and summarize the clinical characteristics, treatment and outcomes for both mother and fetus. The age of these patients was(29±5)years old, and the onset time was from 16 weeks of gestation and 1 month after delivery. All the 12 patients underwent surgical treatment. The patients in the puerperium received aortic surgery after delivery. Four of them received the aortic surgery and continued pregnancy. Five of them underwent aortic repair and cesarean section simultaneously. Surgical treatment should be actively considered in pregnancy complicated with acute Stanford type A aortic dissection. Multi-disciplinary team cooperation can effectively improve the safety of the patients and fetus.

Development and application of isothermal amplification methods for rapid detection of F4 fimbriae producing Escherichia coli

Enterotoxigenic Escherichia coli (ETEC) is the causative agent of a wide range of diseases, which are the important cause of illness and mortality in piglets. ETEC strains expressing F4 fimbriae are frequently associated with post-weaning diarrhea (PWD) and lead to great economic losses in swine production industry worldwide. The aim of this study was to establish a rapid and effective isothermal amplification method for detection of F4 fimbriae. Loop-mediated isothermal amplification (LAMP), Polymerase spiral reaction (PSR) and cross-priming ampli- fication (CPA) were used to develop and optimize the detection method first time. Subsequently, the specificity and sensitivity of these methods were evaluated, and the clinical samples were detected with these methods. All the F4-positive samples could produce ladder-like amplifica- tions products and lead the chromogenic substrate SYBR Green I produce green fluorescence, while in blank control and negative samples lack of this pattern or remained orange. The sensi- tivity of LAMP and CPA were 10 times higher than PSR method. Meanwhile, these three methods were validated with clinical samples, 7 were found positive, while 125 samples were negative, the testing results were consisted with the real-time PCR method. These findings suggested that the isothermal amplification based on the F4 fimbriae is a rapid, effective and sensitive method under resource constrains.

[Discrimination of Armeniacae Semen Amarum from different processed products and various rancidness degrees by electronic nose and support vector machine]

This study was aimed to develop a simple, rapid and reliable method for identifying Armeniacae Semen Amarum from different processed products and various rancidness degrees. The objective odor information of Armeniacae Semen Amarum was obtained by electronic nose. 105 batches of Armeniacae Semen Amarum samples were studied, including three processed products of Armeniacae Semen Amarum, fried Armeniacae Semen Amarum and peeled Armeniacae Semen Amarum, as well as the samples with various rancidness degrees: without rancidness, slight rancidness, and rancidness. The discriminant models of different processed products and rancidness degrees of Armeniacae Semen Amarum were established by Support Vector Machine(SVM), respectively, and the models were verified based on back estimation of blind samples. The results showed that there were differences in the characteristic response radar patterns of the sensor array of different processed products and the samples with different rancidness degrees. The initial identification rate was 95.90% and 92.45%, whilst validation recognition rate was 95.38% and 91.08% in SVM identification models. In conclusion, differentiation in odor of different processed and rancidness degree Armeniacae Semen Amarum was performed by the electronic nose technology, and different processed and rancidness degrees Armeniacae Semen Amarum were successfully discriminated by combining with SVM. This research provides ideas and methods for objective identification of odor of traditional Chinese medicine, conducive to the inheritance and development of traditional experience in odor identification.

[Change pattern and correlation analysis of macroscopic characteristics, active components and rancidness degrees of Armeniacae Semen Amarum in deterioration process]

To discuss the effect of deterioration on the quality of Armeniacae Semen Amarum by observing the changes of macroscopic characteristics, active components and rancidness degrees of Armeniacae Semen Amarum in deterioration process. The traditional macroscopic identification was used to observe, identify and classify the morphologic and organleptic characteristics of Armeniacae Semen Amarum. The contents of amygdalin and fatty oil(two representatives of active components) were detected by HPLC and general rule 0713 in Chinese Pharmacopoeia, respectively. Acid value and peroxide value of the samples were selected as the representative indices of different rancidness degrees, and the general rule 2303 was adopted as the method for quantitative analysis. Then principal component analysis(PCA), partial least square analysis discrimination analysis(PLS-DA) were further utilized to establish the discriminative models of samples with different rancidness degrees, and also to screen out the largest contribution factors. In sensory evaluation, Armeniacae Semen Amarum samples were divided into three groups: non-rancid, slightly-rancid, and noticeably-rancid. The color of seed coat, cotyledon and surface of noticeably-rancid samples was deepened, and the odor differed much from non-rancid samples. Average content of amygdalin and fatty oil in non-rancid samples was 4.12% and 67.77%, respectively, both meeting the requirements of Chinese Pharmacopoeia; and decreased to some extent in slightly-rancid samples. However, the content of amygdalin sharply dropped to 0.074% in noticeably-rancid samples. The acid value and peroxide value were increased significantly with the intensifying of the rancidness degree, from only 1.363 and 0.016 74 in non-rancid samples to 1.865 and 0.023 70 in slightly-rancid samples, even doubled in noticeably-rancid samples(2.167 and 0.033 82). The discriminative models established by PCA and PLS-DA could complete the task of distinguishing the non-rancid samples from noticeably-rancid ones. The contribution degree of amygdalin content as one of the input attributes of discriminative model was higher than 1. Rancidness affected the quality of Armeniacae Semen Amarum, resulting in appearance changes, decrease in content of active components, and increase in acid value and peroxide value. Obviously, noticeably-rancid samples were non-conforming to Chinese Pharmacopoeia and no longer suitable for medicinal use. Rancidness can significantly reduce the quality of Armeniacae Semen Amarum, and even could possibly produce toxicity, which should attach more attention.

Comparison of microendoscopic discectomy and open discectomy for single-segment lumbar disc herniation

BACKGROUND

Lumbar disc herniation is a common disease. Endoscopic treatment may have more advantages than traditional surgery.

AIM

To compare the clinical efficacy and safety of microendoscopic discectomy (MED) and open discectomy with lamina nucleus enucleation in the treatment of single-segment lumbar intervertebral disc herniation.

METHODS

Ninety-six patients who were operated at our hospital were selected for this study. Patients with single-segment lumbar disc herniation were admitted to the hospital from March 2018 to March 2019 and were randomly divided into the observation group and the control group with 48 cases in each group. The former group underwent lumbar discectomy and the latter underwent laparotomy and nucleus pulpectomy. Surgical effects were compared between the two groups.

RESULTS

In terms of surgical indicators, the observation group had a longer operation time, shorter postoperative bedtime and hospital stay, less intraoperative blood loss, and smaller incision length than the control group (P < 0.05). The excellent recovery rate did not differ significantly between the observation group (93.75%) and the control group (91.67%). Visual analogue scale pain scores were significantly lower in the observation group than in the control group at 1 d, 3 d, 1 mo, and 6 mo after surgery (P < 0.05). The incidence of complications was significantly lower in the observation group than in the control group (6.25% vs 22.92%, P < 0.05).

CONCLUSION

Both MED and open discectomy can effectively improve single-segment lumbar disc herniation, but MED is associated with less trauma, less bleeding, and a lower incidence of complications.

[Novel compound heterozygous LoF mutations in SRD5A2 may result in disorders of sex development]

Objective: To investigate the novel genetic cause associated with hypospadias and the strategy for preventing offspring genetic defects in these patients. Methods: In March 2019, a patient with gonadal dysplasia (hypospadias associated with cryptorchidism) was referred to Shanghai General Hospital. His secondary sex characters, level of sex hormones and the development of male reproductive system was assessed through physical examination, sex hormone examination, male reproductive system B-ultrasound and computed tomography (CT). Whole-exome sequencing (WES) was preformed to investigate the pathogenic genetic variations associated with hypospadias and cryptorchidism. Also, Sanger sequencing was conducted to verify the WES results in the pedigree. Semen analysis was used to assess the fertility of the proband and the SRD5A2 gene analysis of his spouse was performed to assess the risk of genetic defects in the offspring. Results: The patient suffered from gonadal dysplasia (hypospadias associated with cryptorchidism). Physical examination showed an inverted triangular distribution of pubic hair, small penis and the volume of the testis was 8 ml. Sex hormone examination revealed the level of FSH, LH, Pituitary prolactin (PRL), estrogen (E(2)), testosterone (T), and sex hormone-binding globulin (SHBG) was 25.81 U/L, 10.84 U/L, 21.09 μg/L, 153 pmol/L, 16.95 nmol/L, and 36.15 nmol/L respectively. B-ultrasound and computed tomography (CT) showed left inguinal testis. Also, semen analysis illustrated that the volume was 0.05 ml and sperm concentration<2×10(6)/ml, suggesting oligospermia in this case. WES sequencing and Sanger sequencing showed compound heterozygous LoF mutations in SRD5A2 [NM_000348.3:C.679C>T(p.Arg227Ter) and NM_000348.3:C.16C>T(p.Gln6Ter)] in this patient. And there were no pathogenic genetic variations of SRD5A2 in the spouse. Conclusion: Novel compound heterozygous LoF mutations in SRD5A2[NM_000348.3:C.679C>T(p.Arg227Ter) and NM_000348.3:C.16C>T(p.Gln6Ter)] may be the primary cause of disorders of sex development.

[Effect of standardized surgical treatment and multidisciplinary treatment strategy on the prognosis of gastric cancer patients: report of a single-center cohort study]

Objective: To explore the effect of standardized surgical treatment and multidisciplinary treatment strategy on the treatment outcomes of gastric cancer patients. Methods: A single-center cohort study was carried out. Clinicopathological and long-term follow up data of primary gastric cancer patients were retrieved from the database of Surgical Gastric Cancer Patient Registry (SGCPR) in West China Hospital of Sichuan University. Finally, 4516 gastric cancer patients were included and were divided into three groups according to time periods (period 1 group: exploration stage of standardized surgical treatment, 2000 to 2006, 967 cases; period 2 group: application stage of standardized surgical treatment, 2007 to 2012, 1962 cases; period 3 group: optimization stage of standardized surgical treatment and application stage of multidisciplinary treatment strategy, 2013 to 2016, 1587 cases). Differences in clinical data, pathologic features, and prognosis were compared among 3 period groups. Follow-up information was updated to January 1, 2020. The overall follow-up rate was 88.9% (4016/4516) and median follow-up duration was 51.58 months. Survival curve was drawn by Kaplan-Meire method and compared with log-rank test. Univariate and multivariate analyses were performed by Cox proportional hazards model. Results: There were significant differences among period 1, period 2 and period 3 groups in the rates of D2/D2+ lymphadenectomy [14.4%(139/967) vs. 47.2%(927/1962) vs. 75.4%(1197/1587), χ(2)=907.210, P<0.001], in the ratio of proximal gastrectomy [19.8%(191/967) vs. 16.6%(325/1962) vs. 8.2%(130/1587), χ(2)=100.020, P<0.001], and in the median intraoperative blood loss (300 ml vs. 100 ml vs. 100 ml, H=1126.500, P<0.001). Besides, the increasing trend and significant difference were also observed in the median number of examined lymph nodes among period 1, period 2 and period 3 groups (14 vs. 26 vs. 30, H=987.100, P<0.001). Survival analysis showed that the 5-year overall survival rate was 55.3% in period 1, 55.2% in period 2 and 62.8% in period 3, and significant difference existed between period 3 and period 1 (P=0.004). The Cox proportional hazards model analysis showed that treatment period (period 3, HR=0.820, 95%CI: 0.708 to 0.950, P=0.008), postoperative chemotherapy (HR=0.696, 95%CI: 0.631 to 0.768, P<0.001) and mid-low gastric cancer (HR=0.884, 95%CI: 0.804 to 0.973, P=0.011) were good prognostic factors. Whereas old age (≥65 years, HR=1.189, 95%CI: 1.084 to 1.303, P<0.001), palliative resection (R1/R2, HR=1.538,95%CI: 1.333 to 1.776, P<0.001), large tumor size (≥5 cm, HR=1.377, 95%CI: 1.239 to 1.529, P<0.001), macroscopic type III to IV (HR=1.165, 95%CI: 1.063 to 1.277, P<0.001) and TNM stage II to IV(II/I:HR=1.801,95%CI:1.500~2.162,P<0.001;III/I:HR=3.588, 95%CI: 3.028~4.251, P<0.001; IV/I: HR=6.114, 95%CI: 4.973~7.516, P<0.001) were independent prognostic risk factors. Conclusion: Through the implementation of standardized surgical treatment technology and multidisciplinary treatment model, the quality of surgery treatment and overall survival increase, and prognosis of gastric cancer patients has been improved.

[Management strategy for the resumption of regular diagnosis and treatment in gastrointestinal surgery department during the outbreak of coronavirus disease 2019 (COVID-19)]

Acute abdomen, abdominal trauma, gastrointestinal bleeding and gastrointestinal tumors are the main conditions that are routinely treated in gastrointestinal surgery department with high incidence and critical condition. These conditions need emergency or selective operations. During the outbreak of the coronavirus disease 2019 (COVID-19), it's a great challenge for us to meet the patients' requirement under the situation. As the COVID-19 was brought under control in China, the Department of General Surgery in Nanfang Hospital resumed regular medical services gradually. Based on our clinical practice, the four major measures of strengthening pre-hospital screening, perioperative prevention and control, medical staff protection, and ward management were adopted. These main measures include the strict implementation of the appointment system and triage system before admission; the conduction of epidemiological and preliminary screening of viral nucleic acids; the chest CT examination during the perioperative period to re-screen COVID-19; the reduction of the risk of droplets and aerosol transmission; the minimally invasive surgery combined with enhanced recovery program in order to reduce patient's susceptibility and shorten the length of postoperative hospital stay; the reinforcement of specific infection control training for medical staff; the strict implementation of hierarchical protection; the establishment of gastrointestinal surgery prevention and control system; the rehearsal of emergency exercise; the installation of quarantine wards; the screening and management of family care-givers; the strict disinfection of environment and materials. Our preliminary practice shows that following the work guidelines issued by the Guangdong Province COVID-19 Prevention and Control Office and adopting precise management strategies in combination with the specific clinical features of gastrointestinal surgery, it is possible to safely resume regular care for the patients and comply to epidemic control at the same time.

[Vascular injury and anatomy during laparoscopy - assisted distal gastrectomy with D2 lymphadenectomy for gastric cancer]

Objective: To evaluate the incidence of intraoperative vascular injury (IVI) and associated anatomical features during laparoscopy - assisted distal gastrectomy (LADG) with D2 lymphadenectomy for gastric cancer. Methods: A descriptive cohort study was performed. Clinical data and operational videos of 278 consecutive gastric cancer patients who underwent LADG with D2 lymphadenectomy for gastric cancer at Department of General Surgery of Nanfang Hospital between January 2010 and December 2017 were retrospectively analyzed. IVI and vascular anatomy during lymphadenectomy were observed and recorded in the following four scenes: scene I: No. 4sb and No.4d of lower left (tail of pancreas) area; scene II: No.6 of lower right (subpyloric) area; scene III: No.5 and No.12a of upper right (suprapyloric) area; scene IV: No. 7, No. 8a, No. 9, No. 11p of central area posterior to the gastric body. IVI was defined as the injury of main perigastric vessel requiring additional procedure for hemostasis such as electrocauterization, gauze compression, clipping or suture. Results: Among 278 patients, 125 (45.0%) had IVI. Two cases of IVI required conversion to open operation and the injuried vascular was left gastric artery (LGA) and right gastric artery (RGA), respectively. Higher incidence of IVI was found in scene II (92/278, 33.1%) and scene IV(39/278, 14.0%). More common IVI was observed in right gastroepiploic vein (RGeV, 57/278, 20.5%) and left gastric vein (LGV, 33/278, 11.9%). The right gastroepiploic vessels were observed in all 278 patients, including 3 (1.1%) cases with 2 RGeVs, and 2 cases with 2 right gastroepiploic arteries (RGeA). RGA was observed clearly in 265 (95.3%) patients, whose ramification pattern was as follows: from proper hepatic artery (PHA, 223/265, 84.2%), from gastroduodenal artery (GDA, 16/265, 6.0%), from left hepatic artery (LHA, 12/265,4.5%), from the crossing of PHA and GDA (8/265, 3.0%), and 6 (2.3%) patients with 2 RGAs simultaneously from PHA and GDA, respectively. The most common injury of RGA (4/12) occurred in LHA. Excluding 2 cases of conversion to open surgery due to intraoperative hemorrhage, among 276 patients, LGV was observed in 270 patients (97.1%), whose drainage pattern was as follows: into the portal vein (PV, 148/270, 54.8%), into the spleen vein (SV, 56/270, 20.7%), into the junction of these two veins (52/270, 19.3%), into left portal vein (LPV, 8/270, 3.0%), meanwhile 6 patients had 2 LGVs simultaneously, including LGVs of 5 cases into PV and SV, and of 1 case into PV-SV junction and SV. The most common IVI was found in those patients with two LGVs (4/6). Conclusions: IVI during LADG with D2 lymphadenectomy is common. The highest risk of IVI is found in scene II and scene IV. Attentions should be paid to anatomic variation of vessels, especially the RGeV, LGV and RGA.

Tumor Immune Microenvironment and Chemosensitivity Signature for Predicting Response to Chemotherapy in Gastric Cancer

Current gastric cancer staging alone cannot predict prognosis and adjuvant chemotherapy benefits in stage II and III gastric cancer. Tumor immune microenvironment biomarkers and tumor-cell chemosensitivity might add predictive value to staging. This study aimed to construct a predictive signature integrating tumor immune microenvironment and chemosensitivity-related features to improve the prediction of survival and adjuvant chemotherapy benefits in patients with stage II to III gastric cancer. We used IHC to assess 26 features related to tumor, stroma, and chemosensitivity in tumors from 223 patients and evaluated the association of the features with disease-free survival (DFS) and overall survival (OS). Support vector machine (SVM)-based methods were used to develop the predictive signature, which we call the SVM signature. Validation of the signature was performed in two independent cohorts of 445 patients. The diagnostic signature integrated seven features: CD3⁺ cells at the invasive margin (CD3 IM), CD8⁺ cells at the IM (CD8 IM), CD45RO⁺ cells in the center of tumors (CD45RO CT), CD66b⁺ cells at the IM (CD66b IM), CD34⁺ cells, periostin, and cyclooxygenase-2. Patients fell into low- and high-SVM groups with significant differences in 5-year DFS and OS in the training and validation cohorts (all P < 0.001). The signature was an independent prognosis indicator in multivariate analysis in each cohort. The signature had better prognostic value than various clinicopathologic risk factors and single features. High-SVM patients exhibited a favorable response to adjuvant chemotherapy. Thus, this SVM signature predicted survival and has the potential for identifying patients with stage II and III gastric cancer who could benefit from adjuvant chemotherapy.

[Efficacy and safety study of microsurgical varicocelectomy in the treatment of non-obstructive azoospermia with varicocele]

Objective: To discuss the efficacy and safety of subinguinal microsurgical varicocelectomy in the treatment of non-obstructive azoospermia (NOA) with varicocele. Methods: The clinical data of 141 patients with NOA and varicocele who underwent subinguinal microsurgical varicocelectomy from March 2015 to June 2017 in Shanghai General Hospital was collected.One hundred and ten patients suffered from varicocele on the left side, 1 on the right side, and the rest (30 cases) were bilateral varicocele. Grade Ⅰ varicocele were found on 7 sides (the right and left side was count respectively), grade Ⅱ on 121 sides, and grade Ⅲ on 43 sides. Sperm analysis, pregnancy rate and complications were recorded after at least 6 months since operation. Results: Eleven cases were lost during the follow-up. Eighteen of the remaining 130 NOA patients processed successful sperm retrieval in post-operative semen analysis (18/130, 13.8%). Six couples(6/130, 4.6%) succeeded in natural pregnancy. Five couples (5/130, 3.8%)underwent successful pregnancy following with intracytoplasmic sperm injection(ICSI). Twenty-six out of the remaining 112 patients underwent the micro dissection testicular sperm extraction (micro-TESE), and 4 patients got a successful sperm retrieval (4/26, 15.4%). Among them, 2 couples had successful pregnancy with ICSI. Totally 2 cases of postoperative infection of incision were found. Conclusions: Microsurgical varicocelectomy had a beneficial effect on sperm quality of patients suffered from NOA with varicocele to some extent, even leading to unassisted pregnancy or avoiding micro-TESE before ICSI. Microsurgical varicocelectomy could be applied in the treatment of NOA with varicocele.

[The drinking status and associated factors in adults in China]

Objective: To investigate the drinking status and associated factors in adults in China. Methods: Based on the 2010-2012 China National Nutrition and Health Survey (CNNHS), a total of 135 824 participants aged ≥18 were included in this cross-sectional analysis. Multivariable logistic regression model was used to investigate the associated factors for drinking status. Results: The overall drinking rate was 30.5% in Chinese adults, 53.8% in men, and 12.2% in women. The excessive drinking rate was 14.0% in men and 1.1% in women. The daily drinking rate was 25.7% in men and 10.9% in women. Men mainly consumed multi-type wines, but women preferred beer. The overall harmful drinking rate was 7.1%. The excessive drinking rate, daily drinking rate, and harmful drinking rate increased first but then declined with age. All the four rates were positively related with physical activity. Conclusions: The drinking rate, excessive drinking rate, daily drinking rate and harmful drinking rate were high in adults in China. Drinking status was associated with age, sex, marital status, education level, smoking status and physical activity.

[Mean blood pressure among the adults in China 2010-2012: based on the results of mercury sphygmomanometer and converted electronic sphygmomanometer]

Objective: To analyze the average systolic blood pressure (SBP) and diastolic blood pressure (DBP) among adults aged 18 years old and above in China between 2010 and 2012; and to compare the difference in the results measured by mercury sphygmomanometer and converted electronic sphygmomanometer. Methods: The data was collected from Chinese Nutrition and Health Surveillance in 2010-2012. 120 428 adults aged 18 years old and above were selected from 150 survey counties (districts) of 31 provinces in China Mainland, by multi-stage stratified and probability proportion to size (PPS) cluster randomization sampling method. The average blood pressure value was calculated from three systolic and diastolic blood pressure readings measured by mercury sphygmomanometer. The value of Electronic Sphygmomanometer was converted by regression formula. Age-standardized results were calculated incorporating a complex sample weighting using the population data from the National Bureau of Statistics in 2009. Results: The overall adjusted mean of SBP based on the value of mercury sphygmomanometer among Chinese adults aged 18 years old and above was 122 mmHg (1 mmHg=0.133 kPa), 124 mmHg in men and 120 mmHg in women. The average SBP value was separately 115, 127, and 137 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average SBP was 122 mmHg in urban and 122 mmHg in rural areas. Mean DBP was 78 mmHg, 79 mmHg in men and 76 mmHg in women. The average DBP was separately 75, 81, and 81 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average DBP was 78 mmHg in urban and 77 mmHg in rural areas. The overall adjusted mean of SBP based on converted electronic device was 129 mmHg,130 mmHg in men and 127 mmHg in women, respectively. The mean of SBP was separately122, 134, and 143 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. Mean SBP was both 129 mmHg in urban and in rural areas. Mean DBP was 76 mmHg, 78 mmHg in men and 75 mmHg in women, respectively. The average DBP was separately 74, 79, and 79 mmHg in groups of adults aging 18-44, 45-59 and ≥60 years old. The average DBP was both 76 mmHg in urban and rural areas. Conclusion: The average SBP and DBP was different between the mercury sphygmomanometer and converted electronic device. However, the results from both measures showed that the blood pressure was higher in men than in women, the blood pressure increased with the increase of age, and there was no difference between urban and rural areas.

[Epidemiological characteristics of waist circumference and abdominal obesity among Chinese children and adolescents aged 6-17 years]

Objective: To analyze the epidemiological characteristics of waist circumference and abdominal obesity among Chinese children and adolescents aged 6-17 years. Methods: Data was from the samples of aged 6-17 years in the China National Nutrition and Health Surveillance program in 2010-2012. P(90) (the same age, the same sex) was used as the diagnostic value for abdominal obesity. Results: The overall waist circumference of children and adolescents in all the age groups appeared higher in males than that in females (P<0.000 1), higher in cities than that in the rural areas (P<0.05), and higher in children with high family income than those with middle or low family incomes (P=0.000 3). The rate of abdominal obesity in children and adolescents aged 6-17 years appeared as 11.2% on average and 10.7% and 11.8% for boys and girls, respectively but with no significant difference (P>0.05). Rates on abdominal obesity appeared as 13.2% and 8.5% for boys while as 12.3% and 11.2% for girls respectively, in urban or rural areas. As for the levels of family income, the abdominal obesity rates appeared as 15.8%, 11.5% and 8.8% respectively for boys while 13.5%, 11.9% and 11.6% respectively for girls, under high, middle and low levels of family income. Conclusion: The rate of abdominal obesity in boys seemed more responsive to the impact of income in urban or rural areas.

[Study on the relationship between family-related factors and obesity of children and adolescents aged 6-17 years]

Objective: To analyze the relationship between family-related factors and the status of overweight and obesity in children and adolescents aged 6-17 years in China. Methods: Data were collected from the China National Nutrition and Health Surveillance in 2010-2012 program. A sample of 6 343 subjects aged 6-17 years was selected, with matched weight, education levels, household income and other family related factors of their parents. Univariate analysis and multivariate logistic regression were used to explore the relationship between family factors and overweight and obesity in school-aged children and adolescents. Results: After adjusted for age, gender and region, results from the multivariate logistic regression showed that both the overweight and obesity of children and adolescents were associated with maternal BMI (OR=1.83, 95%CI: 1.63-2.05), paternal BMI (OR=1.74, 95%CI: 1.57-1.94), mother's educational level (OR=1.24, 95%CI: 1.12-1.37) and household income (OR=1.30, 95%CI: 1.15-1.46). Conclusion: Factors as overweight or obesity status of the parents, mother's educational level and household income were positively correlated with the prevalence of overweight and obesity in Chinese children and adolescents.

[Prevalence and characteristics of overweight and obesity in Chinese children aged 0-5 years]

Objective: To study the prevalence and characteristics of overweight and obesity among Chinese children aged 0-5 years, in 2010-2013. Methods: Data was from the'China Nutrition and Health Surveillance-0-5-Years-Old Children and Lactating Women'project in 2013. Stratified multistage cluster sampling method was used to select 55 districts/counties from 30 provinces (autonomous regions, municipalities) with the sample size of children as 32 862. Definition of overweight and obesity were according to both the WHO 2006 growth standard in children less than 5-year-old and the WHO 2007 growth reference in children of 5-years-old. Results: were calculated by complex weight based on national census from the National Bureau of Statistics in 2010. Results The overall prevalence of overweight was 8.4% among the 0-5-year-old in 2013, with 9.4% in boys and 7.2% in girls. Both of the rates from urban and rural areas were the same, as 8.4%. The prevalence rates of overweight in the 0-, 6-, 12-, 24-, 36-, 48- and 60-71 months age groups appeared as 13.0%, 11.1%, 8.3%, 6.0%, 4.8%, 3.9% and 15.9%, respectively. The rates of overweight in low, medium and high income families were 8.0%, 8.8% and 8.9%, respectively. The prevalence of obesity was 3.1% among the 0-5-year-old, with 3.6% in boys and 2.5% in girls. There was no significant difference seen in urban (3.3%) and rural areas (2.9%). The prevalence rates for obesity in the 0-, 6-, 12-, 24-, 36-, 48- and 60-71 months age groups were 5.8%, 3.8%, 2.5%, 1.6%, 1.2%, 1.3% and 7.8%, respectively. The rates of obesity in low, medium and high income families were 2.8%, 3.3% and 3.5%, respectively. Conclusion: The prevalence rates of both overweight and obesity were increasing among the 0-5-year-olds in China, suggesting that it is necessary to timely conduct the surveillance and intervention programs on overweight and obesity in this target population.

[Epidemiological characteristics of overweight and obesity in Chinese children and adolescents aged 6-17 years]

Objective: To analyze the prevalence rates of overweight and obesity in Chinese children and adolescents aged 6-17 years, and to provide scientific basis for the development of prevention strategies on obesity. Methods: Data was from children and adolescents aged 6-17 years in the China National Nutrition and Health Surveillance 2010-2012 program. In children aged 6 years, criteria of overweight and obesity were followed the WHO growth reference for school-aged children and adolescents. In children and adolescents aged 7-17 years, overweight and obesity were defined by sex and age specific BMI, recommended by Guidelines for prevention and control of overweight and obesity among school-age children and adolescents according to the Chinese guidelines. Results: The overall rates on overweight and obesity were 9.6% and 6.4% among the Chinese children and adolescents aged 6-17 years, with 11.0% (12.8% for boys and 9.0% for girls) in urban and 7.7% (boys 9.7%, girls 5.5%) in rural areas. The rates of overweight and obesity among children and adolescents were 8.4% (boys 9.3%, girls 7.4%) and 5.2% (boys 6.2%, girls 4.1%) in the rural areas. According to the levels of household income, the overweight rates of children in high, middle and low incomes were 12.3%, 10.7% and 8.2%, with obesity as 8.6%, 7.2% and 5.7% respectively. Conclusions: In 2012, the prevalence rates of overweight and obese were 9.6% and 6.4% among children and adolescents aged 6-17 years, respectively, higher in urban than in rural areas and higher boys than in girls. The prevalence rates of overweight and obesity seemed to be related to the levels of household income.

Prognostic and predictive blood biomarkers in gastric cancer and the potential application of circulating tumor cells

Gastric cancer (GC), with its high incidence and mortality rates, is a highly fatal cancer that is common in East Asia particularly in China. Its recurrence and metastasis are the main causes of its poor prognosis. Circulating tumor cells (CTCs) or other blood biomarkers that are released into the circulating blood stream by tumors are thought to play a crucial role in the recurrence and metastasis of gastric cancer. Therefore, the detection of CTCs and other blood biomarkers has an important clinical significance; in fact, they can help predict the prognosis, assess the staging, monitor the therapeutic effects and determine the drug susceptibility. Recent research has identified many blood biomarkers in GC, such as various serum proteins, autoantibodies against tumor associated antigens, and cell-free DNAs. The analysis of CTCs and circulating cell-free tumor DNA (ctDNA) in the peripheral blood of patients with gastric cancer is called as liquid biopsy. These blood biomarkers provide the disease status for individuals and have clinical meaning. In this review, we focus on the recent scientific advances regarding CTCs and other blood biomarkers, and discuss their origins and clinical meaning.

[Epidemiological characteristics of waist circumference and abdominal obesity among Chinese adults in 2010-2012]

Objective: To investigate the epidemiological characteristics of waist circumference (WC) and abdominal obesity (AO) among Chinese adults aged 18 and above. Methods: Data were collected from China National Nutrition and Health Surveillance in 2010-2012. Multi-stage stratifies proportion to the population cluster random sampling method was conducted to determine 120 265 subjects aged 18 and above at 150 counties in 31 provinces in China mainland. WC was determined for all subjects, and AO was judged according to the "Healthy Adult Weight Determination" (WS/T 428-2013). Using the demographic data published by the National Bureau of Statistics of China in 2009, we performed complex sampling weighted treatment to calculate the WC, AO rate and 95%CI. Results: The mean WC of Chinese men aged 18 and above was 82.8 cm, which of urban men (84.1 cm) was higher than that of rural men (81.4 cm) (P<0.001). The average WC of women was 78.5 cm. There was no statistical difference between urban (78.7 cm) and rural women (78.4 cm) (P=0.965). With the increase of education level, the mean WC of male increased gradually from 81.2 cm to 84.3 cm (P<0.001), and the mean WC of female decreased from 80.3 cm to 74.3 cm (P<0.001). With the family income rose, the mean WC of men increased gradually from 81.9 cm to 84.7 cm (P<0.001), and the mean of WC of women decreased from 78.8 cm to 77.6 cm (P<0.001). The AO rate was 25.7% (95% CI: 23.7%-27.7%) in adults aged 18 years and older. The AO rate in urban males (29.8% (95%CI: 26.5%-33.1%)) was significantly higher than that of rural males (22.3% (95%CI: 19.3%-25.2%)) (P=0.001). There was no significant difference in the female AO rate between urban (25.6% (95%CI: 22.8%-28.4%)) and rural areas (25.1% (95%CI: 22.2%-27.9%)) (P=0.772). With the increase of the educational level, the AO rate of men increased from 20.1% (95%CI: 18.0%-22.1%) to 32.6% (95%CI: 28.6%-36.6%) (P<0.001), the rate of women decreased gradually from 31.3% (95%CI: 28.7%-33.9%) to 13.5% (95%CI: 10.9%-16.1%) (P<0.001). With the increase of family income, the AO rate of male increased gradually from 23.3% (95%CI: 20.7%-25.9%) to 31.8% (95%CI: 27.6%-36.1%) (P<0.001), the rate of female decreased from 26.5% (95% CI: 24.2%-28.7%) to 20.0% (95% CI: 17.2%-22.8%) (P<0.001). Conclusion: The prevalence of AO among Chinese residents aged 18 years and above was high, and there were significant differences in WC and AO rate between men and women under different age, region, educational level and family income level.

[The epidemic status of metabolic syndrome among Chinese adolescents aged 10-17 years in 2010-2012]

Objective: To invesigate the epidemic status of the metabolic syndrome (MS) among mainland Chinese adolescents aged 10-17 in 2010-2012. Methods: Data were collected from Chinese Nutrition and Health Surveillance in 2010-2012. Multi-stage stratified proportion to the population cluster random sampling method was conducted to determine 16 872 adolescents in 150 counties from 31 provinces in mainland China. The epidemic status of metabolic syndrome was analyzed by China criterion (defined by Chinese Pediatric Society, Chinese Medical Association) and Cook criterion, respectively. The prevalence of MS and 95%CI were calculated through weighted complex sampling processing by population data released by the National Bureau of Statistics in 2009. Results: Based on China criterion, the weighted prevalence of MS was 2.4% (95% CI: 2.1%-2.6%) among Chinese adolescents aged 10-17. Prevalence in urban was higher than in rural (2.8%, 95%CI: 2.4%-3.2% and 1.9%, 95%CI:1.6%-2.3%, respectively). Prevalence in boys and girls were 2.7% (95% CI: 2.3%-3.0%), and 2.0% (95% CI: 1.7%-2.4%), respectively. Based on Cook criterion, the weighted prevalence was 4.3% (95% CI: 4.0%-4.7%) . The highest weighted prevalence of the components of the metabolic syndrome was low high-density lipoprotein cholesterol (26.8%, 95% CI: 26.0%-27.5%), followed by high fasting glucose (11.5%, 95% CI: 11.0%-12.0%), abdominal obesity (11.1%, 95%CI: 10.6%-11.7%) , hypertriglyceridemia (8.8%, 95%CI: 8.4%-9.3%) , and high blood pressure (6.4%, 95% CI: 6.0%-6.8%). Conclusion: Among the five indicators of metabolic syndrome, the prevalence of central obesity and hypertriglyceridemia were relative high in Chinese adolescents aged 10-17 years, though the prevalence of metabolic syndrome was not high.

FAM196B acts as oncogene and promotes proliferation of gastric cancer cells through AKT signaling pathway

Gastric cancer (GC) is the second leading cause of cancer-related deaths worldwide, but the mechanisms remain unknown. Here we report that family with sequence similarity 196 member B (FAM196B) is highly expressed in primary GC tissues and the expression level is correlated with the clinicopathologic characteristics of GC. In this experiment, knockdown of FAM196B suppressed GC cell proliferation and induced G1/G0 to S phase cell cycle arrest by regulating Cyclin D1, Cyclin A and CDK2 expressions. Furthermore, we investigated the molecular mechanism of FAM196B action in GC. The results showed that knockdown of FAM196B inhibited the activation of AKT signaling pathway. We further revealed that activating of AKT rescued the effect of FAM196B knockdown on cell proliferation and drove cell re-enter into the S phase of the cell cycle with SC79 (a AKT activator). Our findings demonstrated that FAM196B may promote GC cell proliferation by activating AKT signaling pathway. Taken together, this study provides a new evidence that FAM196B functions as a novel oncogene and could be a potential therapeutic target in therapy of GC.

[Dietary intake status of Chinese lactating women during the first month postpartum in 2013]

Objective: To assess the dietary intake status of Chinese lactating women during the first month postpartum. Methods: Data were extracted from Chinese National Nutrition and Health Surveillance, children aged 0-5 years and lactating women (2013). A total of 55 counties from 30 provinces in China (excluding the Tibet Autonomous Region) were selected using a multi-stage stratified cluster randomization sampling method. A group of 3 623 lactating women, at 1-6 months after delivery, were investigated in the study. The semi-quantitative food frequency questionnaire (FFQ) was used to collect information on frequencies and amounts of food consumed. Differences in food consumption rates and dietary intake in lactating women having different characteristics were analyzed and compared. Results: To eliminate abnormal values, 3 300 lactating women were included in the study. During the first month postpartum, food types with higher consumption rates were animal products (98.2%, 3 239) and vegetables (90.7%, 2 987), in addition to cereals (100%) and liquids (100%). The consumption rate of fruits was 67.4% (2 222) and the lowest consumption rate was for dairy products (38.3%, 1 262). The median intake of cereals, vegetables, fruits and animal products were 247.8, 150.0, 40.0 and 178.6 g/d, respectively. The daily median intake of dairy products and soybean/nut products was 0.0 g/d. Overall, the lactating women consumed 895.7 ml/d liquids. About 49.3% (1 627) of the subjects consumed less than the recommended intake for animal products in Chinese Dietary Guideline (2016). More than 50% of the lactating women consumed less than the recommended intakes for the other types of food, especially dairy, soybean/nut and liquids. The consumption rates for dairy products were 26.9%, 29.4%, 31.8% and 33.8% and those for soybean/nut products were 33.9% , 35.8% , 37.5% and 41.7% for the lactating women living in rural areas, with educations at junior high school level and below, with average family incomes under 15 000 yuan per capita in 2012 and who work as household mothers, respectively. These consumption rates for dairy and soybean/nuts were significantly lower than those in women living in cities (48.4%, 55.0%), with an education level of senior high school or above (48.8%, 55.7%), with average family income over 15 000 yuan per capita in 2012 (45.5%, 52.8%) and who work outside the home (43.7%, 49.4%). P values were <0.05 for all comparisons. Conclusion: The daily intake of all foods by lactating women during the first month postpartum was lower than the levels recommended in Chinese Dietary Guideline (2016). The consumption rate of dairy and soybean/nut products during this time period was low, especially for those living in rural areas, with education levels of junior high school and below, with average family incomes less than 15 000 yuan per capita in 2012 and who are housemothers.

[The status of postpartum weight retention and its associated factors among Chinese lactating women in 2013]

Objective: To analyze the status of postpartum weight retention and its associated factors among Chinese lactating women in 2013. Methods: This study was based on the databank of Chinese National Nutrition and Health Surveillance in 2013. Using the multi-stage stratified cluster sampling method, we enrolled 12 514 women, at 0-24 months postpartum, from 55 sites in 30 provinces of China (excluding the Tibet Autonomous Region). Questionnaires were used to collect data on basic characteristics, physical activity, lifestyle, food intake, pre-pregnancy weight, weight before delivery, disease history during pregnancy, delivery date, delivery mode, parity and breastfeeding information. Current body weight and height of each subject were measured. Postpartum weight retention in each subject was calculated as the difference between pre-pregnancy and current weights. High postpartum weight retention was defined as ≥5 kg. Survey sample weights were calculated according to the sampling design and number of children under 2 years old from 2010 population census data of China. Associated factors of high postpartum weight retention were identified by multiple logistic regression analysis. Results: A total of 9 972 women were included in this study. P₅₀ (P₂₅-P₇₅) of weight retention for participants was 3.6 (0.2-7.3) kg and high weight retention accounted for 41.5% of the subjects (4 134/9 972). The weighted means (SE) of weight retention was 3.5 (0.1) kg, and it was at 0 to <3, 3 to <6, 6 to <9, 9 to <12, 12 to <18 and 18 to <24 months postpartum were 5.3 (0.2), 4.5 (0.2), 3.8 (0.2), 3.1 (0.2), 2.8 (0.2) and 3.0 (0.2) kg, respectively. The weighted proportion of high postpartum weight retention was 37.4% (95%CI: 36.0%-38.9%). Compared with women aged under 25 years old, the odds ratio of high postpartum weight retention was 1.31 for women over 30 years old. Compared with women at 18 to <24 months postpartum, the odds ratio of high postpartum weight retention was 2.67, 1.61 and 1.31 for women at 0 to <3, 3 to <6 and 6 to <9 months postpartum, respectively. Compared with women having a pre-pregnant BMI from 18.5 to <25.0 kg/m², the odds ratio of high postpartum weight retention was 1.30 and 0.67 for women having pre-pregnant BMI <18.5 kg/m² and ≥25.0 kg/m², respectively. Compared with women having appropriate gestational weight gain, the odds ratio of high postpartum weight retention was 0.47 and 2.24 for women having low and excessive gestational weight gains, respectively. Compared with farmers, the odds ratio of high postpartum weight retention was 1.44 for housewives. (P<0.05 for all comparisons). Conclusion: Postpartum weight retention in Chinese lactating women is at an intermediate level. High postpartum weight retention is primarily associated with age, postpartum period, pre-pregnant BMI, gestational weight gain and career. The key control factor for weight retention is gestational weight gain, and 1 year postpartum is critical period for weight recovery.

[Construction and improvement of animal models with different positional osseous metastasis of prostate cancer in vivo]

OBJECTIVE

To provide an important tool for the study of diagnose and treatment of prostate cancer (PCa) osseous metastasis and change of bone stress force on prostate cancer (PCa) osseous metastasis and a platform, which is more congruous to clinical process, for prevention and cure of neoplastic bone metastases, and to carry out the construction and improvement of animal models of PCa with different positional osseous metastasis in vivo.

METHODS

Different gradient concentrations of RM-1 cells were inoculated into the cavity of left femoral bone or lumbar vertebra of mice (C57BL/6) respectively. The change of mouse activity, tumor formation, tumor size and survival time were observed respectively. And the femur tissue and spinal tissue were obtained from the mice after death. The gray value of iconography were measured by imageological examination of femur tissue, and the final histopathological examination were taken to determine the tumor type in both femur and spinal tissue.

RESULTS

The tumor growth could be touched at the puncture site in all the mice after inoculated for 7 days. There were no obvious differences in the time of tumorigenesis, the rate of tumor growth and tumor size among the mice in the same group (P>0.05). As the result, the construction femoral bone and lumbar vertebra metastatic models of PCa had been confirmed by iconography and pathology detection. At the same time, the survival time of the mice inoculated with low concentrations of PCa cells was obviously longer than that of high concentrations of PCa cells ( at least 2 weeks longer).

CONCLUSION

The animal models with different positional osseous metastasis (limbs and axial skeleton) of PCa using the same PCa cells (RM-1) had been first constructed successfully in our study. At the same time, a high success rate of construction of PCa animal model with bone metastasis was obtained by femoral bone marrow cavity injection of PCa cells. The rate of tumor growth was rapid, animal survival time was appropriate, and the PCa animal model with bone metastasis can be stably reproduced by our method. These animal models can be used to explore the pathogenesis of different positional PCa bone metastasis and provide a new platform, which were more congruous to clinical process, for prevention and cure of neoplastic bone metastases.

MeCP2, a target of miR-638, facilitates gastric cancer cell proliferation through activation of the MEK1/2-ERK1/2 signaling pathway by upregulating GIT1

Methyl-CpG binding protein 2 (MeCP2) is involved in the carcinogenesis and progression of multiple types of cancer. However, its precise role in gastric cancer (GC) and the relevant molecular mechanism remain unknown. In the present study, we found that miR-638 levels were lower in GC tissues and GC cell lines than in adjacent normal tissues and normal gastric epithelial cell lines, respectively. Low miR-638 levels were associated with poor tumor differentiation, tumor size and lymph node metastasis. MeCP2 expression levels were higher in GC tissues than in adjacent normal tissues. It was found that miR-638 inhibited GC cell proliferation, colony formation, G1–S transition and tumor growth, and induced cell apoptosis by directly targeting MeCP2. MeCP2 promoted GC cell proliferation, colony formation and G1–S cell-cycle transition, and suppressed apoptosis. Molecular mechanistic investigations were performed using an integrated approach with a combination of microarray analysis, chromatin immunoprecipitation sequencing and a reporter gene assay. The results showed that MeCP2 bound to the methylated CpG islands of G-protein-coupled receptor kinase-interacting protein 1 (GIT1) promoter and upregulated its expression, thereby activating the MEK1/2–ERK1/2 signaling pathway and promoting GC cell proliferation. Taken together, our study demonstrates that MeCP2, a target of miR-638, facilitates GC cell proliferation and induces cell-cycle progression through activation of the MEK1/2–ERK1/2 signaling pathway by upregulating GIT1. The findings suggest that MeCP2 plays a significant role in GC progression, and may serve as a potential target for GC therapy.

[Texture analysis based on contrast-enhanced MRI can predict treatment response to neoadjuvant chemotherapy of breast cancer]

Objective: To investigate whether texture analysis based on contrast-enhanced MRI can predict pathological complete response of locally advanced breast cancer undergoing neoadjuvant chemotherapy(NAC). Methods: Forty-seven patients with breast cancer undergone neoadjuvant chemotherapy from January 2015 to February 2016 were divided into pathological complete response (pCR) group or non-pathological complete response (non-pCR) group based on surgical pathology. Their parameters of texture analysis based on MRI before neoadjuvant chemotherapy and after 2 cycles of treatment were analyzed. Parameters(Energy, Entropy, Inertia, Correlation, Inverse Difference Moment)before and after 2 cycles of NAC between pCR and non-pCR groups were compared using Student t or Wilcoxon rank sum test. The diagnostic performance of different parameters was judged by the receiver-operating characteristic (ROC) curve analysis. Results: The post-NAC value was significantly different from that of pre-NAC (all P<0.05). Pre-treatment parameters (Energy, Entropy, Inertia, Correlation, Inverse Difference Moment) were 78.58×10(-5)(55.64×10(-5), 135.23×10(-5)), 10.06 ± 1.02, 7 993.91±2 428.10, (4.76±0.99) ×10(-5) and (18.10±4.13) ×10(-3) in pCR group, and 76.84×10(-5) (48.68×10(-5), 154.15×10(-5)), 10.28±1.26, 7 184.77 (4 938.03, 9 974.04), (5.21±2.01) ×10(-5) and (17.68±5.87) ×10(-3) in non-pCR group. No significant difference was found between both groups. (P>0.05 for all). At the end of the second cycle of NAC, parameters(Energy, Entropy, Inertia, Correlation, Inverse Difference Moment) were (542.11±361.04) ×10(-5,) 7.95±1.28, 16 765.08±97 06.56, (0.43±0.07) ×10(-5,) and (12.18±9.82) ×10(-3) in pCR group, and 133.00×10(-5) (79.80×10(-5,) 239.00×10(-5)), 9.29±1.46, 7 916.64(6 418.89, 10 934.40), (0.38±0.08) ×10(-5) and (14.80±5.06) ×10(-3) in non-pCR group. At the end of the second cycle of NAC, there was significant difference in the parameters (Energy, Entropy, Inertia, Correlation) and Δparameters (ΔEnergy, ΔEntropy, ΔInertia, ΔInverse Difference Moment) between both groups (P<0.05 for all). The area under curve (AUC) of post-treatment ΔEntropy was 0.81, which was the largest one among parameters. Sensitivity of ΔEntropy for predicting pCR was 75.0% and specificity was 85.7%, respectively. Conclusion: Texture analysis based on dynamic contrast-enhanced MRI can predict early treatment response in primary breast cancer.

[Correlation between anatomical factors of spermatic vessels and varicocele]

Objective: To analyze the correlation between anatomy of spermatic vessels and varicocele, providing reference for the preoperative assessment and treatment of varicocele. Methods: A total of 156 patients who underwent microsurgical left subinguinal varicocelectomy at Shanghai General Hospital between May 2015 and July 2016 were included in this study. The severity of varicocele and number of spermatic vessels detected in operations were recorded. According to the number of internal spermatic arteries (ISAs), the patients were divided into three groups: single-ISA group (55 cases), double-ISAs group (63 cases) and multi-ISAs group (38 cases), to analyze the correlation among spermatic vessels and to compare varicocele grade, the volume of testes, the parameter of semen analysis, serum reproductive hormone, surgery time, and hospital stay among the three groups. Results: The number of ISAs was positively correlated with the ipsilateral internal spermatic veins (ISVs) (r=0.210; P=0.008)and lymphatic vessels (r=0.224; P=0.005); the number of lymphatic vessels was positively correlated with the ipsilateral gubernacular veins (r=0.172; P=0.032)and ISVs (r=0.296; P=0.000) . The number of ISVs in the multi-ISAs group (10.58±4.28) was significantly larger than that in the single-ISA group (8.22±3.10, P=0.003). The number of lymphatic vessels in the multi-ISAs group(4.11±1.90)was also significantly larger than that in the double-ISA group(3.76±1.40, P=0.020) and the single-ISA group(3.13±1.52, P=0.007). The number of ISVs in grade 2 varicocele patients (9.74±3.90) was significantly higher than that in grade 3 varicocele patients (8.33±3.10, P=0.013). No significant differences in varicocele grade, change of pre- and post-operative semen analysis, serum reproductive hormone, the volume of ipsilateral testes, surgery time, and hospital stay were observed among the three groups. Conclusions: There is a correlation among various kinds of spermatic vessels. Patients with grade 2 varicocele, especially who have multiple ISAs, are likely to have more ISVs and lymphatic vessels. For these patients, surgeons should pay more attention to protect spermatic arteries and lymphatics carefully while ligating varicose veins completely to prevent recurrence and complications.

[Clinical application of robotic plat form in the treatment of early ovarian cancer]

Objectives: To evaluate the feasibility and safety of robotic system in early ovarian cancer surgery. Methods: The clinical data of 131 patients with early ovarian cancer undergoing surgical treatment from November 2014 to November 2015 were reviewed retrospectively. There were 27 cases of early ovarian cancer, of which 9 cases of robotic group, 10 cases of laparoscopic group, 8 cases of laparotomy group. Age, Body Mass Index (BMI), preoperative neoadjuvant chemotherapy, operating time, operating method, intraoperative blood loss, intraoperative and postoperative complications, pathological type, lymph node dissection, postoperative exhaust time and postoperative hospital stay of all the patients were analyzed. Results: In the robot group, the mean operating time was( 251.4±58.7) minutes, the intraoperative blood loss was (208.9±202.7) ml, and the number of the main abdominal and pelvic lymph nodes was 27.8±8.9. The mean postoperative hospital stay was (11.1±3.5) days, and the mean postoperative hospital stay was( 2.0±0.5) days. All the patients were followed up for 12-24 months. There was no differences were observed among the three groups for operating time, complications, the blood loss, the number of lymph nodes, the hospital stay and survival time (P≥0.05). Conclusion: A robotic approach for the early ovarian cancer is feasible and effective. Compared with traditional laparoscopic surgery and laparotomy, there is no significant difference in operative effect and tumor-free survival. The robotic approach provides a new method for surgical treatment of early ovarian cancer.

[Prevalence of and risk factors for delayed onset of lactation in Chinese lactating women in 2013]

Objective: To study the prevalence of delayed onset of lactation (later than 3 days) in lactating women in China and to analyze its influencing factors. Methods: Data were extracted from Chinese National Nutrition and Health Surveillance-Mothers, from mothers with children under 2 years of age (in 2013). A total of 11 178 women who were lactating or had lactated were selected from 55 counties of 30 provinces (excluding the Tibet Autonomous Region) in China, using the multi-stage stratified cluster randomization sampling method. Basic information, including onset of lactation, initiation of breastfeeding, breastfeeding difficulties and breastfeeding knowledge were collected using a questionnaire investigation. The prevalence of delayed onset of lactation were analyzed by the weighted processing of complex sampling from the 6^th national population census data. A multiple logistic regression was used to analyze the factors associated with delaged onset of lactation. Results: Among 11 178 lactating women, 3 388 had an onset of lactation later than 3 d. The prevalence of delayed onset of lactation was 30.3%. After complex weighting, the prevalence of delayed onset of lactation was 31.2% (95% CI: 25.7%-36.8%) for lactating women in China. Delivery by Caesarean section (OR=1.28, 95%CI: 1.06-1.53) and initiating breastfeeding ≥4 h (OR= 2.34, 95%CI: 1.76-3.11) were the negative factors for delayed onset of lactation. Compared with those living in large cities, lactating women living in medium or small cities (OR=1.39, 95%CI: 1.05-1.84) had a higher risk of delayed onset of lactation. Compared with the lactating women doing housework, the risk of delayed onset of lactation was lower (P<0.05) among those whose occupations were as leaders of Enterprises/Institutions (OR=0.68, 95%CI: 0.47-0.99), in catering and service trades (OR=0.61, 95%CI: 0.43-0.86), in agriculture/forestry/fishery/herdsmen fields (OR=0.65, 95%CI: 0.44-0.96) and who were unemployed (OR= 0.64, 95%CI: 0.46-0.90). Breastfeeding education during pregnancy might lower the risk of delayed onset of lactation (OR=0.78, 95% CI: 0.62-0.98). Conclusion: The prevalence of delayed onset of lactation was relatively high for Chinese lactating mothers. Caesarean section and late initiation of breastfeeding were the primary risk factors. Lactating mothers living in medium or small cities and those doing housework appear to be high-priority groups for intervention. Based on our findings, breastfeeding education during pregnancy is recommended to lower the risk of delayed onset of lactation.

Interleukin-17-Producing Neutrophils Link Inflammatory Stimuli to Disease Progression by Promoting Angiogenesis in Gastric Cancer

Purpose: Elevated levels of neutrophils have been associated with poor survival in various cancers, but direct evidence supporting a role for neutrophils in the immunopathogenesis of human cancers is lacking.Experimental Design: A total of 573 patients with gastric cancer were enrolled in this study. Immunohistochemistry and real-time PCR were performed to analyze the distribution and clinical relevance of neutrophils in different microanatomic regions. The regulation and function of neutrophils were assessed both in vitro and in vivoResults: Increased neutrophil counts in the peripheral blood were associated with poor prognosis in gastric cancer patients. In gastric cancer tissues, neutrophils were enriched predominantly in the invasive margin, and neutrophil levels were a powerful predictor of poor survival in patients with gastric cancer. IL17⁺ neutrophils constitute a large portion of IL17-producing cells in human gastric cancer. Proinflammatory IL17 is a critical mediator of the recruitment of neutrophils into the invasive margin by CXC chemokines. Moreover, neutrophils at the invasive margin were a major source of matrix metalloproteinase-9, a secreted protein that stimulates proangiogenic activity in gastric cancer cells. Accordingly, high levels of infiltrated neutrophils at the invasive margin were positively correlated with angiogenesis progression in patients with gastric cancer.Conclusions: These data provide direct evidence supporting the pivotal role of neutrophils in gastric cancer progression and reveal a novel immune escape mechanism involving fine-tuned collaborative action between cancer cells and immune cells in the distinct tumor microenvironment. Clin Cancer Res; 23(6); 1575-85. ©2016 AACR.

[Efficacy evaluation and exploration of TACE combined with CT-guided precision microwave ablation treatment for primary liver cancer]

OBJECTIVE

To analyze the clinical therapeutic efficacy of transcatheter arterial chemoembolization combined with CT-guided percutaneous precision microwave ablation for the treatment of primary liver cancer and its influencing factors.

METHODS

A total of 126 patients with primary liver cancer were treated by transcatheter arterial chemoembolization combined with CT-guided percutaneous precision microwave ablation from Mar 2010 to Oct 2014 in our center. The treatment effect, postoperative complications and recurrence rates were observed, and the factors related to recurrence and survival time were analyzed.

RESULTS

All 126 primary liver cancer patients with 201 tumors were ablated for 177 times, and 113 cases with 185 tumors were completed ablated, the complete ablation rate was 92.0%. In all patients, 4 cases had serious complications, the incidence rate was 3.2%. 37 cases had recurrence, with a recurrence rate of 29.4%. All patients were followed up for 10 to 65 months, 17 patients died, and the 1-, 2-, and 3-year cumulative survival rates were 95.2%, 88.1%, and 84.1%, respectively, and the 1-, 2-, and 3-year progression-free-survival rates were 81.5%, 62.7% and 49.2%, respectively .Univariate analysis showed that preoperative AFP level, Child-Pugh score, BCLC stage and the largest tumor size were associated with the survival of patients who received TACE combined with CT-guided precision MWA, and the preoperative AFP level, internal medicine therapy, tumor number and the largest tumor size were associated with the progression-free-survival after the treatment (P<0.05). Multivariate analysis showed that Child-Pugh score and BCLC stage were independent factors affecting the survival of patients with primary liver cancer patients treated with TACE combined with CT guided percutaneous MWA, and the tumor number and the maximum tumor size were independent factors affecting the progression-free-survival of the patients (P<0.05).

CONCLUSION

TACE combined with CT-guided percutaneous precision microwave ablation therapy for primary liver cancer has reliable safety and efficacy.

Is it possible to rapidly and noninvasively identify different plants from Asteraceae using electronic nose with multiple mathematical algorithms?

Many plants originating from the Asteraceae family are applied as herbal medicines and also beverage ingredients in Asian areas, particularly in China. However, they may be confused due to their similar odor, especially when ground into powder, losing their typical macroscopic characteristics. In this paper, 11 different multiple mathematical algorithms, which are commonly used in data processing, were utilized and compared to analyze the electronic nose (E-nose) response signals of different plants from Asteraceae family. Results demonstrate that three-dimensional plot scatter figure of principal component analysis with less extracted components could offer the identification results more visually; simultaneously, all nine kinds of artificial neural network could give classification accuracies at 100%. This paper presents a rapid, accurate, and effective method to distinguish Asteraceae plants based on their response signals in E-nose. It also gives insights to further studies, such as to find unique sensors that are more sensitive and exclusive to volatile components in Chinese herbal medicines and to improve the identification ability of E-nose. Screening sensors made by other novel materials would be also an interesting way to improve identification capability of E-nose.

MiR-30a suppresses non-small cell lung cancer progression through AKT signaling pathway by targeting IGF1R

MicroRNAs play critical roles in the development and progression of human cancers. Although miR&mdash;30a has been suggested to function as a tumor repressor in several tumors, its role in non&mdash;small cell lung cancer (NSCLC) has not been investigated in detail. This study investigated the expression and role of miR&mdash;30a in human NSCLC. The expression of miR&mdash;30a is significantly decreased in clinical NSCLC tissues and cell lines. Overexpression of miR&mdash;30a inhibited NSCLC cell proliferation, G1/S and S/G2 transition in vitro, whereas suppression of miR&mdash;30a facilitated NSCLC cell proliferation, G1/S and S/G2 transition. Using a luciferase reporter assay, insulin&mdash;like growth factor 1 receptor (IGF1R) was determined to be a direct target of miR&mdash;30a. Furthermore, silencing IGF1R resulted in the same biologic effects of miR&mdash;30a overexpression in NSCLC cells, which included suppressed NSCLC cell proliferation and trigering cell cycle arrest through PI3K/AKT signaling pathway by inhibiting cell cycle regulators (CDK2, CDK4, Cyclin A2 , Cyclin D1). These results demonstrate that miR&mdash;30a influences NSCLC progression through PI3K/AKT signaling pathway by targeting IGF1R in A549 cells, which suggest miR&mdash;30a as a novel strategy for NSCLC diagnosis and treatment.

Long-term oncologic outcomes of laparoscopic vs open surgery for stages II and III rectal cancer: A retrospective cohort study

AIM: To evaluate the 5-year survival after laparoscopic surgery vs open surgery for stages II and III rectal cancer.

METHODS: This study enrolled 406 consecutive patients who underwent curative resection for stages II and III rectal cancer between January 2000 and December 2009 [laparoscopic rectal resection (LRR), n = 152; open rectal resection (ORR), n = 254]. Clinical characteristics, operative outcomes, pathological outcomes, postoperative recovery, and 5-year survival outcomes were compared between the two groups.

RESULTS: Most of the clinical characteristics were similar except age (59 years vs 55 years, P = 0.033) between the LRR group and ORR group. The proportion of anterior resection was higher in the LRR group than that in the ORR group (81.6% vs 66.1%, P = 0.001). The LRR group had less estimated blood loss (50 mL vs 200 mL, P < 0.001) and a lower rate of blood transfusion (4.6% vs 11.8%, P = 0.019) compared to the ORR group. The pathological outcomes of the two groups were comparable. The LRR group was associated with faster recovery of bowel function (2.8 d vs 3.7 d, P < 0.001) and shorter postoperative hospital stay (11.7 d vs 13.7 d, P < 0.001). The median follow-up time was 63 mo in the LRR group and 65 mo in the ORR group. As for the survival outcomes, the 5-year local recurrence rate (16.0% vs 16.4%, P = 0.753), 5-year disease-free survival (DFS) rate (63.0% vs 63.1%, P = 0.589), and 5-year overall survival (OS) rate (68.1% vs 63.5%, P = 0.682) were comparable between the LRR group and the ORR group. Stage by stage, there were also no statistical differences between the LRR group and the ORR group in terms of the 5-year local recurrence rate (stage II: 6.3% vs 8.7%, P = 0.623; stage III: 26.4% vs 23.2%, P = 0.747), 5-year DFS rate (stage II: 77.5% vs 77.6%, P = 0.462; stage III: 46.5% vs 50.9%, P = 0.738), and 5-year OS rate (stage II: 81.4% vs 74.3%, P = 0.242; stage III: 53.9% vs 54.1%, P = 0.459).

CONCLUSION: LRR for stages II and III rectal cancer can yield comparable long-term survival while achieving short-term benefits compared to open surgery.

Modeling of particulate matter dispersion from a poultry facility using AERMOD

This study evaluates the performance of AERMOD, the current U.S. Environmental Protection Agency (EPA) regulatory model, in simulating particulate matter (PM10 and PM2.5) dispersion from a poultry pullet facility. At the source, the daily mean PM10 and PM2.5 concentrations with strong diurnal patterns were estimated to be 436.01 ± 166.77 μg m⁻³ and 291.09 ± 105.81 μg m⁻³, respectively. This corresponded to daily mean emission rates of PM10 and PM2.5 as 0.067-0.073 g sec⁻¹ and 0.044-0.047 g sec⁻¹,respectively. The modeled hourly PM concentration showed acceptable accuracy relative to the measured PM concentrations downwind of the source. Increasing the averaging period from hourly to daily resulted in improved prediction. The simulations revealed that PM concentrations at and beyond the property line of the poultry facility were within the National Ambient Air Quality Standards. This study suggested that AERMOD is effective in predicting and assessing the impacts of PM downwind of poultry facilities.

Laparoscopic vs open D2 gastrectomy for locally advanced gastric cancer: A meta-analysis

AIM: To conduct a meta-analysis comparing laparoscopic (LGD2) and open D2 gastrectomies (OGD2) for the treatment of advanced gastric cancer (AGC).

METHODS: Randomized controlled trials (RCTs) and non-RCTs comparing LGD2 with OGD2 for AGC treatment, published between 1 January 2000 and 12 January 2013, were identified in the PubMed, Embase, and Cochrane Library databases. Primary endpoints included operative outcomes (operative time, intraoperative blood loss, and conversion rate), postoperative outcomes (postoperative analgesic consumption, time to first ambulation, time to first flatus, time to first oral intake, postoperative hospital stay length, postoperative morbidity, incidence of reoperation, and postoperative mortality), and oncologic outcomes (the number of lymph nodes harvested, tumor recurrence and metastasis, disease-free rates, and overall survival rates). The Cochrane Collaboration tools and the modified Newcastle-Ottawa scale were used to assess the quality and risk of bias of RCTs and non-RCTs in the study. Subgroup analyses were conducted to explore the incidence rate of various postoperative morbidities as well as recurrence and metastasis patterns. A Begg’s test was used to evaluate the publication bias.

RESULTS: One RCT and 13 non-RCTs totaling 2596 patients were included in the meta-analysis. LGD2 in comparison to OGD2 showed lower intraoperative blood loss [weighted mean difference (WMD) = -137.87 mL, 95%CI: -164.41--111.33; P < 0.01], lower analgesic consumption (WMD = -1.94, 95%CI: -2.50--1.38; P < 0.01), shorter times to first ambulation (WMD = -1.03 d, 95%CI: -1.90--0.16; P < 0.05), flatus (WMD = -0.98 d, 95%CI: -1.30--0.66; P < 0.01), and oral intake (WMD = -0.85 d, 95%CI: -1.67--0.03; P < 0.05), shorter hospitalization (WMD = -3.08 d, 95%CI: -4.38--1.78; P < 0.01), and lower postoperative morbidity (odds ratio = 0.78, 95%CI: 0.61-0.99; P < 0.05). No significant differences were observed between LGD2 and OGD2 for the following criteria: reoperation incidence, postoperative mortality, number of harvested lymph nodes, tumor recurrence/metastasis, or three- or five-year disease-free and overall survival rates. However, LGD2 had longer operative times (WMD = 57.06 min, 95%CI: 41.87-72.25; P < 0.01).

CONCLUSION: Although a technically demanding and time-consuming procedure, LGD2 may be safe and effective, and offer some advantages over OGD2 for treatment of locally AGC.

[Rapid determination of beet sugar content using near infrared spectroscopy]

In order to classify and set different prices on basis of difference of beet sugar content in the acquisition process and promote the development of beet sugar industry healthily, a fast, nondestructive, accurate method to detect sugar content of beet was determined by applying near infrared spectroscopy technology. Eight hundred twenty samples from 28 representative varieties of beet were collected as calibration set and 70 samples were chosen as prediction set. Then near infrared spectra of calibration set samples were collected by scanning, effective information was extracted from NIR spectroscopy, and the original spectroscopy data was optimized by data preprocessing methods appropriately. Then partial least square(PLS)regression was used to establish beet sugar quantitative prediction mathematical model. The performances of the models were evaluated by the root mean square of cross-validation (RMSECV), the coefficient of determination (R2) of the calibration model and the standard error of prediction (SEP), and the predicted results of these models were compared. Results show that the established mathematical model by using first derivative (FD) and standard normal variate transformation (SNV) coupled with partial least squares has good predictive ability. The R2 of calibration models of sugar content of beet is 0.908 3, and the RMSECV is 0.376 7. Using this model to forecast the prediction set including 70 samples, the correlation coefficient is 0.921 4 between predicted values and measured values, and the standard error of prediction (SEP) is 0.439, without significant difference (p > 0.05) between predicted values and measured values. These results demonstrated that NIRS can take advantage of simple, rapid, nondestructive and environmental detection method and could be applied to predict beet sugar content. This model owned high accuracy and can meet the precision need of determination of beet sugar content. This detection method could be used to classify and set different prices on basis of difference of beet sugar content in the acquisition process.

Techniques and feasibility of laparoscopic extended right hemicolectomy with D3 lymphadenectomy

AIM: To illustrate the critical techniques and feasibility of laparoscopic extended right hemicolectomy (LERH), according to our previous experience.

METHODS: Anatomical relationship and operative techniques were demonstrated. One hundred and five consecutive patients who underwent extended right hemicolectomy with D3 lymphadenectomy between January 2008 and May 2011 were included in the present study [laparoscopic group (n = 48) vs open group (n = 57)].

RESULTS: The right retrocolic space was the main surgical plan of the LERH. The superior mesenteric vein was the most important anatomical landmark for vascular dissection. The medial-to-lateral dissection approach made the LERH performed efficiently. Compared with the open group, the LERH group had less blood loss (111.7 ± 127.8 mL vs 170.2 ± 49.7 mL, P = 0.023), faster return of flatus (3.0 ± 1.6 d vs 3.7 ± 1.3 d, P = 0.019), and earlier diet (4.2 ± 1.4 d vs 5.0 ± 1.2 d, P = 0.005). Five patients (10.4%) underwent conversion during laparoscopic surgery. The cancer recurrence rates between the two groups were comparable (laparoscopic vs open, 8.6% vs 9.1%, P = 0.335).

CONCLUSION: For an advanced tumor located at the hepatic flexure or proximal transverse colon, LERH with D3 lymphadenectomy using a medial-to-lateral approach seems to be safe and feasible when the superior mesenteric vein serves as the main anatomical landmark and the right retrocolic space severed as the surgical plan.

Detergent-dependent separation of postsynaptic density, membrane rafts and other subsynaptic structures from the synaptic plasma membrane of rat forebrain

We systematically investigated the purification process of post-synaptic density (PSD) and post-synaptic membrane rafts (PSRs) from the rat forebrain synaptic plasma membranes by examining the components and the structures of the materials obtained after the treatment of synaptic plasma membranes with TX-100, n-octyl β-d-glucoside (OG) or 3-([3-cholamidopropyl]dimethylammonio)-2-hydroxy-1-propanesulfonate (CHAPSO). These three detergents exhibited distinct separation profiles for the synaptic subdomains. Type I and type II PSD proteins displayed mutually exclusive distribution. After TX-100 treatment, type I PSD was recovered in two fractions: a pellet and an insoluble fraction 8, which contained partially broken PSD-PSR complexes. Conventional PSD was suggested to be a mixture of these two PSD pools and did not contain type II PSD. An association of type I PSD with PSRs was identified in the TX-100 treatment, and those with type II PSD in the OG and CHAPSO treatments. An association of GABA receptors with gephyrin was easily dissociated. OG at a high concentration solubilized the type I PSD proteins. CHAPSO treatment resulted in a variety of distinct fractions, which contained certain novel structures. Two different pools of GluA, either PSD or possibly raft-associated, were identified in the OG and CHAPSO treatments. These results are useful in advancing our understanding of the structural organization of synapses at the molecular level. We systematically investigated the purification process of post-synaptic density (PSD) and synaptic membrane rafts by examining the structures obtained after treatment of the SPMs with TX-100, n-octyl β-d-glucoside or CHAPSO. Differential distribution of type I and type II PSD, synaptic membrane rafts, and other novel subdomains in the SPM give clues to understand the structural organization of synapses at the molecular level.

Laparoscopic vs open extended right hemicolectomy for colon cancer

AIM: To evaluate the feasibility, safety, and oncologic outcomes of laparoscopic extended right hemicolectomy (LERH) for colon cancer.

METHODS: Since its establishment in 2009, the Southern Chinese Laparoscopic Colorectal Surgical Study (SCLCSS) group has been dedicated to promoting patients’ quality of life through minimally invasive surgery. The multicenter database was launched by combining existing datasets from members of the SCLCSS group. The study enrolled 220 consecutive patients who were recorded in the multicenter retrospective database and underwent either LERH (n = 119) or open extended right hemicolectomy (OERH) (n = 101) for colon cancer. Clinical characteristics, surgical outcomes, and oncologic outcomes were compared between the two groups.

RESULTS: There were no significant differences in terms of age, gender, body mass index (BMI), history of previous abdominal surgery, tumor location, and tumor stage between the two groups. The blood loss was lower in the LERH group than in the OERH group [100 (100-200) mL vs 150 (100-200) mL, P < 0.0001]. The LERH group was associated with earlier first flatus (2.7 ± 1.0 d vs 3.2 ± 0.9 d, P < 0.0001) and resumption of liquid diet (3.6 ± 1.0 d vs 4.2 ± 1.0 d, P < 0.0001) compared to the OERH group. The postoperative hospital stay was significantly shorter in the LERH group (11.4 ± 4.7 d vs 12.8 ± 5.6 d, P = 0.009) than in the OERH group. The complication rate was 11.8% and 17.6% in the LERH and OERH groups, respectively (P = 0.215). Both 3-year overall survival [LERH (92.0%) vs OERH (84.4%), P = 0.209] and 3-year disease-free survival [LERH (84.6%) vs OERH (76.6%), P = 0.191] were comparable between the two groups.

CONCLUSION: LERH with D3 lymphadenectomy for colon cancer is a technically feasible and safe procedure, yielding comparable short-term oncologic outcomes to those of open surgery.

Timing of xenon-induced delayed postconditioning to protect against spinal cord ischaemia-reperfusion injury in rats

BACKGROUND

This study was designed to assess the neuroprotective effect of xenon-induced delayed postconditioning on spinal cord ischaemia-reperfusion injury (IRI) and to determine the time of administration for best neuroprotection in a rat model of spinal cord IRI.

METHODS

Fifty male rats were randomly divided equally into a sham group, control group, and three xenon postconditioning groups (n=10 per group). The control group underwent spinal cord IRI and immediately inhaled 50% nitrogen/50% oxygen for 3 h at the initiation of reperfusion. The three xenon postconditioning groups underwent the same surgical procedure and immediately inhaled 50% xenon/50% oxygen for 3 h at the initiation of reperfusion or 1 and 2 h after reperfusion. The sham operation group underwent the same surgical procedure without aortic occlusion, and inhaled 50% nitrogen/50% oxygen. Neurological function was assessed using the Basso, Beattie, and Bresnahan score at 4, 24, and 48 h of reperfusion. Histological examination was performed using Nissl staining and immunohistochemistry, and apoptosis was detected by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labelling staining.

RESULTS

Compared with the control group, the three xenon postconditioning groups showed improvements in neurological outcomes, and had more morphologically normal neurones at 48 h of reperfusion. Apoptotic cell death was reduced and the ratio of Bcl-2/Bax immunoreactivity increased in xenon-treated rats compared with controls.

CONCLUSIONS

Xenon postconditioning up to 2 h after reperfusion provided protection against spinal cord IRI in rats, but the greatest neuroprotection occurred with administration of xenon for 1 h at reperfusion.

MECP2 promotes cell proliferation by activating ERK1/2 and inhibiting p38 activity in human hepatocellular carcinoma HEPG2 cells

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide and currently represents the leading cause of death amongst cirrhotic patients, but the mechanisms remain unknown. In this experiment, we investigated the expression of Methyl CpG-binding protein 2 (MeCP2) in HCC, the effect of MeCP2 on the proliferation of human HCC HepG2 cells, and the activation of mitogen-activated protein kinases (MAPKs) signaling pathways. The results showed that MeCP2 expression levels was higher in human HCC tissue than normal hepatocellular tissue, and MeCP2 siRNA reduced the proliferation of HCC HepG2 cells by decreasing cell activity and cell division in vitro. After MeCP2 siRNA treatment, the proportion of G1/G0 phase cells increased, but the proportion of S and G2/M phase cells decreased, indicative of G1/G0 cell cycle arrest. Furthermore, the proportions of early and late apoptosis in HCC HepG2 cells were enhanced after MeCP2 siRNA treatment. It was also found that activation of extracellular signal-regulated protein kinase (ERK) and p38 signaling pathways were involved in the proliferation of HepG2 cells. After MeCP2 siRNA treatment, p-ERK1/2 levels decreased, but p-p38 levels increased. Our findings demonstrated that MeCP2 promoted the proliferation of human HCC HepG2 cells with activation of ERK1/2 signaling pathways, suggesting a novel mechanism for pharmacological study of treatment for human HCC.

Association between smoking and p53 mutation in lung cancer: a meta-analysis

AIMS

To carry out a meta-analysis on the relationship between smoking and p53 gene mutation in lung cancer patients.

MATERIALS AND METHODS

PubMed, Web of Science, ProQest and Medline were searched by using the key words: 'lung cancer or lung neoplasm or lung carcinoma', 'p53 mutation' and 'smoking'. According to the selection criteria, 15 articles were identified and methodologically analysed by stata 12.0 software package. Crude odds ratios with 95% confidence intervals calculated using the fixed-effects model were used to assess the strength of association between smoking and p53 mutation in lung cancer.

RESULTS

In total, 15 articles with 1770 lung cancer patients were identified; 69.6% of the patients were smokers, 30.4% were non-smokers. Overall, smokers with lung cancer had a 2.70-fold (95% confidence interval 2.04-3.59) higher risk for mutation than the non-smokers with lung cancer. In subgroup analyses, the increased risk of p53 mutation in smokers than in non-smokers was found in the non-small cell lung cancer (NSCLC) group (odds ratio = 2.38, 95% confidence interval = 1.71-3.32) and in the NSCLC and SCLC group (odds ratio = 3.82, 95% confidence interval = 2.19-6.69).

CONCLUSIONS

This meta-analysis strongly suggests that p53 mutation is associated with smoking-induced lung cancer. Smokers with lung cancer had a higher risk for p53 mutation than non-smokers.